Balance in Dance: A Scoping Review

Balance in Dance: A Scoping Review | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Balance in Dance: A Scoping Review View ORCID Profile Miko Gianola Fratnik , View ORCID Profile Isobel Jupp , View ORCID Profile Phaedra Petsilas , View ORCID Profile Peter Dunleavy , View ORCID Profile Matthew Banger , View ORCID Profile Alison McGregor , View ORCID Profile Richard L. Abel doi: https://doi.org/10.1101/2025.06.04.25328967 Miko Gianola Fratnik 1 Department of Statistics and Quantitative Methods, University of Milano-Bicocca , Milan, Italy 3 MSk Laboratory, Faculty of Medicine, White City Campus , Imperial W12 0BZ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Miko Gianola Fratnik For correspondence: gianolafratnik{at}gmail.com Isobel Jupp 2 Rambert School of Ballet and Contemporary Dance 3 MSk Laboratory, Faculty of Medicine, White City Campus , Imperial W12 0BZ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Isobel Jupp Phaedra Petsilas 2 Rambert School of Ballet and Contemporary Dance Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Phaedra Petsilas Peter Dunleavy 2 Rambert School of Ballet and Contemporary Dance Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Peter Dunleavy Matthew Banger 3 MSk Laboratory, Faculty of Medicine, White City Campus , Imperial W12 0BZ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Matthew Banger Alison McGregor 3 MSk Laboratory, Faculty of Medicine, White City Campus , Imperial W12 0BZ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Alison McGregor Richard L. Abel 3 MSk Laboratory, Faculty of Medicine, White City Campus , Imperial W12 0BZ, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Richard L. Abel Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Balance is a fundamental component of dance performance, yet its definition and assessment in dance remain challenging. This scoping review aims to bridge the gap between existing balance research and practical applications by critically evaluating current measurement technologies, examining factors influencing balance performance, and exploring the mechanisms through which these factors interact with dance execution. A comprehensive search of PubMed and Embase databases identified 69 relevant papers published since 1999, focusing exclusively on studies on people who regularly engage in dance. Our analysis revealed limitations in standard balance assessment tools, with most current tests failing to sufficiently challenge skilled dancers. Recent developments in dance-specific assessments, particularly modifications of the Star Excursion Balance Test, show promise, though their effectiveness varies across different dance styles and skill levels. Force plate analysis combined with skill-based tests provide a more comprehensive assessment of capabilities, especially with respect to motor skill acquisition and injury recovery. Literature analysis identified several factors affecting balance in dance: aerobic capacity, muscle fatigue, lower extremity strength, and previous injuries. Additionally, technical considerations, such as pointe shoe degradation, significantly impact balance strategies and injury risk. Although strength training shows positive effects on balance and dance-specific skills, the influence of cognitive load, nutrition, and long-term training adaptation remains unclear. Future research should prioritize developing and validating dance-specific balance measures while investigating targeted interventions for different dance populations. This synthesis emphasizes the critical need for dance-specific approaches to balance assessment and training, with direct applications for both research methodology and dance education practices. Introduction Sustained single-leg balance is fundamental to many dance styles, making balance control a critical skill for dancers. Over the past decade, researchers investigated how balance capabilities influence dance performance, as stability is essential for achieving aesthetic movement qualities, particularly in anatomically challenging positions [ 1 ]. Professional dancers dedicate substantial training time to developing and maintaining balance skills that exceed performance requirements. However, dancers experience fluctuations in balance abilities, with the underlying causes of these variations remaining poorly understood. Inconsistencies in balance control not only affect performance quality and cause frustration but may also increase injury risk [ 2 , 3 ]. Recent research has advanced our understanding of balance measurement and assessment protocols, yet there remains a critical need to synthesise and translate these findings for both researchers and practitioners [ 2 - 4 ]. Understanding how various factors— including proprioception, aerobic capacity, muscle fatigue, strength, previous injuries, and nutrition—affect balance in dance is crucial for optimising training and performance [ 4 – 6 ]. A scoping review approach is ideal for this purpose, as it enables a comprehensive synthesis of diverse information sources whilst bridging the gap between research and practice. Unlike systematic reviews, which examine specific research questions