‘I felt a pop’: How do you fix a busted ballet dancer?

‘I felt a pop’: How do you fix a busted ballet dancer?

November 21, 2021

A snapped tendon could once mean curtains for a career. How do today’s dancers make it back on stage when disaster strikes?

You may imagine a serious ballet injury as a sudden, calamitous drama; a catastrophe in tights.

It does happen. When New York City Ballet star Robert Weiss snapped his Achilles tendon during a 1978 performance, the loud “pop” famously carried to the stalls. He thought the floorboards had given way beneath him, but, in the audience, his friend Rudolf Nureyev knew better and rushed backstage to help him to hospital.

Rudolf Nureyev knew a popped Achilles when he heard it. The year after he rushed to the aid of Robert Weiss, he broke a bone in his own foot while dancing the Nutcracker. Credit:Getty Images

Then there was American David Hallberg, the international superstar, alumnus of the Bolshoi and American Ballet Theatre, and now artistic director of the Australian Ballet. At his 2018 debut with the Royal Ballet in London – an eagerly anticipated moment long delayed by a career-threatening ankle injury – disaster struck.

“Midway through the first act, taking off for a jump, I felt a pop in my calf, and from then on a sharp pain inflicted by just stepping on it,” he recounted on social media. “I finished the act through sheer grit of determination but I knew in my gut I couldn’t possibly continue.”

Career-threatening injuries can creep up on dancers, too. In 2016, one of the Australian Ballet’s then rising stars Benedicte Bemet had seized the rare chance to dance a principal role, at the end of a busy season.

“I was in a bit of pain, but I thought it was manageable,” she says of her niggly Achilles tendon. Fast-forward a couple of months and she could barely walk. “I took my Christmas holiday in a bit of pain. And tendons notoriously hate rest. I didn’t realise that at the time, I thought rest was good. It was really, really angry.”

Back in the 1970s, Weiss had surgery (luckily for him, a Danish specialist had been in the audience and supervised his operation). But operations are risky and can leave a dancer permanently restricted. For Hallberg and Bemet (she is pictured at rehearsals in the video below), recovery was slow and complex – though non-surgical – requiring huge reserves of physical and mental strength.

Why do ballet dancers get injured so much? And how is it that dancers who once might have had to hang up their pointe shoes forever are now returning from injury stronger than before?

Below: Benedicte Bemet rehearses with fellow dancers at the Australian Ballet.

Is injury common among ballet dancers?

Yes. But perhaps not for the reasons you might think. A study in Britain in 2014 found that professional dancers were far more likely to suffer injuries than rugby players: 80 per cent of dancers incur at least one injury a year that affects their ability to perform, compared to 20 per cent for rugby or football players.

Muscles and joints were the most common sites for injury, according to the British Fit to Dance 2014 survey. Other studies found that over-use was the most common cause of injuries for female dancers while men were more susceptible to sudden, traumatic injuries. And they found that younger dancers were more likely to be injured than older ones.

Why are professional dancers so vulnerable? Partly because their workload is so intense: top companies perform many times more each year than sports teams play matches. There are 23 rounds in a typical AFL season, for example; in 2019 (a typical year) the Australian Ballet scheduled 289 live performances.

But Matthew Wyon, professor of dance science at the University of Wolverhampton and one of dance science’s leading experts, has another theory. And it’s not a flattering one.

“There’s quite a bit of evidence that most ballet dancers are only slightly fitter than the average person on the street,” he says. “I always call them ‘boy racer’ cars: flashy exteriors but with an engine that is working overtime.”

One of the ways to measure fitness is the amount of oxygen you consume per kilogram of body weight: it’s how efficient you are at using the fuel in the air to burn in your muscles. Distance runners and cross-country skiers would score in the 70s and 80s, soccer players in the 50s and 60s. Sedentary people would score low 30s. Dancers score from the 30s up to early 40s. And, just as surprisingly, they’re not that strong, either.

“The better your dancer is, the less fit they are. Because dance doesn’t stress them any more.”

“We had a principal dancer just coming back from an ACL [anterior cruciate ligament] injury,” says Wyon, “and we were testing his good leg against his injured leg, and the force [the good leg] was putting out was about 35 kilos; that’s nothing.”

For comparison, an average gym bunny would barely raise a sweat doing a leg press of four or five times this amount.

Why is this so? Wyon believes it’s because of the way dancers train.

“None of their training causes them to get either stronger or fitter until right up close to a performance. Ballet dancers are technically unbelievable. They’ve got an economy of movement we never see in sport. But it means the dance no longer puts a stress on the body. They don’t have that physical adaptation. So, in fact, the better your dancer is, the less fit they are. Because dance doesn’t stress them any more.”

