Prevalence, Incidence, Severity, and Anatomical Location of Overuse Injuries in Male and Female Ballet Dancers: A Systematic Review and Meta-Analysis

Abstract

Background: Ballet dancers are deemed at a great risk of overuse injuries due to high training loads, biomechanical requirements related to technique, maturation, hypermobility, and injury history. Sex differences are known from previous studies, which have mainly focussed on all injury types particularly on the foot and ankle complex. Aims: To critically analyse the literature for differences between female and male professional and pre-professional ballet dancers in terms of prevalence, incidence, severity, and anatomical location of overuse injuries. Methods: The search for published original peer-reviewed articles from 2000 to July 2025 was conducted on PubMed, Web of Science, and Embase. The protocol was registered on PROSPERO (CRD420251104232). Screening, data extraction, and analysis were conducted by multiple independent reviewers according to PRISMA guidelines. The Newcastle-Ottawa Scale and AXIS were used for quality assessments including risk of bias. Meta-analysis of the difference between males and females for prevalence and anatomical location was calculated using a log-odds ratio; incidence was analysed using effect size. The Grade tool was used to assess certainty. Results: Nine cohort and 2 cross-sectional studies were included (n = 1650 dancers). The foot and ankle complex were the most affected region in both sexes. No significant difference was found in the prevalence, incidence, or anatomical location of overuse injuries in females compared to males ( P > .05). Only 2 studies with contrasting findings were included for severity. All studies but 1 were of high quality; The certainty was very low. Discussion: Findings indicated that overall, the prevalence, incidence, and anatomical location of overuse injuries do not differ between male and female ballet dancers. However, these results refer to pre-professional and professional ballet dancers only. The findings of this study should be interpreted with caution due to low certainty score assessed by using the GRADE tool.