through standardised methodologies, scoping reviews offer broader perspectives by integrating findings across multiple disciplines. This integration of industry, medical, and academic knowledge provides a holistic understanding of dancers’ balance and highlights areas requiring further investigation. Aim and objectives This scoping review aims to bridge the gap between existing balance knowledge and practical applications. The review critically evaluates current technologies and tests for measuring balance in dance, evaluating the effectiveness and applicability of existing measurement techniques. It examines factors influencing balance performance, including physiological and biomechanical aspects, and explores the mechanisms through which these factors interact with balance and dance performance. Additionally, it aims to define balance in the context of dance, expanding on the generic definition to capture the dynamic and complex nature of dance movements across various styles. Finally, the review identifies future research directions for improved measurement tools and interventions. This includes suggesting new methodologies and technologies that could enhance the accuracy and reliability of balance assessments, refining existing tools, and recommending targeted interventions to support dancers’ balance and overall performance. By addressing these objectives, the review seeks to contribute to the advancement of dance science and practice, ultimately enhancing the health and performance of dancers. Methods A comprehensive search of PubMed and Embase was conducted in June 2024 to identify studies discussing factors influencing balance in dance. The search strategy incorporated specific keywords and Boolean operators to ensure precision and relevance. The keywords included ‘balance’, ‘dance or dancer’, and combinations such as ‘aerobic capacity’ or ‘muscle strength’ or ‘muscle endurance’ or ‘nutrition’ or ‘previous injuries’ or ‘cognitive load’ or ‘self-efficacy’. The search was refined to exclude articles focusing on unrelated populations and those who do not engage in academic dance regularly. This approach yielded 69 initial studies relevant to the topic. Articles were selected based on their pertinence, with no restrictions on study design, and only publications dated after 1999 were included. Eligible studies were reviewed and synthesized scopingly to provide a comprehensive overview of the factors influencing balance in dance, highlighting critical elements such as aerobic capacity, muscle strength, endurance, nutritional aspects and prior injuries. This synthesis aims to present an inclusive and detailed understanding of the subject. In this review, ‘dancers’ refers to individuals aiming for or engaged in a professional dance career. Those dancing recreationally are labelled as ‘recreational dancers,’ while children are categorised by age. This distinction is crucial as the term ‘dancer’ varies in research, affecting its applicability due to distinct characteristics at each level of experience and dance style. Balance Definition of balance Balance is a prerequisite for obtaining the aesthetic parameters necessary of most dance styles. To our knowledge, there is no consensus on a definition of balance in dance that encapsulates the dynamic nature of this skill [ 1 ]. Static balance is defined as the ability to maintain the centre of pressure within the limits of the base of support with minimal movement [ 7 ] while dynamic balance is defined as the ability to maintain stability during weight shifting via changes in the base of support [ 8 ]. This paper proposes to expand on these generic definitions to establish a common understanding of the terminology for dance. These definitions must account for the fact that dance movement is not static but often transitions through different levels, travels through space, and can interact with living and inanimate partners. Static balance in dance could be defined as the ability to maintain the resulting forces on the body within the desired base of support. This would expand the current definition to body positions that, unlike quiet standing, require significant muscle activation to keep the centre of mass within the base of support. Dynamic balance would also integrate the element of weight shifting. Balance is usually acquired during development; it’s a trainable skill through practice and tends to decay with advanced age. Dancers have a greater ability to maintain static balance compared to the general population, but it is unclear how and when this ability is developed through dance training [ 9 ]. Current Methods for Measuring Balance in Dancers Drawing from sport science, efforts to capture balance can be broadly divided into two complementary categories: technology and tests. Technology, both wearable and stationary, can be used to digitally measure balance, while tests are the tasks and procedures employed to evaluate balance [ 10 ]. Balance has been widely tested in the general population [ 11 ]. In the context of dance research, despite recent publications laying the groundwork by improving previous methods [ 12 ], the optimal tools for measuring balance are still undetermined. Balance