Dance Physiotherapy is 'En Pointe'
- Dave Fahey
- Jul 5, 2018
- 4 min read
Over the past four weeks, I’ve been completing my La Trobe University Sports Masters placement at The Australian Ballet with the fantastic Sue Mayes and her team. Why’s that!?...I hear you footy and soccer heads ask… Well, my interest in the Ballet all started when a little Ballerina walked into my treatment room with posterior and lateral ankle pain.
I had never felt more like a fish out of water since my first few weeks of work. It seemed she was dealing with posterior impingement, but my 'go to management' was a tape blocking plantarflexion. Well there’s two problems with that!
Ballet Dancers hate tape on the bottom of their feet, it impacts on their proprioception
Ballet dancers need their plantarflexion to dance… Uh Oh!
I fumbled my way through an initial assessment, and put out an emergency tweet to Sue. I had seen her present at the SMA conference in 2015, and knew she was the Physiotherapist for The Australian Ballet (TAB), with a particular interest in the foot and ankle.
I expected a short reply tweet with some advice, but I got a whole lot more than that. Long story short, Sue invited my little Ballerina and I to the Australian Ballet, and assessed and treated her for an hour… ON A SATURDAY! I was so grateful for her help, but also realised I needed more than an hour with Sue if I was going to get my head around the 26 bones and 33 joints in the foot!!!
Throughout my four-week crash course placement in dance and performance physio and medicine, I have learnt and been taught so much, but who reads anything but the subheadings in 2018, so I’ll keep it short and sharp:
1. Evidence based practice can exist in sport, if you want it to!
Sport gets a pretty bad wrap for being the arena of the ‘gurus’ with clinical ‘art’ and tokenistic placebo sprooked in the media. This is not the case at TAB. Almost every management plan in place was backed by evidence, and evidence from the past 3-5 years. Yes at times it was extrapolated and applied to different populations or regions, but it served as a framework for clinical reasoning, and it works!
2. Knowing the language of your sport is important, but asking questions builds rapport
The first time I saw a ‘Releve’ was in ‘class’ on my first day, and I certainly couldn’t pick it from an ‘arabesque’… but it didn’t matter. I asked questions and learnt throughout the month. Just like showing a friend from overseas around your city, the dancers were happy to, and I think even enjoyed, teaching a dance rookie all the lingo. It was also a great way to get to know the dancers and earn their trust. Word of advice...If you don’t know about a sport your working in, don’t pretend… ASK!
3. The foot and ankle is complicated, but gets oversimplified in team sport.
Before I went to TAB, an ankle roll was an ankle roll, it needed some tape and progressive loading. I’m not saying I didn’t clinically reason, but one can only clinically reason within the realm of their knowledge. Taking the time to learn the anatomy, mechanics and pathologies of the talocrural joint, subtalar joint the joints of the midfoot and forefoot really opens your world up to what needs to be assessed, managed or at least considered.
4. Chronic Loading needs to be prioritised over ‘fresh legs’
The amount of work the dancers do each day is mind-blowing! An hour of morning exercises, 90 mins of ‘class’ (think skills session for dancers), more strength work/rehearsal in the afternoon, and a performance that night (of a different ballet to the rehearsal… confusing).
Why don’t they break? They do it day in day out, and kind of have since they were 5 years old. The issues come with breaks, holidays and lighter weeks. Sue and her team aim to keep the dancers’ workload as consistent as possible, and ensuring any increase or decrease in load is done progressively. Their low injury rate speaks for itself. The great thing is that it is ingrained into the culture, and the dancers understand the need for continued consistent work! I have found this less so in team sports.
5. Physios need to collaborate across sports as often as possible!
I was lucky enough to witness ballet and footy collide at the North Melbourne Football Club (NMFC). Sue consults for NMFC, mainly on hip and ankle/foot injuries, and seeing Ben Jacobs and Sam Wright on Etihad stadium shows you the translation must be effective! I think physios, S&C staff and medical teams are often too possessive of players, and wary of seeking external opinion through fear of showing inadequacy or breaching confidentiality. However, the sharing and collaborative culture Matt (head physio), NMFC and Sue at TAB create just makes so much sense. We all have different clinical strengths and weaknesses; we all want to see the best athletes doing their thing. Let’s share ideas and provide the best support to the superstars as possible.
6. Dancers are some of the best athletes to work
Imagine the perfect patient…
Highly motivated
Incredible coordination,
Excellent mobility,
High quality bodyweight strength
Ridiculous body awareness
Approachable with no ego
… you just described a ballet dancer.
Working in the gym or the treatment room with a dancer is so much fun, because they are so good at picking up cues and corrections, they do it all day every day! Never have I seen adjustments to exercises with such precision, it gives physiotherapy every chance to be effective!
I said it was going to be short, but I just had so much fun, and learnt so much. For those working in sport, I would encourage you to seek placements, work experience or even just network, with professionals outside your sport. You could be missing that clinical gem you need, that’s common knowledge in that other world!
Check out the ‘Ballet Anatomy’ videos created by Apiary for the TAB. They clearly and beautifully illustrate the intimate relationship the dancers have with their bodies.
Ballet Anatomy: Muscles
https://australianballet.com.au/tv/ballet-anatomy-muscles
Ballet Anatomy: Feet
https://australianballet.com.au/tv/ballet-anatomy-feet
Ballet Anatomy: Hands
https://australianballet.com.au/tv/ballet-anatomy-hands
Ballet Anatomy: Eyes
https://australianballet.com.au/tv/ballet-anatomy-eyes
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