Dance is an extremely popular activity among adolescents and has a range of associated physical and psychological health benefits. However, pain and injury in young elite dancers is pervasive, and the underlying risk factors are poorly understood. This study investigated the incidence of pain and injury in elite adolescent Irish dancers and examined a range of potentially associated biopsychosocial risk factors. Thirty-seven championship level Irish dancers completed baseline questionnaires recording any episode of pain or injury over the previous 12 months. Additionally, dancers provided information regarding their dance practices, general health, sleep, eating habits, and a range of psychological factors including mood, catastrophizing, passion for dance, and achievement motivation. A baseline physical screening protocol including assessment of balance, fitness, flexibility, endurance, and functional movement was conducted. Subjects were separated into a "more pain and injury (MPI)" group (N = 17) or "less pain and injury (LPI)" group (N = 20) based on their reported pain and injury history over the previous year. Statistical analysis was conducted using independent samples ttest, the Mann-Whitney U test for skewed variables, and the test of independence for categorical variables as appropriate. Eighty-four percent of subjects recorded at least one pain or injury during the previous year. The lower limb, particularly the foot and ankle, was most commonly affected. Factors significantly associated with pain and injury included having an unusual number of troublesome body parts (p = 0.002), often or always dancing in pain (p = 0.033), and high levels of anger or hostility (p = 0.045). This study demonstrates that elite adolescent Irish dance is associated with a substantial risk of pain and injury that appears to be greater than that incurred by young dancers from other genres. Proposed explanations include inappropriate technique progression, unique choreographic features, and an overly arduous calendar of competitive events. A prospective study nearing completion will help clarify causal factors in these dancers.