tests have been identified by researchers working on measuring dancers’ balance by adapting pre-existing tests or creating new ones. Clarke [2021] compared different balance tests—including the original Star Execution Balance Test (oSEBT), Romberg test, Pirouette tests and Airplane test - and concluded, through correlation analysis of the agreement of the test’s scores, that these existing tools were not relevant or sufficiently challenging for dancers [ 13 ]. The study used descriptive statistics to underline the need for more thorough research on balance in dance and highlighted the need for a greater sample size to adequately power inferential studies going forward. Batson (2010) started by modifying the oSEBT [ 14 ] with timed tests, cognitive tasks, and sensory changes, but found that these adjustments did not adequately capture university-level dancers’ balance strategies [ 15 ]. Building on these earlier studies, Beckman, since 2022 has made notable progress in adapting the oSEBT for dancers. In 2022, Beckman introduced a dance-specific version of the oSEBT (dsSEBT), incorporating ballet and contemporary dance movements by limiting trunk rotation and adjusting foot positions to improve specificity [ 16 ]. While these changes did not significantly affect reach distances, they lead to higher error rates, recorded through a proposed scoring system. This suggested the test had become more challenging and better aligned with dancers’ needs by emphasising proprioceptive feedback. In 2023, Beckman explored how tempo and the order of movements affected the dsSEBT [ 17 ]. The study found that varying the tempo (beats per minute) did not significantly impact reach distances, centre of pressure, or error scores, indicating that tempo alone isn’t crucial for assessing dancers’ balance. However, the study emphasised the importance of completing the full test sequence, as opposed to simplifying it through isolating specific directions as in the Y-Balance Test (YBT), underscoring the need for a comprehensive approach. By 2024, Beckman synthesised these insights to create a practical and challenging balance test for dancers, incorporating the most effective modifications from previous research [ 12 ]. This latest version introduced distinct difficulty levels and found a strong correlation between performance on the oSEBT and the new dance-specific stages of the dsSEBT. Despite the study’s small sample size and its focus on ballet and contemporary dance university students, it suggests that further validation and adaptations to different dance styles are needed. Beckman’s work marks a significant advance in developing a more accurate and challenging balance assessment for dancers. The ‘Airplane test’ is a clinical test used to assess single-leg balance, and is a more advanced variant of the single leg step down test [ 13 ]. In this test, the trunk is leaned forward, and the non-support leg is extended backwards, with the pelvis kept parallel to the ground. The participant performs five controlled pliés (knee flexion parallel to the foot) while horizontally adducting the arms to touch the fingertips to the ground [ 13 , 18 ]. The Airplane test assesses whether neutral lower extremity alignment is maintained in at least four out of five pliés. A key advantage is that it requires no additional equipment and is quick to administer. The Airplane test has been proposed as a possible indicator of a dancer’s functional balance and skill level [ 13 , 19 , 20 ], however the test has been shown to not be a reliable indicator. Richardson e t. al . [2010] compared, among other things, the Airplane test against teacher assessment of pointe shoe readiness and did not find agreement on young vocational dance students’ [12.3 ± 2.2 years] pointe shoe readiness between the two. There was some agreement on the lack of readiness among vocational students under twelve. This suggests that passing the Airplane test may be necessary but not sufficient for teachers to assess pointe shoe readiness. The main limitation is its moderate difficulty, making it less suitable for detecting small changes. It could serve as a clinical cut-off, but its applicability requires further research. Technologies to assess balance To improve the accuracy of the balance measures explored above, it is possible to integrate these tests with technologies, which enable a greater level of detail in assessment. Currently, one of the most widely used technologies to assess balance in dance is force plates. This technology measures Ground Reaction Forces (GRF): the forces created against the standing surface during static and dynamic movement. Through GRF measurements of the GRF it is possible to obtain the centre of pressure (COP), which is the projection on the floor of the sum of forces at the point where the total forces are applied. The COP is used to measure postural control and balance. Researchers have used COP during turns to describe the difference in balance strategies between novice (12.0 ± 1.9 years) and experienced (17.8 ± 3.4 years) female adolescent ballet students, determining that older students were better able to control the trajectory of the COP [ 21 ]. Additional research