Despite intense hip pain, Annmaria Mazzini waited until leaving the the Paul Taylor Dance Company to have one hip replaced in 2011, followed by the other in 2016.
But, it turns out, a hip replacement no longer spells an automatic end to a dance career. While the surgery remains a last resort, new technologies work better and last longer, allowing dancers to continue performing for several years after getting a replacement.
Mazzini, for example, has continued to dance. She even performed a duet just three months after her second hip replacement, having rehearsed for four months prior on a deteriorating hip. "It was really a gift to have that dance to do right before and after the surgery, because I had something to compare," she says. "There were parts of the duet where my whole body used to tense up, and now to be able to do them so easily is just euphoric."
1. Will I Need A Hip Replacement?
Photo by Matthew Murphy for Pointe
Probably not, although the surgery is common among dancers. Those who end up needing one typically start off with some kind of abnormality of the joint, says Dr. Douglas Padgett, who's performed hip replacements on more than 100 dancers at Hospital for Special Surgery in New York City. "Very often the hip socket is somewhat shallow, which can lead to excessive load and wear."
2. Aren't Hip Replacements Only For Old People?
Angela Towler continued performing with Rambert Dance Company after getting a hip replacement in her 30s. Photo by Nick Guttridge
Not any more. Implants used to be made with a plastic that degraded over time, lasting only about 12 to 15 years. But the new gold standard lasts 30 or more years, making hip replacements a reasonable option for a younger age group, says Dr. Roy Davidovitch, a hip surgeon at New York University Langone Medical Center.
3. What Questions Should I Ask?
Ask your surgeon about dual mobility hip replacements, a recent advancement that potentially allows for greater range of motion and a lower dislocation rate after surgery. Also inquire about the anterior approach to surgery, in which the surgeon enters the hip from the front without cutting through the large muscles in the back of the hip. Davidovitch, who specializes in the anterior approach, says it can have particular benefits for dancers since dislocation after surgery is less likely, making large ranges of motion safer.
4. What Will Recovery Be Like?
Wendy Whelan in physical therapy after her hip surgery
You'll need physical therapy two to three times per week for about three months after surgery, and once per week for three more months after that. "Usually the leg has gotten stiff, so we look to free up the muscles to allow for the hip to have full range of motion," says Michelle Rodriguez, a physical therapist and founder of Manhattan Physio Group. "There's soft-tissue work, strengthening, conditioning and stabilization of the core." Ninety-five percent of recovery happens within the first 6 to 12 weeks, says Davidovitch. "But I tell my patients it's one year to full recovery because you have to recover from the residual injuries, the compensatory patterns that developed when you were in pain."
5. Will My Dancing Change?
Annmaria Mazzini. Photo by Darial Sneed
After three to six months, most dancers get back almost their full range of motion. Though Rodriguez cautions that dancers are likely to notice a reduction in their turnout. However, dancing on a hip replacement will not feel quite the same as dancing on a natural hip joint. Repetitive, high-impact movements—like lots of jumping—can wear down even the best hip implant. But after years of extreme pain, many dancers are happy to make these trades. "I have a freedom in my body that I didn't have a year ago," says Mazzini.
When it comes to food, dancers can be the pickiest. And for good reason! Dancers have to finely tune their diets to fuel their bodies.
But what happens when you're working overseas? Three American dancers who've joined companies abroad gave Dance Magazine a glimpse at how their eating habits have changed in their adopted countries.
Jon Bond at Nederlands Dans Theater: "These kids can cook!"
Rahi Rezvani, courtesy NDT (Jon Bond rehearsing Hofesh Shechter's Clowns)
Rehearsal day lunch: "At NDT, we only get a 45-minute lunch break. They have a canteen where you can order sandwiches, lasagna, salads and breakfast all day. But I sometimes sneak out for Thai food or KFC. "
Homesick for: "Can I get some In-N-Out, some Mercer Kitchen, some Popeyes, some real Mexican food, some Dominican food, tres leches, some Roscoe's chicken and waffles, Chipotle and some Levain Bakery, please?!"
