The quiet injuries we don’t hear about

ACC is making changes to how it classifies different parts of the sports sector to make it fairer to align the levies with injury risk, and if the changes go ahead professional ballet dancer levies could increase 1000 percent.

“Ballet dancers have similar injury rates to sports players, like rugby players,” said the chief executive of ACC, Megan Main in an RNZ interview, noting that ballet had previously been categorised with much less risky activities, like theatre and opera. Could ballet really be that dangerous?

In many ways, yes it can be. Ballet and rugby are vastly different, yet both come with their own set of risks and potential for injury. To understand whether ballet is dangerous and how it compares to rugby, we need to look at injury statistics and the nature of injuries in both disciplines.

I’ve dedicated my career to understanding and preventing injuries in sports and performing arts, both the high-impact world of rugby and the graceful yet demanding realm of ballet. I’ve led studies that have significantly influenced injury prevention strategies, such as the RugbySmart – Rugby Toolbox, which has helped reduce severe neck injuries in rugby. My work in ballet has focused on the relationship between physical maturation and overuse injuries, providing insights into how we can better manage training loads for young dancers.

Ballet: The hidden dangers

Ballet is a graceful and elegant art form, but it demands a high level of physical exertion and precision. Professional ballet dancers experience around 4.4 injuries per 1000 hours of dancing. About 64 percent of these are overuse injuries, with traumatic injuries making up 32 percent. The severity of these injuries varies, with an average recovery time of seven days.

A study we conducted in 2014 at the Australian Ballet School on aspiring classical ballet dancers highlighted that managing training intensity and volume was crucial, especially during periods of rapid growth. Overuse injuries are common among young dancers, particularly when they are skeletally immature.

We found a strong correlation between foot growth and injuries in male dancers, suggesting that monitoring foot growth can help predict injury risk. On average, youth dancers up to the age of 19 were injury-free 91 percent of the time, with the most common injuries affecting the trunk, back, foot, and knee. Joint pain and sprains were the most frequent types of injuries, emphasising the need for careful workload management during vulnerable growth periods.

Pointe work, which involves dancing on the tips of the toes, can cause significant stress on the feet and ankles, resulting in Achilles tendonitis and stress fractures. Repetitive jumps, such as jetés and sautés, often lead to stress fractures in the legs and knee pain.

Moves that require extreme flexibility, like extensions and arabesques, can cause hip injuries. Rapid spinning movements, such as pirouettes, can result in ankle sprains and knee injuries if not performed correctly. Dramatic leaps like the grand jeté can cause traumatic injuries to the lower extremities, especially if the landing is not well-controlled.

Additionally, lifts and partner work, which require a lot of physical exertion and coordination, can lead to back injuries and muscle strains. It’s crucial for dancers to use proper technique, maintain balanced training routines, and allow adequate recovery time to minimise these risks and ensure a long, healthy career in ballet. In other words, yes, ballet can be dangerous.

Rugby: The high-impact sport

Rugby is known for its physicality and high-impact collisions. Professional rugby players experience around 91 injuries per 1000 hours of rugby. These injuries are often more severe, with an average recovery time of 18 days. Most rugby injuries are contact-related, occurring during tackles and rucks.

Our research has shown that rugby tackling, scrums and rucks as fundamental parts of the game, can cause significant stress on the shoulders, neck, and head resulting in shoulder dislocations, cervical spine injuries, and concussions. Rapid changes in direction and high-speed running can cause hamstring strains, ankle sprains and knee ligament tears.

Repetitive impacts and physical demands of the game can lead to overuse injuries such as tendinitis and stress fractures. It’s crucial for rugby players to use proper technique, engage in strength and conditioning programmes, and allow adequate recovery time to minimise these risks and ensure a long, healthy career in rugby. (RugbySmart is an education-focused injury prevention programme.)

How do ACC levies work?

Everyone who earns a salary in New Zealand pays an ACC levy, which is deducted as part of their PAYE (Pay As You Earn) withholdings. This levy covers injuries that happen outside of work, such as during sports or at home. For professional athletes, New Zealand Rugby pays ACC levies for contracted rugby players, and Ballet NZ pays levies for their professional dancers.

These levy rates are calculations based on several factors. The Earners’ levy is a flat rate currently set at $1.39 per $100 of liable income (excluding GST), covering injuries that occur outside of work. The work levy varies depending on the risk associated with the type of work and the employer’s claims history, with higher-risk professions, such as professional sports, potentially having higher levies.

Ballet vs rugby: who wins?

It’s clear that rugby has a higher incidence of injuries, and they tend to be more severe, but ballet injuries can still be significant and often involve chronic issues due to repetitive strain. According to ACC in 2023 rugby-related injuries accounted for a significant portion of the total sports injury claims. Ballet wasn’t as high in the rankings, but still presented a notable risk, particularly for those at a professional level.

Both ballet and rugby require rigorous training and proper injury prevention strategies to ensure the safety and well-being of participants. Comparing the two highlights the different types of physical demands and risks associated with each, underscoring the importance of tailored approaches to injury prevention and management in both fields.