investigated how feedback affects pirouette ( Table 4 ) performance [ 16 ]. Using COP, no difference was found between giving or not giving feedback on the quality of pirouette execution. Nevertheless, participants believed that having feedback [internal or external depending on the individual performer] on their executions positively impacted their performances. This shows that dancers’ perception of balance and performance is subjective, and force plates can provide them with objective measurements. View this table: View inline View popup Download powerpoint Table 1. Factors impacting balance in dance View this table: View inline View popup Download powerpoint Table 2. Technologies measuring balance in dance View this table: View inline View popup Download powerpoint Table 3. Factors impacting balance in dance View this table: View inline View popup Download powerpoint Table 4. Dance terminology and positions Other researchers have used force plates together with Electromyography (EMG) and optoelectronic systems to document increases of COP sway after fatigue protocol [ 22 ]. Similar procedures were carried out to examine differences in balance strategies when comparing new and dead pointe shoes [ 23 ]. Dead pointe shoes are shoes that have been worn and no longer offer support for the foot while en pointe. This study compared lower extremity biomechanics, including sway, muscle recruitment, and ankle stability, in professional ballet dancers performing relevé and arabesque in both new and dead pointe shoes ( Table 4 ). The aim was to assess whether shoe deterioration impacted biomechanics, similar to how worn-out running shoes affect runners. Increased sway and tibialis anterior activation in the results could suggest that worn pointe shoes compromise stability as dancers compensate for the diminished support resulting in an increased risk for injury. Identifying degradation thresholds is essential for understanding their impact on biomechanics and balance. Factors Influencing Balance Performance and the underlying mechanisms in dance Dance technique is not the only factor which determines balance, there are many demands affecting a dancer’s ability to balance. When performing, dancers must be aware of their surroundings and environment, including tracking the music, other performers, and stage staff, whilst simultaneously preparing for the upcoming choreography. Aerobic capacity and cardiovascular fitness may impact balance in dance. Among the general population, research has shown that that after short-term intensive exercises, hyperventilation, rather than fatigue, is responsible for increased postural sway [ 24 ]. Further, studies found that balance was also disrupted after general post-exercise aerobic fatigue [ 25 ]. However, the authors reported no difference before and after fatigue in the YBT using the Dance Aerobic Fitness Test ( DAFT ) [ 26 ] protocol. This might be due to two reasons: the DAFT might not effectively exhaust dances’ aerobic systems, and the YBT might not effectively measure changes in balance and postural control due to ceiling effects. Supporting this, Bulkey found that by using the high-intensity dance performance fitness test (HIDPFT) enabled detection of changes in COP in professional dancers (ballet, jazz, or contemporary) [ 22 ]. Understanding how different responses to exercise individually contribute to balance acquisition and adaptation would help minimise their effect on dancers. To date, no study has been able to measure the effects of cognitive load and mental fatigue on dance performance. Researchers found that standard cognitive load protocols such as the Stroop tests were not taxing enough to influence balance in young healthy people [ 6 , 27 ]. Similarly, Baston (2010) [ 15 ] tried to integrate a cognitive load component into the dsSEBT and found that the variability in responses did not allow for accurate measurement of the SEBT, nor was it possible to deduce any conclusion on the impact of cognitive load on balance performance. Strength has recently been investigated in dance research in the context of jumping in elite ballet dancers [ 28 ], but its relation with balance in dance remains debated. One study [ 29 ] examined whether core and lower limb strength training could improve balance and dance-specific skills, like pirouettes, in university-level dancers using a program based on Jeffreys’ core stabilisation techniques [ 30 ]. After nine weeks, dancers showed improved oSEBT, anti-rotation abilities, and pirouette performance. However, it was unclear whether these gains were from dance classes alone or were the result of added strength training. Additional trunk stabilisation work may play a role in improving both static and dynamic balance performance as well as dance-specific performance. Future studies could measure the effect of similar strength training protocols on other styles of dance trough case-control study to isolate its impact, refining strength and conditioning programs in different dance populations. Some research has investigated the association between strength and aesthetic competence and the relationship between aerobic conditioning and dance performance but the