How does a doctor guide a patient safely back from an injury? A doctor must apply objective and subjective sensibility towards the continuous monitoring of tissue healing. Additionally, after meticulous history taking and physical exam, the doctor must be in charge of identification and remediation of causative factors. To optimize injury healing, I find myself guiding each patient down what I term the “healing tightrope”. Please bear with me as I try to explain how I have grown into this.
I have seen many different types of injuries, infrequently alone but usually in combination, in varying degrees of severity, over the past 45 years. I am fortunate to have been trusted by professional dancers to return them to dance safely for the duration of my career. For not only the dancer, but for all patients, the return can obviously not be any sooner than the recovery would allow, lest injury return. But critically, in the case of a dancer, the return also cannot be any later than the recovery should allow, lest they lose work, prestige, and unnecessarily prolong the re-adaptation of their soma to the high-level challenge that is their art form. It is my savvy from the back end of this statement which I have been able to apply not only to my dancer patients, but to every patient, e.g., the lifelong runner who feels she is betraying that same runner because of her injury; the passionate amateur-highly-competitive platform tennis player; the spirited and understandably impatient lifelong-athletic 82 year old with bilateral foot stress fractures and osteoporosis who loves to walk; the type 1 diabetic who must resume activity to maintain a safe and sustaining metabolism; the 44 year old father of 3 whose dad died at his age of heart disease who is trying to stay fit to maintain cardiovascular health; the grandmother whose responsibility is to walk little Amari home from school; and the most common one of all, the everyday human being who just wants to get rid of whatever-injury as soon as is safely possible.
Professional dancers begin their training as early as 3 years old, and continue at ever-increasing high levels of activity until they acquire membership in a ballet company as an apprentice at 16-18 years old. During the typically 100,000+ hours of dancing in a career, a dancer will develop and must maintain strength, flexibility, activity-specific bone density, superb balance sense, musical skills with exquisite body timing, partnering and ensemble performance skills, speed with precision, a social interaction and hierarchical station within the company, resilience to minor injury and an intuitive body sense of what may be more serious, and an awareness of equilibrium changes that might signal a more serious injury.
And at times during their career, the lucky ones will experience those fleeting yet eternal moments on stage when they sense that everything they are doing is perfect, which many dancers say is the greatest feeling they will ever have in their life.1
During their time as professional dancers, they will acquire injuries, learn new roles, try to fix what can be fixed, but invariably dance through injury. If they have knowledge of a role and a dancer assigned to that role is more injured than they, they are called upon, even if they are injured, to perform that role if they can. I have often had both the assignee and the replacement in my office on the same day, trying to work with both. That’s the way it is.
These are my collaborators who will question me if they can do certain elements of class as they go through their healing processes. I will give them assignments until their next visit. They will report and refine the results. We will gradually add challenge as time proceeds. They are excellent at following instructions, and excellent at offering suggestions that help me give the instructions. All fine-tuned to the individual’s case and status. Doing this on average 22 times per week for over four decades has surely honed my skill set.
The COVID lockdown bisected this continuum, yielding a sinister advantage to dancers, a new pandemic if you will, and one no less unique to our times. During the 18 months or so of not performing, and more importantly not having to substitute, many of these individuals had the opportunity to rest, treat and completely shed injuries they’d been carrying from season to season. On March 12, 2020 New York theatres shut down, and a few days later dance studios also closed their doors. Then between March 22 and July 17, 2021, dance studios in NYC began to trickle open. On September 15, theatres were back in business and dancers joyously returned to stage to exhibit their artistry. But the superhuman display we go to theatre to witness was being executed by minimally rehearsed soldiers, depleted of the theretofore incomprehensible physical adaptation they’d acquired through years and years of continuous dancing.
So what happened? They got injured. Quickly. Both physically and even more devastatingly, spiritually, as the excitement of return was crushed by disappointment. Those were sad days for all. Some of the older (>30 y.o.!) dancers quit, for them it was just “their time”. Unfortunately for others it was because their bodies just couldn’t reacquire the gestalt for the challenging roles that their status in the company had earned. And then those who could adapt jumped in. That’s the way it is.
And now, finally, our denouement. Many of these instant injuries were new to the individual. They were neophyte injuries, ones you would never expect to see in an experienced dancer. They were injuries you would see in a student dancer in their first few months of class, not the chronic ones these pros had carried from season to season. Why? Because the pros had lost strength in muscles specific for their choreography, and other muscles had to over work and got injured. Because their bones could not sustain the impact of repeated high leaps, or repeated jamming the bones in the backs of their ankles en pointe, and they got stress fractures simply from dancing en pointe. Or their ligaments weakened, as did their sense of balance, and they got sprains. Or their feet expanded during the lockdown, their pointe shoe “makers” retired due to lack of work, and they developed ulcers between their toes from ill-fitting pointe shoes, some ulcers infected with MRSA, and some developed stress fractures from ill-fitting pointe shoes as well. And so on.
It's taken two years after theatre reopening for the onslaught of this post-lockdown syndrome to be nearly over, but for my patients, my colleagues and myself, a little flower has appeared through the ashes. The flower is a remonstration of the published data that tissues heal better, and stay stronger, if they are allowed to just enough metered-out progressive challenge, even if they are in the throes of injury.
This is what I call the "healing tightrope", which I have learned to adjust for each patient in my practice, per my objective and subjective sensibilities.
For this facility, on behalf of my patients and myself, I profoundly thank every one of the 48,600-and-counting dancers who’s trusted my counsel.
1 Larsen, Gavin. "The Highest Note." Being a Ballerina, University Press of Florida, 194.