The discipline at the heart of dance

Ballet may be a creative art form, but don’t be fooled by the apparent ease and elegance: there is discipline and even pain at the heart of dance. Dancers work through long hours, pushing themselves to the limit, often training and dancing from ten in the morning until the end of a performance that night. Their strength and fitness is built and maintained through constant endurance training.

Dancers have to look after their bones and joints as part of their job. All the occupational hazards that threaten sportspersons are there: repetitive strain on certain parts of the body, a commitment to precision and performance at all times, and a hyper-competitive environment where you are encouraged – and even expected – to work through the pain.

And just like professional sport at the highest level, the pressures on our ballet stars are enormous. The statistics have borne this out for years: a 2000 report in the Anxiety, Stress and Coping journal claimed that the injury rate for professional ballet dancers over the course of eight months was 61%. This is comparable to rates found in contact sports such as rugby and American football.

Unsurprisingly, a lot of ballet injuries in ballet occur in the ankle – up to 40% of them, in fact – and there are a lot of things that can go wrong in the lower limbs:

Acute Trauma

Understandably, the typical ballet routine involves multiple instances of large skeletal forces decelerating and impacting the ankle area. It’s something that the ankle can be remarkably resilient to when the process is finely balanced: when the necessary concentration and timing goes amiss, however, the problems can start. At best, the dancer runs the risk of ankle sprain – at worst, serious injury.

Chronic Ankle Instability

An offshoot of persistent ankle strain, this ailment may be rotational or varus (inward-tilting). The former usually occurs during inside turns, where the upper body is rotated outward while the feet remain anchored to the floor, and is particularly hard to rehabilitate.

Other injuries include hindfoot sprains and dislocations, swelling and tenderness of the mid-foot which could be a sign of undisplaced injuries and joint separation, fractures of the fifth metatarsal, and common-or-garden chronic overuse injuries such as stress fractures.

The final similarity that can be drawn between the worlds of dance and sport is the borderline-obsessive refusal amongst certain participants to know when to stop – or the luxury of doing so to get themselves healed. The ballet blog Gramilano collected a range of quotes from professional ballet dancers earlier this year, a lot of which could be inserted into the average sports interview without anyone noticing.

All of them tell a story familiar to any professional sportsperson: a huge amount of physical and psychological pressure from an early age, a work ethic that demands that the participant ‘toughs it out’ whenever injuries occur, and a lingering fear that everything they’ve worked for can be taken away at any moment.

Fortius Clinic’s consultant orthopaedic surgeon James Calder specialises in treating the foot and ankle. He sees cases in ballet dancers, of bone and joint overloading as a result of excess strain, especially in the knees, ankles and feet.

Mr Calder is the Medical Advisor to Dance UK and treats dancers at Birmingham Royal Ballet and the Royal Ballet, Covent Garden. He works closely with Greg Retter, Clinical Director of Ballet Healthcare at the Royal Ballet. Formerly Rehabilitation Manager for the British Olympic Association’s Intensive Rehabilitation Unit for elite Olympic athletes, Mr Retter’s role at The Royal Ballet is to oversee and lead the healthcare team of 15 individuals across a wide range of disciplines, including sports science and physiotherapy, Pilates, gyrotonic, psychology, nutrition, soft tissue therapy and sports medicine.

Greg says: "Our dancers can suffer injuries from cumulative excess load on their bones and joints, and the resulting wear and tear injuries can be much the same as those that the average person acquires over a long life, except for dancers the wear and tear is magnified and accelerated."

Ensuring that every dancer achieves a long and full career is at the core of The Royal Ballet Healthcare team's work. And they are well supported in their work, with superb facilities in the Royal Ballet Mason Healthcare Suite, which provides vital healthcare facilities for the 100 dancers of the Company, helping dancers avoid and recover from injury. 'The facilities at The Royal Ballet are very similar to what you might imagine at a Premiership football club,’ Mr Retter observes.

We can all learn about how to care for our bones and joints so as to reduce wear and tear, with regular moderate exercise.

Retter recommends adult ballet classes. "Ballet requires you to move joints through their full ranges, lubricating the joint and helping it move more easily," he says. "It's also quite slow, so you can easily maintain control of your movements, reducing the chance of accidents."

Whatever exercise you choose, avoid damaging your bones and joints by listening to your body.

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