specific relationship between those and balance is yet to be understood [ 31 , 32 ]. Strength and muscle fatigue are different measures of a muscle’s ability to generate force. Research by Lin et al . (2016) [ 33 ] explored how lower leg muscle fatigue affects balance and biomechanics in dancers during movements like relevé. The research was motivated by the belief that muscle fatigue impairs sensory feedback, affecting balance and increasing injury risk. The findings showed that lower limb fatigue altered biomechanics, particularly in the medial-lateral axis, and dancers shifted body weight to compensate. The study suggests that targeted conditioning programs could train muscle endurance to mitigate these biomechanical changes and reduce fatigue-related injuries. Muscle fatigue appears to affect balance and muscle activation patterns, especially during repeated weight-bearing plantar flexion exercises. Differences in muscle metabolism may explain these findings. The soleus, rich in slow-twitch oxidative fibres, resists fatigue better than the gastrocnemius, [ 33 ] supporting its key role in sustaining relevé. While the gastrocnemius acts as the prime mover, future research could examine fatigue effects on core stabilizers, hip flexors, and external rotators, which contribute to dancer stability. Injuries are common in dance, with injuries in elite ballet dancers having an incidence rate of 3.9 (per 1000 hours) making it similar to cricket but lower than rugby union or ice hockey [ 34 ], with foot and ankle injury accounting for up to 62% of all injuries [ 35 - 40 ]. To achieve positions like relevé and arabesque on pointe, ballet and ballet-derived styles require a greater ankle mobility range than the general population [ 41 ]. This could be a contributing factor to the high prevalence of foot and ankle injuries among ballet dancers which, long term, can lead to CAI and could hinder balance due to altered muscle activation patterns in proximal joints [ 33 ]. Hung et al . (2021) investigated the prevalence of ankle instability in dancers (ballet) and its relationship with dynamic balance and lower extremity strength [ 42 ]. The researchers aimed to explore whether ankle instability correlated with decreased motor proficiency. The results indicated that dancers fell between the proposed cut-offs for chronic ankle instability (CAI) but showed no significant interaction in single-leg balance control and leg dominance. Contrary to expectations, the study inferred that ankle instability did not impact strength. The study may have been limited by the lack of challenging positions for dancers. Furthermore, Hung’s findings did not agree with extensive research on both the general population [ 43 ] and high-performing athletes that finds CAI affects the lower extremity muscle chain [ 44 ]. The discrepancy may be due to the sensitivity of the measurement tools used in the study. Therefore, It is crucial to study dancers using advanced technologies to further explore the link between balance, prior ankle injuries, and CAI. There is potential to benefit from strength training for ankle injuries in dancers, as research [ 45 ] demonstrated that strength exercise intervention combined with blood flow restriction improved ankle stability and functionality, as measured by the Foot and Ankle Ability Measure (FAAM) [ 46 ]. This indicates that strength training, which likely enhances balance, leads to better functional outcomes in dancers with chronic ankle instability. Although there is literature available on dancer’s nutritional intake, little has been published on the effect of nutrition on physical performance in dance. Even when expanding research to other aesthetic sports, is evident that further research is necessary. Research in artistic gymnastics found that carbohydrate supplementation was able to supply muscle demands and improve athlete’s focus, as shown by the reduced number of falls when under fatigue [ 6 , 47 , 48 ]. Similar studies should be replicated in different dance situations, such as full-length ballet performances or other styles that require repeated intermittent efforts and significant mastery of balance, to determine if similar findings apply to dance. Proposed areas for practical application of future research and in dance education Among the objectives for this review was proposing areas for future research to develop better measurement tools and interventions. Building on previous studies by Beckman (2024), a larger sample size is needed to further validate the SEBT and test the efficacy of the step approach taken in stratifying the 2024 version of the test [ 12 ]. Furthermore, since the test has been developed specifically for ballet and contemporary university dance students, validation and adaptations are needed for other populations. Future research should strengthen this new test by increasing the sample size and adapting it to other dance styles. Beckman’s work marks a significant advance in developing a more accurate and challenging balance assessment. As some universities offering dance programs implement screenings across their student population to monitor their well-being and progress, the SEBT and force plates