Local delights: "Kaasbroodjes (baked cheese pastries) and dinner parties with my colleagues—these kids can cook!"
Chelsea Adomaitis at Paris Opéra Ballet: "Everyone has dessert with lunch"
Angela Sterling for Pointe
Allergies abroad: "I think the first words I learned in French were "je suis allergique à…" I know the types of foods here that tend to contain my allergens—soy, nuts, garlic, mustard—so I have a general idea of what to avoid."
Diet changes: "The salads here are very cool: different combinations of grains and fruits along with vegetables—quite different from what I'm used to. And the desserts! The selection is endless. And everyone has one with lunch. It's pretty amazing."
New food habit: "Judging the freshness of my baguette in hours rather than days."
Nicole Assaad at Hong Kong Ballet: "It can be tough being a Westerner in Asia"
Conrad Dy-Liacco, Courtesy HKB
Diet changes: "I eat much more sushi and Korean food now. I have kimchi with almost everything."
Culinary comparisons: "It can be tough being a Westerner in Asia. I have a very athletic, Hispanic build, which is great for normal life, but I am very aware of what I put into my body to keep an appropriate image for the dance world. Most of my Asian colleagues are naturally very thin. I've seen them eat noodles day and night, which for my body wouldn't work so well. Instead of comparing my diet to theirs, I focus on all the amazing and delicious foods I can enjoy."
Unexpected discovery: "I can find 'home' in food. There's an Argentinian place that reminds me of my dad's famous Venezuelan-style BBQs. Even Asian restaurants remind me of my mom's Chinese rice and spring rolls."
The minutes after curtain comes down can be the trickiest of a dancer's day: Despite your adrenaline high and the impulse to celebrate the night's achievements, you need to jumpstart your body's recovery so that you can take the stage again the very next day.
Smart dancers like Parisa Khobdeh follow a carefully calibrated routine during busy performance weeks, whether they're at home or on the road. The 14-year Paul Taylor Dance Company veteran shares her tried-and-true post-show rituals.
Photo by Francisco Graciano, via Instagram
Stretch: "While I'm still warm, I have a 10-minute routine with a friend in the company, where I actively stretch and she passively stretches me, then vice versa."
Ice: "I'll fill a bucket or trash can with ice, add water and stand in it for at least a minute. Bringing down any inflammation helps me feel better the next day."
Eat: "I eat my biggest meal of the day after the show. I always have protein and vegetables. I try to avoid sugary foods during show weeks, and that includes vegetables that are higher in sugars."
Hydrate: "I add electrolytes to refuel while I'm hydrating. I love coconut water. I also avoid alcohol when I'm performing."
Sleep: "I prefer eight hours a night, though that can be a luxury. To relax before bed, I read a book or meditate. I'll forfeit staying out late—I can save that for after the season."
Craving candy? Doubling down on dessert?
In sensible amounts, sweets can be tasty treats and can even provide a quick energy boost. According to well-designed research, athletes like dancers tend to metabolize sugar efficiently, so they can safely consume reasonable amounts as part of a healthy diet.
But if you fuel up on too many sweets, you risk being "overfed and undernourished," says certified dietitian nutritionist Heidi Skolnik. That's because sugar provides quickly digested calories (16 per teaspoon) and no other nutrients.
If your cravings feel out of control, here's how to tame them without feeling deprived.
1. Fuel Up
"When a dancer is overly craving sweets," says Skolnik, "it's usually because they're hungry." Satisfying meals that combine protein, carbohydrates and healthy fats—think turkey sandwich with a piece of fruit, or a stir-fry with chicken—will keep you satisfied and powered with steady energy.
2. Cheat 10 Percent
Skolnik swears by the "10 percent rule": If a dancer needs 2,500 calories per day, then roughly 250 of those calories can be "discretionary" and spent on a scoop of ice cream or a candy bar. "If the rest of your food is nutrient-rich," she says, "you're gonna do fine."
