Your Body

September 30, 2009

Boston Ballet soloist John Lam was flying high, literally, when he busted his anterior cruciate ligament (ACL) while dancing the lead Russian in The Nut­cracker last December. “It was more trau­­matic psychologically than physically,” says Lam. “I was so looking forward to all that was on my plate at the time.”


An injury can wreak physical and emotional havoc on any dancer’s career. Patching yourself up, gulping some pain medicine, and running back onstage is rarely a smart choice for dance longevity. But neither is holing up on the couch watching reruns. Just how far away do you need to stay from what you love? Very few injuries require you to stop dancing completely. Most let you continue a range of activities that prevent you from losing too much ground, and actually can speed recovery. What you can do will be determined by your physician and your physical therapist. Once the acute trauma and inflammation have settled down, it’s time to evaluate what’s possible.

Keep Moving. 
Physical therapist Glenna Batson focuses on the “when” and “what” of movement. “Too much directly after an injury can be damaging,” says Batson, who teaches at the Hollins University/ADF MFA program. “But the really important question is the kind of movement. The general idea is to do RICE (rest, ice, compression, elevation) at least 24 hours after an acute injury, then keep movements within a small to medium range for a period of time, followed by strengthening/stretching and other conditioning regimes.”


Movement can aid the recovery process. It helps the blood circulate and stimulates the lymph system, which facilitates healing. “Atrophy can set in within 24 hours,” says Batson. “Movement is actually a healing agent for both physiological and psychological reasons.”


Lam had his ACL reconstructed within a few weeks of injury, and spent the next six months in a rigorous post-surgical protocol that included aqua therapy, massage, and intense strength training. “My knee was hooked up to a Continuous Passive Motion machine hours after surgery to prevent scar tissue,” recalls Lam. “I was never not moving.”


Improve Other Areas.
  According to Marika Molnar, PT, president of New York’s Westside Dance Physical Therapy, there is almost always work you can do. “You can address those core stabilization issues that you never had time for,” says Molnar, who has been heading up PT services at New York City Ballet for 29 years. “I have seen dancers return from injury with a stronger and more flexible core.” Batson encourages many forms of movement in the rehab process, but cautions about their limitations. “Floor barre is good for internal strengthening and re-aligning but does not necessarily translate into dynamic movement across space,” says Batson. “Dance movements are very context/task specific.”    


Returning to class is different from  swimming or other non–weight-bearing exercises. If your doctor says you can return, good communication between the artistic and the medical staff is essential. Lam credits Boston Ballet artistic director Mikko Nissinen’s support in his recovery. “When a dancer gets injured it’s so easy just to say ‘Next,’ ” quips Lam. “Mikko stood by me the whole road back.”


Lam started to dance again this past summer under the guidance of his former teacher and mentor Sergiu Stefanschi at Canada’s National Ballet School. He worked one on one and took senior boys’ class every day for six weeks. “The first day back was disappointing,” says Lam. “In my mind I was all there, but my body wasn’t. I have a new knee now and I have to learn how to dance with it.”


The location of the injury is a major factor in how soon you can return to class. “If you have a strained back you can take a modified class, but ‘modified’ is the key word here. You need to avoid bending and arching and keep your legs below 45 degrees,” says Molnar. “I give each dancer a personalized menu, including time limits.” She tracks their progress in class so they can measure improvement, which is fundamental to a dancer’s mental health. “When you’re back in your environment you will feel like you are progressing faster,” she says. Although she warns that “sometimes when a dancer gets back into class they forget they have a problem and try to keep up.”


Use Your Mind. 
There will be injuries where class and other activities are off-limits due to restricted weight-bearing. That can be necessary for most fractures, after certain surgeries, moderate to severe sprains, and blood-infused strains. If the severity of the injury means you can’t keep moving, all is not lost. “Isometrics, visualization, and electric stimulation can be used,” says Batson. “Slow, meditative work like Feldenkrais or Alexander Technique also work well. When you imagine movement, the exact same parts of the brain are activated as wehn you actually perform the movements.”


Gradually, Lam regained his mobility to near full capacity and will dance in Balanchine’s Four Temperaments this season. Although he appreciates all the steps he’s taken, Lam believes he might need to be really dancing to complete his recovery. “It was in class that I could let go of all that I had been through and really listen to the music and let it breathe through the movement,” he remembers. “My body is cooperating now.”



Nancy Wozny writes about the arts and health from Houston.


Photo: Nathan Sayers.