On the face of it, the lifts and jumps that dancers perform seem to require extraordinary strength. But, behind the scenes, a lot is accomplished by perfect balance; by aligning bones and locking joints so that, rather than relying on muscles to hold your partner aloft, the weight transfers through your frame to the floor.

“As soon as they were being watched, they could pull it out. This is just a phenomenon and we’re trying to explain it.”

And the “floating” appearance of a jump relies, again, on technique as much as lift-off power: by lifting and lowering arms and legs during a leap, the dancer’s centre of gravity can travel the parabola that the laws of physics require while their body seems to defy science in mid-air. The same effect can be seen in a basketball player’s hang time on their way to a dunk.

Evidence of their reliance on technique can also be found in dancers’ almost freakish ability to ignore fatigue when it matters.

In one experiment, Wyon’s team made a dancer exercise until they were “absolutely dead on their feet” and then perform a double pirouette on to arabesque (which is where they stand en pointe with one leg in the air behind). “And they could pull it off, even when they were having trouble doing the fatiguing dance in between. As soon as they were being watched, or having the data collected, they could pull it out. This is just a phenomenon and we’re trying to explain it – and it could be how they’re trained.”

Technique, it seems, honed over hours of practice each day and since an early age, hides a multitude of flaws. Wyon has seen a male dancer “built like a stick insect” who could lift any of the women in the company – purely through ability. “His technique was so good for doing it, beautifully. Once. But if you asked him to do it three times, he couldn’t.”

Below: Benedicte Bemet pirouettes in David McAllister’s Grand Pas Classique.

But why does this matter?

“They’re always training and dancing at close to their maximum,”
says Wyon.

Most people operate near 40 per cent of their physical capacity in daily life. Sportspeople and dancers work at a baseline of about 80 per cent when they’re “on”, occasionally pushing themselves to the limit.

“So, they’re always at the edge rather than having any reserve,” Wyon says. And once fatigue sets in, “that’s when the potential for injury suddenly comes. Because he hasn’t got that reserve underneath, to be able to protect him when he’s tired.”

One wobble, one waver, and the dancer suddenly has to rely on a tired muscle or tendon that can’t take it.

“They’re really good at what they do, but as soon as they get slightly outside that [they lack] physical competency, the ability to do other sorts of movements.”

“There was a view that dancers would perform until, at some point, they broke down … and that was that.”

This explains, says Wyon, why you tend to see an increase in injuries in dancers about a week, or two weeks, into performance time. Their bodies just haven’t been prepared for the demands. Injury prevention was not considered, supported or prioritised in the tradition-bound companies.

Dancers would often not report niggles or early signs of injury, and would address symptoms only when they stopped them from performing. And the stakes are high. Until recently, injuries could easily end careers. Across the industry there was a view that dancers would perform until, at some point, they broke down … and that was that.

Marilyn Jones in 1977 with son Damien, then 4, who would go on to become a star of Australian ballet. Credit:Fairfax Media

Are ballet dancers dropping like flies, then?

When the Australian Ballet’s Damien Welch retired from the company he reported a laundry list of accumulated injuries: six operations on his legs and two screws in his foot (which he’d fractured during jumps), back injuries and stress fractures.

He was the son of Australian dance luminary Marilyn Jones, who herself damaged her Achilles tendon when a floorboard broke under her jump.

But the Australian Ballet is one of a group of pioneering dance companies around the world that have beefed up their in-house medical expertise and are leading the way in the search for better treatment, rehabilitation and – most importantly – injury prevention.

Dr Sue Mayes is the director of artistic health at the ballet, where she’s worked since 1997 – at first in the littlest room in the building as the company’s first full-time touring physio, now leading a high-tech medical and physiotherapy operation. A dancer in her youth, as she grew up Mayes was increasingly drawn to medicine, poring over the intricate, beautiful drawings of muscles, flesh, organs and bones in Gray’s Anatomy.

Mayes sees all sorts of injuries, some unique to ballet. Pointe shoes lead to impingement at the back of the ankle, and pain and irritation to the structures around the bone. She used to see a lot of calf tears, as dancers pushed off from a jump and felt that tell-tale twitch in the muscle.

Dr Sue Mayes is the Australian Ballet’s director of artistic health.Credit:Kate Longley / Australian Ballet

Knee injuries aren’t as common in classical ballet as they are in contemporary dance, which has more twisting and turning moves while a dancer is planted on the ground. About 30 per cent of injuries in classical ballet are to the lumbar spine: in women, due to the impingement of soft tissues in the lower back from bending into moves such as arabesques; in men, from the heavy lifting, catching, flinging and twisting of their partner. Hip problems make up about 7 per cent of their injury list.