3. Eat More Breakfast
"The hormone neuropeptide Y is released when you undereat in the morning," Skolnik says. "It elevates over the day and makes you hungry at night—even if you eat a good dinner." Steady your hunger hormones with a satisfying breakfast, like eggs with potatoes, or oatmeal and fruit.
4. Consider Your Cravings
Do you go for crunchy toffee, gooey brownies or creamy frozen treats? Satisfy your texture preferences all day long with healthy substitutes. "If you like chewiness, try dried mangoes," says Peggy Otto Swistak, a registered dietitian nutritionist who consults with Pacific Northwest Ballet. For crunch, snack on lightly sweetened whole-grain cereal. "The fiber is there, too, which sweets typically don't have."
5. Watch Out for Added Sugars
Maple syrup, agave, honey and fruit-juice concentrate sound like healthy alternatives, "but they're just liquid sugar," says Swistak. "Biochemically, they're the same." Read labels to identify these added sugars, which count towards that discretionary 10 percent. By contrast, the naturally occurring sugars in whole foods like fruit or plain milk come "packaged" with fiber, protein and other nutrients that slow absorption, promote health and ensure sustained energy. They don't trigger cravings, and they don't count as sweets.
6. Don't Rely on Substitutes
A couple packets of Sweet'N Low in your coffee won't hurt you, says Swistak. But reconsider that daily six-pack of diet cola: "The newer thinking is that artificial sweeteners actually cause you to be hungry," she says. Adds Skolnik, "Why train yourself to like things super-sweet? Get used to having less, not more."
I feel torn about taking time off from dance to have a child. I'm married and my biological clock is ticking. I just don't know what age to take the leap for the health of the child.
—Would-Be Mother, San Francisco, CA
In addition to the baby's health, there's also your health to consider when contemplating motherhood. For example, the risks of high blood pressure, gestational diabetes and cesarean sections are higher for women who get pregnant after 35. Your baby's chance of having Down syndrome or another chromosomal disorder begins to rise significantly starting in your mid-30s, so your doctor may recommend prenatal screening. You can reduce chromosomal risks by freezing your eggs in your 20s or early 30s. Doing so could also help you avoid problems with fertility that develop with age. The timing is up to you, but it's easier to get back in shape for dance if you don't wait too long. For example, New York City Ballet principal dancer Ashley Bouder had a baby at 32 and returned to performing in less than five months.
Send your questions to Dr. Linda Hamilton at firstname.lastname@example.org.
Many dance companies and physical therapy offices are jumping in on a new trend: recovery boots. But what are they? And, more importantly, how can dancers benefit from them?
The Royal Ballet's Olivia Cowley in a pair of recovery boots
We asked Gregory Retter, clinical director at The Royal Ballet, which recently invested in its own set.
How do recovery boots work?
Through sequential compression; it's an idea that's been around awhile, but the boots make it accessible. They have four chambers—foot, calf, mid-thigh, upper thigh—that gradually fill up with pressure to help flush metabolic waste from the muscles. It's almost like squeezing a tube of toothpaste.
When should dancers use them?
Whenever you need to recover. They're particularly useful after a day of rehearsals before an evening performance to feel fresh again. We also use them to reduce any swelling from injury in the legs.
How long should dancers have them on?
20 to 45 minutes.
Is there anything dancers need to do while wearing them?
These boots are part of a whole recovery strategy. We encourage dancers to sip electrolyte-replacement fluids while lying back in a reclined position in the boots, and to zone out for some psychological recovery, too. We also encourage dancers to wear compression garments afterwards, to maintain the positive effects of compression while they're walking around.
Ballet students have always been subject to the strictest dress codes in the dance world. But with the rise of athleisure, some dancers are moving away from leotards and tights to sport a more casual studio look. Though the disappearance of formal dancewear may be welcome from a comfort point of view, does it have bigger implications for your technique?
Socks or Shoes?
Dawn Hillen, ballet teacher at the Ailey Extension and Steps on Broadway, generally puts function above form, though she notes that the two aren't always mutually exclusive: "When a student comes to class, the most important thing is that they be able to deliver the movement in the style that we're working on. Ballet is done in shoes for a reason—the shoes protect and support feet."