could be incorporated into existing protocols to improve the specificity and reliability of these longitudinal data acquisitions. Pointe shoes are a significant component of ballet training. The papers examined in this review aimed to validate ballet teachers’ assessment through clinical tests but were unsuccessful. Building on that work, future research could focus on the application of guidelines for pointe shoes readiness together with standardisation of some of the criteria such as functional core strength and ankle mobility [ 49 , 50 ]. Regarding pointe shoes, COP measurements have used to determine changes of biomechanics when wearing new and dead shoes; further research could use similar methods to determine the threshold for ‘dead’ pointe shoes and potentially put systems in place to reduce associated acute and chronic injuries. In several sports, including football, rugby, skiing, and running, technology allows for the mass production of shoes to be built according to athletes’ unique anthropometric parameters, including the insertion of tracking devices in footwear. Given the recent innovations in pointe shoe manufacturing, similar technology could be implemented in dance to help reduce strain on the body and improve performance. Regarding aerobic demand measurement, the HIDPFT test appears to challenge dancers to the point of compromising balance. Identifying which component is most demanding could help minimize its impact, potentially improving balance and overall performance [ 22 ]. Among the general population aerobic capacity impacts balance, with hyperventilation causing increased postural sway after intense exercise, while muscle fatigue shifts balance reliance to proximal joints [ 24 ]. Nutrition’s impact on dance performance remains under-explored, but evidence from related sports suggests proper nutrition could enhance dancers’ focus and performance. Researchers could implement an initial case-control study to understand the impact of glucose supplementation during long bouts of activity in dance, such as rehearsals and full-length performances, measuring injury rates and perceived exertion. Subsequent studies could explore how glucose supplementation affects balance specifically or other aspects of fitness that subsequently influence balance, such as aerobic fitness and muscle fatigue. To better translate the research into practical applications, studies should examine the timing, frequency, and concentration of the glucose supplementation. The general guidelines of 30-60g of carbohydrates per hour could be a starting point [ 51 ]. Regarding guidelines for dance education, this review suggests that training lower limb muscle fatigue could be an effective way to improve balance, potentially allowing for better overall results. This could be done by running the same routine multiple times in a row or by training a specific muscle group separately from a dance context to improve muscle endurance while dancing. For dance students with ankle sprains exercise intervention combined with blood flow restriction improved ankle stability and functionality, this training could be supplemental to the dance classes or could occur during said classes in case of a recent injury as a replacement for “sitting out” part of classes. Finally, adequate carbohydrate supply during training and performance could improve performance among dancers. Research needs to explore timing and specificity of nutrition requirements for different dance styles, populations, and skill levels. Conclusion This scoping review has highlighted the complexity of balance in dancers, emphasised the need for a more comprehensive and dance-specific understanding of balance performance. The findings underscore the limitations of current balance measurement tools and the importance of developing dance-specific definitions and assessments that can capture the nuanced demands of various dance styles. Factors such as muscle fatigue, strength, previous injuries, and potentially nutrition have been identified as significant influences on dancers’ balance, suggesting that a holistic approach to training and performance preparation is crucial. The integration of advanced technologies, like force plates with genre-specific movements, offers promising avenues for more accurate balance assessment, particularly in monitoring motor skill acquisition and injury recovery. However, the review also reveals significant gaps in our current knowledge, particularly in understanding the effects of cognitive load and the long-term impact of dance training on balance. As the field of dance science continues to evolve, future research should focus on [ 1 ] developing more sensitive and specific balance measures for dancers, [ 2 ] exploring the underlying mechanisms of balance adaptation in dance training, and [ 3 ] investigating targeted interventions that can enhance both performance and injury prevention. By advancing our understanding of balance in dance, we can not only improve the training and performance of dancers but also potentially contribute to broader applications in physical therapy, fall prevention, and general fitness. 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