Dancer Health and Wellness Programme
by Rebekah Rimsay
September 17, 2020
"The Dancer Health and Wellness Programme helps our dancers function at their optimal levels by identifying and addressing any imbalances (in mobility or strength) in order to avoid or reduce the severity of an injury. It is better to prepare the body for the physical demands of ballet rather than react to injuries after they occur. That is why focusing on their physical, mental and emotional health, while providing the proper interventions necessary, helps minimize the obstacles they will face." - Paul Papoutsakis, Company Athletic Therapist
Ballet is a tradition based art form – ethereal, expressive and ephemeral – but it is also a formidable athletic pursuit. It is often said that dancers regularly put their bodies through physical strain similar to football players but with pointed feet, a smile and synchronized to music. What is also true is that dancers’ athletic prowess, until recently, has been achieved without much help from sports science and medical intervention. Funding is plentiful for studying the optimization of the human body for sports as world titles, Olympic medals, corporate sponsorships and national pride translate into money and fame. For dance, until recently, we could only borrow this sports science to try to adapt it to the detailed complexity of ballet. But sports is not ballet. It lacks the alterations in forces that pointe shoes place on feet and ankles, the torque on small joints when turning on demi pointe or the long seasons that don’t allow for ramp-up periods and adequate recovery time.
When I joined The National Ballet of Canada in 1990, we had a part time physiotherapist who set up a portable table in our dancer lounge (which was also the storage room for our touring containers) for three hours, three times a week, to treat a company of 80 dancers. Our podiatrist would set up a makeshift clinic once every few months and provided a home-made toe traction machine and a few vials of crazy glue (for use on split toenails) to tide us over in his absence. We had massage therapy twice a week for a few hours which took place behind some spare office cubicle dividers. Back then, there was little talk of injury prevention. Coping with injury was all we could hope for, patching up the ‘ouches’ using heat, ice and Saran wrap with castor oil overnight. It was ballet in the trenches, survival medicine at best.
Over the passing years, those seeds of care developed into the acknowledgement that dancers need consistent medical intervention to keep them on stage through managing and treating injuries. A relationship with the Sports Medicine Experts, headed by Dr. Michael Clarfield, was established to give dancers more access to onsite physiotherapy and sports medicine doctors who could diagnose injury quickly and provide expedited intervention to get dancers back up and dancing sooner. This medical perspective led to a more scientific approach to dealing with injury and eventually to the National Ballet joining The Dance/USA Task Force on Dancer Health. This organization includes all the major classical ballet and contemporary dance companies in North America and provides a forum where medical professionals who work with dancers can collaborate on research, exchange ideas and advocate for changes in practices, policies and workplace conditions. This gathering of dance health representatives has helped cultivate the burgeoning field of dance science where an important goal has emerged – injury prevention.
The current Dancer Health and Wellness programme that the dancers of the National Ballet benefit from today places its strongest focus on prevention. Yearly health screenings are provided for dancers at the beginning of every season with the aim of identifying weaknesses and imbalances in strength and flexibility that could lead to injury. Then, customized strengthening programmes are developed for individual dancers to help them improve on these areas of improvement before they push their bodies to the limit in rehearsal and performance. It also means addressing dancers’ overall health through providing access to a spectrum of health professionals such as family doctors, nutrition experts, naturopaths, mental health professionals, eyecare physicians, podiatrists, orthopedic doctors, sports medicine specialist, personal trainers, Pilates and movement experts. There is strong evidence that weakness in any one area of health can be a drain on a dancer’s physical resources and increase the risk of injury.
Dancers, however, still need day to day maintenance treatment because, despite prevention efforts, the effects of six hours of pointe work, lifting, jumping, flexing and repetition can still result in strains, pain and fatigue. Dancers are treated with hands-on and modality techniques that help loosen and rebalance soft tissue and keep pain and inflammation in check. Highly targeted exercises are prescribed by Company Athletic Therapist Paul Papoutsakis to rebalance, release and relieve pain and fatigue that results from a dancer’s response to specific repertoire– hopefully before a downward spiral to injury.
The final focus of the wellness team is to treat injuries that were not preventable or happen despite best efforts. Sometimes dancers still experience fatigue if their workload suddenly increases due to filling in for another dancer or the repertoire is particularly demanding or repetitive. Some of these injuries just need extra therapy and time off but occasionally, some can be catastrophic and require surgery and/or months of rehabilitation to return to the stage. The latter can take a psychological toll on dancers who face a daunting uphill battle of strength building, retraining and overcoming fears of the step or situation that caused the injury. This is a clear example of where the wellness team can address multiple levels of rehabilitation through performance psychology, mental health care, cross training, nutrition to optimize healing and provide a broad web of support. When a dancer is sidelined, unable to partake in their artistic pursuit, this encompassing approach can help foster focus and optimism for a full and fruitful return to the stage.
During this time in the midst of the COVID-19 pandemic in which we optimistically prepare for theatres to re-open and audiences to return, dancers are preparing to occupy the studio and stage after an extended period of time off, for some, longer than they’ve ever been away from the rigors of ballet training. It will be exciting to see how the Dancer Health and Wellness programme evolves in response to this novel situation by tapping into existing dance science and exploring new ideas among the international ballet community. This body of information will be essential in assisting dancers on a safe training course so they are prepared for the complexity of movement, strength, flexibility and power needed to perform the rich and varied repertoire planned for this season.