Dance medicine is a relatively new field, pioneered by those who dared to understand the art form, to unravel its idiosyncratic aesthetics and its effects on the human body.
ABT's ace health team includes physical therapists (PTs) Peter Marshall and Julie Daugherty, orthopedists William G. Hamilton and Phillip A. Bauman, and massage therapist Olinda Cedeno. Together, they stand at the very forefront of dance medicine helping dancers stay on stage.
Marshall began working with dancers back in the early 1980s. "Dancers found their way to my door," recalls Marshall, who has published dance-related articles in numerous journals, including American Journal of Sports Medicine and Clinics in Sports Medicine. "Back then, I was not familiar with the lexicon of dance. Dance medicine didn't exist." Wanting to know more, Marshall began observing class, learning the intricacies of classical technique that place distinct demands on the human body.
Marshall joined the ABT staff in 1983, becoming one of the very first full-time PTs in a professional ballet company. He names several key elements in maintaining health. "Dancers need to learn to work with their own limitations, whether it concerns turnout or extension. That means not blindly pushing beyond what their bodies can do safely," he says. "Proper rest, nutrition, hydration and preparation for the day are also important."
For Daugherty, a dancer's health is a delicate balance between being well rehearsed and not over training. She studied dance herself, and has been working with dancers for most of her professional life. Daugherty names cross-training as a crucial piece of the health puzzle. The days when a dancer could get all that they needed for core strength and flexibility in the actual dance class have long gone. "Men need upper body strength," she says, "while women require core strength for stabilization." ABT's new state of the art PT gym, made possible by a generous donation by The Anna-Maria and Stephen Kellen Foundation in honor of Dr. Phillip Bauman, makes cross-training convenient and achievable within a dancer's busy schedule. It is fully equipped with treadmills, stationary bikes, free weights, and a Pilates reformer and cadillac. Because it's located right next to the PT offices, Marshall and his staff can keep an eye on the dancers. "The gym is great," says Daugherty. "It makes it so much easier for dancers to include this training in their daily lives; they don't have to join another gym."
Although the field has certainly drawn from sports medicine, the lives of dancers differ drastically from athletes. "You can tape up a sprained ankle and send a football player back on the field, but you can't strap up a pointe shoe," says Daugherty. "Every ounce of a dancer's range of motion is so important."
Heading off a potential problem can reduce the likelihood of injury. To that end, Marshall and his medical team developed an evaluation screen tailored precisely to the requirements of ABT dancers. This is a way to pinpoint potential weaknesses or habits that could develop into injuries. "We can really get to know each dancer and give them the tools for prevention," says Marshall.
ABT's dancers benefit from the fact that Marshall and Daugherty are on site during rehearsals, performances and even on tour. "We get to know them and their habits and pat- terns," says Daugherty. A dancer can wander into their office when they feel something isn't quite right. "We can make an assessment right away. Catching an injury early can dramatically improve the outcome, preventing a more serious injury down the road," says Marshall. "We can start treatment immediately."
Dealing with an injury while on tour comes with another set of variables. Having a PT available on tour can make all the difference in recovery time. "There's a lot of dynamic elements to being on the road, dancers are away from friends, family and their usual rou- tine," says Marshall. "For some it may be their first time out of the U.S."
Communication is key to the success of the process. The staff works closely with Dr. Hamilton and Dr. Bauman. Keeping artistic staff informed is equally crucial. "They really listen to us," says Daugherty. Although injury may be a common occurrence, navigating the way back onto the stage can determine the success of any comeback. "Sometimes I have to play Dr. No," quips Daugherty, when it comes to making deci- sions on a safe return to the stage. Marshall and Daugherty's familiarity with the physical demands of ABT's repertory allows them to work closely with artistic staff to minimize setbacks and further injury.
Educating the next generation of dancers and educators ranks as a high priority. To that end, ABT created The Healthy Dancer: ABT Guidelines for Dancer Health, a national training curriculum. The easy to use guide covers everything from need-to-know anatomy to nutrition. Both Marshall and Daugherty use the guide in ABT's teacher trainings, and Daugherty explores the guide in more detail in her classes as part of New York University Masters in ABT Ballet Pedagogy. "Teachers are on the front line when it comes to dancers' health," says Daugherty. In converted dressing room at Sadler's Wells Opera House, Peter Marshall employs manual techniques to realign Maria Ricetto's sacroiliac joint.
Like ballet itself, dance medicine is not static and continually evolves based on the shifts in the art form itself. "It's hugely important to stay current with research," says Daugherty, who finds dancers a fascinating population to work with. As technique pushes forward into new directions of virtuosity, the anatomical knowledge needed to accomplish those new levels must move as well. "The art form is always changing," says Marshall. "The demands on dancers have increased dramatically. We are seeing utilization of more extreme ranges of motion. Competition continues to get stiffer. The challenge to us is to keep up." Marshall also notes that there's an impact to dancers as choreographers expand their vocabularies and push the boundaries of classical ballet.
Dance medicine has come far over the past two decades, yet there's more work to do, especially in research. Marshall and his team's work are directly impacting both the quality and duration of a dancer's career. "ABT's efforts are important and I am pleased to be part of it," he says. "Artists are dancing longer and healthier, and hopefully enjoying it more."
Nancy Wozny, an editor at Dance Magazine, is a scholar in residence at Jacob's Pillow Dance Festival