I'm a dancer who is currently injured and unable to walk a lot. My physical therapist and my massage therapist are giving me opposite instructions. My PT believes that I should do her exercises, even if they cause some of the "bad pain," and take three different kinds of exercise classes. My massage therapist tells me that I shouldn't do anything that causes "bad pain" and only do one exercise class per week for now. Who should I listen to? —Rachel
Freelance dancer Rebecca Greenbaum was looking forward to a fun and lucrative Nutcracker gig when she became plagued by ankle pain. An orthopedist diagnosed her with tendonitis and sent her to physical therapy. Though it was informative, her ankle troubles persisted. "I would maybe feel better for a day, but the pain would come back," she recalls, so her therapists suggested acupuncture. Greenbaum was skeptical, but she was willing to try anything. Finally, she found relief that lasted: Acupuncture combined with physical therapy got Greenbaum onstage, pain-free. Two years later, both treatments remain part of what Greenbaum calls her arsenal for maintaining wellness.
Getting injured is overwhelming for any dancer, and figuring out a recovery strategy can add to the stress. Oftentimes, it takes a team of medical professionals to help you return to the stage safely. Since knowing who to see can be confusing, we've outlined some of the most common practitioners ballet dancers might visit and why.
After what appears to have been an emotionally draining injury-rehabilitation program, American Ballet Theatre and Bolshoi Ballet star David Hallberg has returned to the stage.
A little over a year ago, Hallberg buzzed his hair, posted a semi-cryptic message on Instagram and dropped out of the ballet world altogether. He moved to Australia to treat a lingering ankle injury, specifically seeking out Sue Mayes and the Australian Ballet's physical therapy team. Now healthy, he made his comeback in Sydney on the evening of December 13. He performed the role of Franz in Coppélia, as a guest artists with the Australian Ballet.
Hallberg tackled his therapy program with a dancer's usual determination and drive, though that didn't keep him from experiencing self-doubt. "Emotionally, some days I was just going by the words of my team and not my own self-belief," he told the Sydney Morning Herald. His pride also took a knock, when students from the Australian Ballet School witnessed him slowly working his way back from injury to peak condition.
Fortunately, those moments of struggle have paid off: Not only was Franz a brand new role for Hallberg to add to his repertoire, but the entire ballet world wished him well during his comeback performance.
Your @abtofficial family is with you @davidhallberger as you return to the stage tonight with @ausballet! Behind you always, every step of the way, on stage and off! As the Aussies say, "Chookas!" ❤️ | 📸: @rosalieoconnorphotography @abtofficial #ballet #abtballet
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“It’s changed the way I dance, but also the way I condition myself … The team really taught me the power of prevention: even if it’s a fluke accident, you can often prevent it from happening if you have this really strong, intuitive, honed-in and turned-on support system.” Principal Dancer David Hallberg @davidhallberger on working with our Rehabilitation Team. Tonight, after being away from the stage for two-and-a-half years, David will return to ballet as Franz in Coppélia, dancing with Principal Artist @amber_e_scott … Chookas! Read more about David’s rehabilitation through the link in our bio ⭐ #TABCoppélia 📷 @klongersklongers
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This guy is 1 of the most beautiful people inside and out, an inspiration to me, and a driving force in the dance world. All my love to him tonight as he returns to the stage in Australia. Love you so much David. Hope to see you soon!! Go get em... #Inspiration @davidhallberger #MyRomeo #Strength #NoAwardNeeded #AthleteofGod
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— Marina harss (@MarinaHarss) December 13, 2016
Australian audiences can still catch the danseur noble on December 16, 19 and 21. We'll keep you updated on his next moves!
I just found out I fractured my talus (ankle) and can’t dance for 4-6 weeks. How should I ease my way into dance after my doctor gives me the okay? —Emily, Winchester, VA
You’re wise to want to ease back into shape, because bone injuries need plenty of time to heal. I had a fractured ankle once, so I know from experience! Since your talus is a weight bearing bone, you’ll probably be off your feet for a while. I asked Michael Leslie, a physical therapist on staff with the San Francisco Ballet, for some expert advice. He recommends doing floor barre as a way to stay active during your time off. “It’s non-weight-bearing, and you’ll have a stronger core when you come back,” he says.