Half the injuries Mayes’ team sees are to the foot and ankle: swollen joints where friction and loading have led to inflammation.

“It’s really common for dancers and athletes,” Mayes explains. “You get the swelling in the joint and then the swelling can sort of escape, heading to the tissues, and they form these little balloon-like structures.”

Whenever Mayes puts a dancer under an MRI she finds a “page-long list” of abnormalities around the joints, she says, though many do not affect performance.

But back injuries are much more dangerous. “Over my time there were two or three reasons dancers had to finish [working], and one was injury to the lumbar disc,” she says. The other main reason was dancers having babies.

Below: Miwako Kubota and Benedicte Bemet share an ice footbath post-show.

What can dancers do about injury?

There have been lots of advances in treatment of simple or niggling injuries, but the more dramatic change is in the reduction of career-ending injury, and the reduction in the need for risky, all-in surgery.

Mayes recalls that when Bemet came in for treatment “she had this tendinopathy around her heel. They can take a year [to mend]. They’re really horrible. Every time you bend your ankle or put weight through your ankle it’s horrible pain.”

Bemet had overloaded it. She had got to the state where she couldn’t even plié – the knee bend that’s the most basic ballet move.

The fix was not cortisone or surgery. If you operate on something like this, the dancer will lose some range of movement in their foot, permanently. And that, in turn, can impact on other joints.

It may sound simple, but in ballet it is a revolution … they are experimenting with techniques to painstakingly rebuild the dancer from the inside out.

“We’re [always] going to see if we can do it non-surgically,” says Mayes, “because a dancer loves that swan neck, that hyper-extended shape. If you lose even five degrees of that it’s going to be obvious to the eye and harder to function with. So, we avoid surgery at any cost – we’ve done very few operations in the last 10 years.”

For a year, Bemet had to run through a simple, repetitive exercise routine involving the movement method Pilates, little jumps, or jogging up and down a stairwell, designed to restore strength and function to her foot.

It may sound simple, but in ballet it is a revolution. Rather than rushing dancers to hospital, they are experimenting with techniques to painstakingly rebuild the dancer from the inside out. Research published by Mayes and her team looks at each joint and each injury, and assesses what particular types, frequency and power of exercise are best to get a dancer back to the stage.

Sue Mayes with dancer Sara Andrlon.Credit:Christopher Rodgers-Wilson, courtesy Australian Ballet

But without the perceived “quick fix” of surgery, dancers must call on deep reserves of mental strength and patience. For four months, Bemet hardly improved. All she had to show for the strength exercises was increased strength; no reduction in pain.

“We just make these little short-term goals,” says Mayes. “Rehab is this torturous roller-coaster of emotions and physical capabilities.

“A dancer is nourished by performing on stage; if they lose that opportunity they lose the opportunity to express their artistry. Their careers are relatively short and there are always younger dancers progressing through the ranks. If a dancer misses a year they may miss a performing or promotion opportunity.

“In a long rehab, they can lose a sense of themselves, they risk having nothing if they do not recover from the injury.”

“In the past, their identity was solely a ‘ballerina’ due to growing up and spending their whole lives in a ballet school or company. In a long rehab, they can lose a sense of themselves, they lose their identity, they risk having nothing if they do not recover from the injury.”

And a long rehab is draining. It’s hard work maintaining motivation, and a dancer can lose hope.

“They can start to question whether it is all worth it,” says Mayes. “They question whether they will ever be able to dance again. If they return will they be as good? They miss the camaraderie. They can feel isolated.”

Bemet as an 18-year-old backstage in rehearsals for Swan Lake in 2012.Credit:James Braund

Bemet says that dark time is “still a part of me”. “Until that point, ballet was how I identified myself, it was where I put my self-esteem, my value, my self-worth. To have that taken away … I was just completely lost, and quite depressed, especially because it really took such a long time to even get any sign that it was going to heal.”

In a memoir, Hallberg (who had the same injury as Bemet, exacerbated by botched surgery) reveals his own psychological crisis as he was working on rehab under Mayes’ team. During his recuperative exile in Melbourne he spent hours on park benches, downing six-packs of Carlton Draught, “the stereotypical drunk, the one whom everyone would fear and take pains to avoid”.

He shaved his head and chain-smoked, sleeping in until noon.

David Hallberg with Australian Ballet principals Chengwu Guo and Ako Kondo in January 2021.Credit:Simon Schluter

But a common feature of great ballet dancers is determination. They didn’t get to the top by chasing shortcuts.

