Ballet Dancers Get Racked Up About as Often as the Rams or Raiders

Tracy-Kai Maier felt an annoying twinge in her hip while rehearsing one of the more difficult moves in a modern ballet piece.

Like most athletes, Maier at first denied that she had a serious injury. Instead she continued to dance and the injury became more and more debilitating. The 27-year-old prima ballerina with the San Francisco Ballet had unfortunately entered the dark side of her profession. A place where pain replaces beauty, grace and elegance.

“I kicked my leg up and there was a pinch,” Maier said. “Every day after that it got weaker and weaker until I lost all strength in it.”

Maier had ripped part of a tendon in her hip joint during a movement that requires the dancer to turn her entire leg inward and kick it up in back of her. “The leg just isn’t supposed to do that normally,” she explained.

Pyriformis syndrome, as the hip injury is called, is common among ballet dancers, who constantly push their hip joints farther than nature intended they be pushed.

Each year, ballet dancers suffer debilitating joint injuries at a rate that is rather shocking to those outside the dance world.

“The injury rate with professional dancers depends on age and longevity,” said Dr. Jean Rosenbaum, director of the American Aerobics Assn. “The younger a dancer starts, the more injury prone they are because the joints have not yet fully formed. The older dancers, because of their longevity, are also more prone to injuries. The injury rate as a whole is very high--more than 80%.”

Rosenbaum’s studies define an injury as any incident that keeps a person from dancing.

Sports Medicine Pioneer

Dr. James Garrick, one of the nation’s pioneers in sports medicine and the director of St. Francis Hospital’s revolutionary DanceMedicine Clinic, says the injury rate for dancers is similiar to professional football.

“There were just slightly more injuries in the (San Francisco Ballet’s) company in the course of last year that required time out than there are people in the company,” Garrick said. “That injury rate is about what it is in professional football.”

A recent study of 85 ballerinas over a three-year period revealed that 72 of the study group suffered 268 injuries collectively. Knee injuries accounted for 7% of the total, but when it came to career-ending injuries, knee injuries accounted for 56%. Treatment of the 268 injuries cost the ballet companies involved $363,000.

While most football injuries are related to contact, ballerinas usually become injured because of technique and turnout problems, resulting in stress fractures, tendonitis, bursitis and other slowly developing “overuse injuries.”

Maier is rather typical of all dancers. She started dancing at age 6 as a child in Sacramento, has had sprained ankles, lower back problems, tendonitis in her feet and ankles, and various other injuries in her feet and legs.

She spends hours on damage control, applying ice, ultrasound and friction massage to the injured areas of her body. She also takes preventive steps and does exercises to keep from getting injured.

Maier says she has been lucky during her eight years with the San Francisco company and has only had to stop dancing once, in her first season, before she learned how to keep from getting seriously injured.

Garrick began concentrating on the treatment of sports injuries while at the University of Washington in the early 1970s. He later moved to San Francisco and started one of the country’s leading sports medicine centers at St. Francis Hospital, where he has treated Joe Montana, Brian Boitano, Billie Jean King and others.

In the early 1980s, after seeing a steady stream of aerobic dancers coming to his clinic for treatment, he opened the nation’s first dance medicine department along with an associate, Patrice Whiteside.

Over the last few years, his DanceMedicine clinic has become a focal point for injured ballerinas. Dancers such as Natalia Makarova and several company members from the Bolshoi Ballet have been among those treated.

Garrick and other specialists at the clinic see about 2,500 patients a month for injury diagnoses, treatment, preventive measures and surgeries. Their aim is to get athletes back on the field, in the gym or on the stage as soon as possible.

The dance medicine portion of the clinic features rooms for diagnosis, an evaluation area similar to a dancer’s studio and several rooms for treating various injuries.

“Dancers have been all but ignored except for certain areas of the country,” Garrick said.

“Everybody in sports medicine wants to take care of football players, but the truth is that there are more little girls taking dance lessons than there are little boys playing football,” he said.

When a dancer comes to Garrick with an injury, he asks him or her to reproduce the movements that cause them pain in a diagnosis area of the clinic that is equipped with a mirror and a wooden bar.

Routine Observed

At the bar, Garrick watches the dancer go through his or her routine, while asking questions about the specific causes of pain.

But he doesn’t ask, “Where does it hurt?” He asks what specific ballet movement causes the most pain: “when you do a rond de jambe, pas de chat or sous-sous? “

Once the diagnosis is made, Garrick and his team then pattern a rehabilitation program designed to get the dancer back to work as quickly as possible.

Whiteside, always outfitted in dance wear, oversees a room full of rehabilitation equipment that looks like medieval torture devices. The machines allow dancers to strengthen weak muscles or keep uninjured muscles in shape while the dancer is sidelined, by encouraging movement that replicates ballet movements precisely.

“It’s a complete approach to rehabilitation,” Whiteside said. “Elite dancers are so good at cheating around injury you have to get to know their body.”

Serious dancers usually begin their careers before the age of 10, spending about three hours a week at the barre and in front of the mirror. At this earliest stage of dancing, injuries are mostly “growing children things,” such as sore joints and toes, Garrick said.

The more critical stage in ballet occurs at age 11 or 12, when most children become weeded out because they have the wrong build or are not serious enough.

“If you have certain kinds of hips, you’re not going to be a ballet dancer,” Garrick said. “You start to see real ballet-type injuries at age 11 or 12,” he said.

‘Turnout Problems’

Young ballerinas become injured most often because of “turnout problems,” which occur because they attempt to turn their toes out, in Charlie Chaplin-type fashion, farther than their hips will turn out in their hip sockets, Garrick said. A well-turned-out leg is a basic element to the graceful movement and appearance of the dancer.

But young dancers, in their enthusiasm to make the all-important cut, sometimes push their legs too far or try to “cheat” by turning their toes out farther than their hips will allow, causing hip muscle strains and knee injuries.

The largest number of injuries occur between the ages of 13 and 18 when the intensity of training “increases tenfold,” with dancers spending more than 20 hours a week in the studio, Garrick said.

During these “pre-professional” years, female dancers learn to dance on their toes in pointe shoes, causing foot soreness and problems such as bunions and tendonitis, and both male and female dancers learn to dance as partners, leaving many dancers with back problems and muscle strains.

But the most commom injuries among pre-professionals are similar to those among professional dancers, mostly 19 to 25, Garrick said. They are foot and toe stress fractures and tendonitis, injuries that develop slowly often because of problems of technique and choreography.

Garrick and rehabilitation specialists often work with dancers to pinpoint technique problems and help them to change their movements to prevent recurrence of injuries caused by faulty technique.

In other cases, the choreography of a certain performance can cause a dancer to become injured, as when the San Francisco Ballet performed a ballet called “Papillon,” French for butterfly, in 1986.

“Dancers had to wear wings so that they would look like butterflies,” Garrick said. “In order to look like proper butterflies they had to arch their backs, so during the weeks they performed Papillon, everyone had back pain,” he said.