Quantifying achilles tendon stress in female ballet dancers using shear wave tensiometry: linking dance movements to tendinopathy - achilles tendinopathy is a painful injury that sidelines elite…

The National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded Brigham Young University $562,975 on September 1, 2026, under the Arthritis, Musculoskeletal and Skin Diseases Research program (CFDA 93.846) to quantify Achilles tendon stress in female ballet dancers using shear wave tensiometry and develop tools to prevent tendon injury and support rehabilitation.

The project addresses Achilles tendinopathy, which sidelines elite ballet dancers four times more frequently than other athletes. Existing assessment methods lack sensitivity to dancer-specific pain, and direct measurement of tendon stress during dance movements has proven difficult. The research will adapt shear wave tensiometry into a portable, wearable system accommodating the extreme ranges of motion required in ballet en pointe. The study targets female dancers from the BYU Theatre Ballet Company, actively recruiting women while excluding pregnant or lactating participants and male dancers who do not train en pointe. The research aims to establish a scientific foundation for clinicians, pedagogues, and athletes to build training and rehabilitation regimens protecting dancers from injury.

The period of performance runs through August 31, 2029, with work conducted in Provo, Utah.

Quantifying achilles tendon stress in female ballet dancers using shear wave tensiometry: linking dance movements to tendinopathy - achilles tendinopathy is a painful injury that sidelines elite ballet dancers four times more frequently than other athletes and can end their dance careers. Ballet dancers train in extreme ranges of motion without periodization, placing intense and chronic stress on the achilles tendon. Tendon stress is widely believed to be a major contributor to achilles tendinopathy; however, the stresses during dance remain unknown because of difficulty in measuring achilles tendon stress in situ. Additionally, IT is difficult to evaluate the severity of achilles tendinopathy in ballet dancers because the industry standard victorian institute of sport assessment-achilles (VISA-a) survey is not sensitive to dancer pain. This project proposes to develop monitoring and survey tools that can quantitatively evaluate programs to prevent injury and facilitate rehabilitation in female ballet dancers. Women will be actively recruited into this project. The subject population targeted by this study includes elite dancers EN pointe in the brigham young university (BYU) theatre ballet company. These ballet companies include ~12% male dancers, who will be excluded from the study because the male dancers do not train EN pointe where the achilles tendon is most strained. Women who are pregnant or lactating will not be enrolled. Our long-term objective is to establish a firm scientific foundation upon which clinicians, pedagogues, and athletes can build training and rehabilitation regimens that protect dancers from injury. Specific aim 1: quantify achilles tendon stresses associated with dance movements using a new, wearable shear wave tensiometry system. We will adapt shear wave tensiometry to be portable and to accommodate female ballet dancers' large range of motion. We will validate shear wave tensiometry with achilles tendon stress predictions from motion capture, musculoskeletal ultrasound, and biomechanical models. We will identify which dance movements generate the greatest tendon stresses. Specific aim 2: establish a ballet-specific questionnaire for achilles tendinopathy. We will create a ballet-specific questionnaire to quantify the severity of achilles tendinopathy in female dancers. Effectiveness will be determined by correlating both the VISA-a and new questionnaires' results with visually apparent damage to the tendon as seen in ultrasound imaging. Specific aim 3: identify relationships between tendon stress and achilles tendinopathy in ballet dancers. We will perform repeated tensiometry measurements in female ballet dancers over a full season to identify changes in achilles stress and build a predictive model that correlates tensiometry data with achilles tendinopathy pain established in survey questions and clinical diagnoses. Engaging a multidisciplinary team of experts and providing biomedical research experiences for over 15 undergraduate students, this project will inform clinicians and pedagogues about dance movements that may unintentionally accelerate or exacerbate achilles injury and establish a clear link between tendon stress and achilles tendinopathy. Further, by improving the quality and versatility of shear wave tensiometry, its impact will extend to injury diagnosis and assessment for other tendon injuries and to other athletes and the general population who experience achilles tendinopathy.