“It was gruelling and time-consuming and meticulous,” recalls Bemet. “You have to do [the exercises] at the same time every day, for the same amount of time, in the same order. It’s so full-on. But I’m a bit of a perfectionist. I was more than happy to do everything they said to do. It was swallowing my pride and my ego, and knowing that I had to start back again from scratch, learning how to stand in first position, learning how to plié again, all these things I’ve totally taken for granted.

“You have to go back to baby ballet and be that blank canvas, take on information about your technique. But when you’re so broken, you’ll do anything. If they said, ‘Stand on your head’, I’d be like, ‘Absolutely, I will do it’.”

She came back a better dancer, and mentally stronger – the experience renewed her love and commitment to the art – but she was physically stronger, too. She was no longer a boy racer.

Benedicte Bemet and Brett Chynoweth in a performance of Counterpointe in Sydney in April.Credit:Courtesy Australian Ballet

But don’t ballet dancers hate looking muscly?

Mayes is still fighting battles to get her ballet dancers fitter and stronger, to ward off injury. One of the battles is against dancers’ fear of strength.

“They don’t want to bulk up,” she says. “We want this ballet aesthetic that is long and slender.”

It’s taken a long time to prove that a stronger dancer doesn’t end up looking like the Hulk. It’s all in the way you do it: Popeye muscles develop from high load and lots of repetitions, while the dancers work either with high load and low reps, or low load and high reps, resulting in muscles that can support and protect joints without bulging out of their leotards. It also helps that Mayes can prove to them they will get injured less.

Wyon says new research shows that a good, strength-based prevention program, based on techniques developed by Mayes and others, almost immediately reduces chronic injuries by half.

Plus, they’ve done blind studies, with observers who don’t know which dancer has been doing a strength program, and proven that fitter dancers dance better.

Another fight Mayes is still trying to win is against stretching – especially the unfathomably bendy stretching that dancers are able to pull off, whether they should or not.

“It’s still kind of controversial,” she says.

You don’t actually want a too-stretchy calf. When a joint goes to its full range of movement without the muscles to control it, that’s when injury happens.

Ballet dancers love to sit in splits for hours. They wear it as a badge of honour, plus it feels good, particularly to a body battered by the demands of their career.

But, says Mayes, you don’t actually want a too-stretchy calf, for example. When a joint goes to its full range of movement without the muscles to control it, that’s when injury happens.

Plus, research shows that stretching a muscle actually reduces its power output.

Mayes points out this is a lesson that Olympic sprinters have learned, too.

“You used to see sprinters stretching their hamstrings before the race and, almost inevitably, one of them would tear a hamstring during it. But in recent Games they have switched to dynamic warm-ups: jogging, keeping their body warm. Immediately pre-race it’s about keeping their heart rate up, all their muscles warm and their body active, but without any extreme range of movement.”

Younger dancers, especially, have to be trained out of stretching. Wyon finds himself spending hours on Instagram telling young dancers (or, often, American cheerleaders) who love to do extreme stretches, “that’s bad, you shouldn’t be doing that”.

“They’re trying to force their bodies into these weird and wonderful positions, but they’re stretching ligaments rather than muscles and tendons,” he says. “That means we’ve got increased laxity, which means we are more likely to get injured, unless we increase the muscle strength around that joint to be able to control it and support it. You get these cases of wibbly-wobbly knees, and when they get fatigued they won’t be able to control their bodies.”

Brett Chynoweth and Benedicte Bemet in their constumes for the Black Swan pas de deux in Swan Lake in October 2021. Credit:Eddie Jim

Do dancers stay fixed long-term?

For more than 15 years, since it transformed its injury treatment and prevention program, the Australian Ballet has not lost a single dancer to injury. “Which is amazing,” says Mayes.

“We’ve got women who are dancing into their late 30s, men dancing until
they’re 40, which was never heard of in our company.”

When they leave the company now, it’s rare for a dancer to leave with an injury that bothers them.

“Dancers that retired before we really brought in all the strategies are getting hip replacements in their early 50s. We won’t know [if we’ve changed that] for another 10 years, but I’m hoping.”

Mayes also hopes the work they’re doing will help dancers long after their retirement.

“Dancers that retired before we really brought in all the strategies are getting hip replacements in their early 50s. We won’t know [if we’ve changed that] for another 10 years, but I’m hoping.”

She can now look her dancers in the eye and tell them that, whatever it is, she can fix it.

“The thing we always start off with is, ‘You’ll come back from this injury. And this will not just leave you where you were at. If you commit to this rehab, you will come back better than ever’.”

And Bemet did. She fought back, she healed, she returned to the stage. And she was promoted to principal artist soon after.

The Australian Ballet’s Celebration Gala runs November 25 to December 3 in Sydney, December 9 to 18 in Melbourne.

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