PC Liza Voll
Yuka Kawazu, who teaches at Ballet Arts in New York City, has a more relaxed attitude toward ballet slippers, but is still strict when it comes to safety: "I would never want any of my students to get injured during class, so I make sure students tuck their laces inside their shoes." Both teachers agree that socks should only be worn only occasionally and with a clear purpose: to examine the movement of the foot or decrease friction in a turn.
And as for bare feet, the decreased cushion on landings can make jumps dangerous, so always opt for shoes during centerwork.
Trading Tights for Pants
Modern alterations to legwear tend to focus on function: microfiber in tights allows dancers to move more freely, while spandex and other synthetic fiber warm-ups keep muscles from fatigue. But these materials have their downsides. Hillen notes: "If we're looking to create a ballet line, then baggy clothes hide the form and get in the way. Tights make a dancer feel pulled up, and ballet needs to be pulled up." Kawazu explains that many beginners don't appreciate the value of tights at first, but "after a few classes, students realize that they need tighter clothes for optimal movement."
American Ballet Theatre's Skylar Brandt layers patterned shorts onto a otherwise classic look. PC Quinn Wharton.
"Since ballet is a classical art form and we're creating a masterpiece," Hillen notes, "wearing shorts and bare feet takes us away from the idea of classical beauty. Mismatched outfits and messy dancewear—those used to be earned, once you were hired by a company." And of course, there are technical reasons for many of ballet's style rules: for example, ponytails can throw off dancers' spot during pirouettes.
Marjorie Feiring adds her own style to a functional, formal look. PC Quinn Wharton.
Last month, members of New York City Ballet teamed up with designer Cole Haan to create a comfy, yet stylish line of shoes that are wearable from the stage to the streets. Because in a career where you're almost constantly working on your feet, it's vital for dancers to have supportive and safe footwear, even when you're not in the studio.
To ensure your feet are always feeling performance-ready, we asked two podiatrists who've worked with dancers what to look for—and what to avoid—when shopping for new springtime kicks.
Make Sure It’s Wide Enough
According to Manhattan-based podiatrist Thomas Novella, dancers often have "wide-ball, narrow-heel" feet. Soles not manufactured widely enough at the ball will eventually stretch and produce pressure and discomfort under the borders of the foot.
Look For a Firm, But Flexible Sole
Look for a sole that's flexible at the ball of the foot, but firmer in the mid-shank. "A shoe which is too rigid will force the Achilles tendon to work overtime, and flexibility at the ball of the foot will reduce that stress," says Atlanta-based podiatrist Frank Sinkoe. Novella adds that this enhances a normal gait, protects the midfoot from strain and helps protect tired feet and ankles.
Try this test: If you grab the shoe with both hands at the ball and the heel, it should resist twisting (like the way you would wring out a towel).
Check The Inside
Before purchasing a new pair of kicks, put your hand inside the shoe and press into the sole at the ball. You don't want to feel bumps or irregularities.
Both doctors suggest investing in a removable insole—they can be customized more than the actual shoe to cater to your specific needs.
Replace heavily worn shoes "as often as you can afford," or at least annually, says Novella.
Shop At Night
Never try on new shoes at the beginning of the day, since your feet will be less swollen than usual. According to Novella, it's best to fit your shoes at the end of the day and maybe even after class, while your feet are at their largest, and always size up if you're unsure.
Avoid Sandals and High Heels
If you're prone to injury or are dealing with foot pain, it's smart to avoid high heels and sandals altogether. "When wearing a sandal, the toes will curl to keep the foot in contact with the shoe," Sinkoe says. "If you're having pain in the ball of the foot, this may increase stress to the area and worsen the pain." Novella warns that wearing high heels will lead to a greater chance of sprained ankles or metatarsal injuries, especially in dancers with prior injuries. "Too high of a heel can cause a heel bruise, yet a low heel can also lead to foot strain," he adds.