You can start adding cross-training activities, like Pilates and Thera-Band exercises, when your doctor gives you clearance. Once the bone is healed, try a standing barre. “Use pain as your guide,” says Leslie, “gradually increasing the level of difficulty over time.” If you have access to a pool, try giving yourself barre in the water—I found pool barre especially helpful when I was recovering from my injury because gravity is less of a factor. Once you feel stronger, gradually begin center exercises. Listen to your body, and stop if your ankle begins to hurt. It’s tempting to want to push through the pain, but you could jeopardize the healing process.
Leslie advises you to stretch carefully. You can stretch your hips, hamstrings and quads, but avoid overstretching the calf muscle and ankle. Instead, try gently flexing the foot, using the muscles in front of your shin with both a bent and straight leg to get a moderate stretch. He also recommends the doming exercise (see “Ask Amy” June/July ‘09) to strengthen your foot’s intrinsic muscles. “Doming strengthens the muscles right around the ankle joint, but doesn’t put excess stress on it,” he says.
Be patient—you will probably feel weaker as you start back, and you might get frustrated easily. Certain steps are also scary if they irritate your foot, but try not to start compensating. For instance, I had an awful time with pirouettes to the left when I came back from my stress fracture. It took me a while to work through the fear and turn properly again. Stay focused with your strengthening exercises and listen to your body. With time, you’ll come back a smarter and stronger dancer.
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If I’m trying to work through a minor injury, when do I know it’s time to sit out or see a doctor?
Mickey Cassella, PT, director of physical therapy services at Boston Ballet: There’s no such thing as a “minor injury” when you’re a dancer. If you have a hint of something not feeling right, seek the advice of a doctor or physical therapist who works with dancers. We can often prevent major injuries by looking after minor ones.
Know your body’s limitations. Sometimes you’ll tweak something in rehearsal but it just goes away. If it keeps getting worse as you dance, stop. When you’re not sure if it might go away, rest for 24 hours—if it still bothers you, see a dance medicine professional. Don’t compare your injury with other dancers’ because no two injuries are alike. Even teachers won’t have all the answers about your body.
Every dancer hurts at some point during the day. You have to listen to your body and figure out how far can you push before you have to take a few steps back and rest.
I’m anxious about the process of coming back from an injury. What’s it like?
Lauren Toole, dancer with Los Angeles Ballet: I tore my meniscus and had to have surgery on my knee in June. It took me six months to come back 100 percent. You have to listen to your body and take the time it needs to heal. Once you get the OK from the doctor to go back to dancing, be confident knowing that you’re healed and you have your strength and mobility back. There might be residual pain from scar tissue, but the actual injury is no longer there.
Follow all of the instructions your doctor and physical therapist give you. I had to be on crutches for six weeks. It was hard, especially when I started thinking that I was getting better. Don’t rush to get back. Do all of your physical therapy exercises every day. It will help you return to dancing without fear once you’re better. I had to ride the stationary bike every day and do Pilates on the Reformer and leg lifts with a Thera-Band. By doing those exercises, you’re working on your body as a dancer, so you never get so removed from dancing.
Another important thing is to keep yourself busy. It will help your overall state of mind, both when you’re injured and when you’re coming back.
What should I be doing to prevent Achilles tendonitis?
William Hamilton, MD, consulting orthopedist for New York City Ballet and American Ballet Theatre: Tendonitis happens when the tendon is overstrained, causing microscopic ruptures and an inflammatory response. The most common cause is tightness. Stretch out your calves whenever you can (especially on the triangular wooden stretch box). Overload, which happens as the tendon gets weak, is the second most common cause. This can be compounded by working on hard floors. If you have to dance on a hard floor, do a very careful warm up, a lot of stretching and keep warm all day with wool legwarmers. At the end of the day, give your Achilles an ice massage for 20 minutes.
Following an injury, make sure to allow for adequate rehabilitation to strengthen your calves. And don’t force your turnout by using the floor instead of your hips. Ten percent of dancers have an os trigonum bone in the back of their ankles that keeps them from rising to full relevé, which means the Achilles is constantly strained. The only way to fix that is to surgically remove the bone, but we don’t recommend it unless the dancer has chronic pain.
Putting elastics in your pointe shoe ribbons won’t prevent Achilles tendonitis, but it’s recommended for dancers who’ve had Achilles tendonitis before.