In 2015, David Hallberg, the internationally lauded American classical ballet dancer, was in desperate straits. He was suffering an ankle injury that, after much futile treatment including two operations, was still “a swollen red ball” (his words). As he recounts in his recent autobiography, Body of Work, he had two options: either retire, or take his chances and seek treatment with the medical team at The Australian Ballet. He chose the latter. “Everything in New York became a far-off memory,” he writes. “I had flown to the bottom of the world. Now I was in it for the long haul. This was the last-ditch effort.”
He was not wrong. It was seven months before he could jump without using the barre, and two-and-a-half years before he could consider himself fully recovered. That’s a long time in dancer years. But he did recover, where before such an option had seemed hopeless. His gratitude The Australian Ballet has been naked and public. He even distributed leaflets to the audience at his Australian comeback performances, saying: “The Australian Ballet in its entirety has brought me to this moment I share with you tonight. . .. I am so deeply grateful to David McAllister and the team I have worked so intimately and extensively with . . . They have not only nurtured me back to health physically but in true Aussie form, they have opened their hearts and, through their generosity, given me an artistic rebirth. . . ..”
The AB medical team to which he owes his rebirth consists of a multidisciplinary group of experts. Principal physiotherapist Sue Mayes recently gained her PhD in research at LaTrobe University (and is currently researching ankle and hip-joint injuries in professional ballet dancers as part of the partnership between The Australian Ballet and La Trobe University). She is joined by body conditioning specialist Paula Baird, ballet mistress and rehabilitation specialist Megan Connelly, strength and conditioning instructor Sakis Michelis (all former dancers themselves) as well as other physiotherapists, myotherapists, a sports and exercise physician and a general practitioner.
In addition to the in-house team, the company employs externally a consultant psychologist, podiatrist, dietitian and surgeon. Together they pool their expertise to create a co-ordinated dream-team of medical miracle makers.
It hasn’t always been thus. Until the introduction of an in-house medical team, the dancers had to seek treatment outside the company. Injuries were rife. The combination of the AB’s busy schedule (one of the world’s busiest), touring obligations and the increasing athleticism of contemporary classical choreography was playing havoc with the dancers’ bodies. The injury rate was obviously bad for morale and bad for performance standards. Furthermore, the company’s WorkCover premiums were soaring. In response, the company appointed a sports and exercise physician, (the late) Ken Crichton, as medical director, in 1994. This in itself was an acknowledgement that medical expertise from the sports world could be helpful to dancers. Mayes was appointed as the company’s first full-time, in-house physio in 1997. A second followed in 2002. As the pool of expertise grew, the approach to the prevention of injury and rehabilitation became increasingly sophisticated and effective. With the company’s resources properly dedicated to their dancers’ health and welfare, the rate of injuries began to decrease.
Today, dancers no longer just “swing a leg” to get warm or throw on a pair of legwarmers to “stay warm” after a show. Instead, the team has adapted and implemented many high-level sports’ practices to the dancers’ warm-up and cool-down regime. Dancers will immerse their bodies in ice after strenuous performances and use hot and cold spas for recovery. Weight and resistance training is used as preventative and rehabilitative exercise, for both men and women. Pilates also plays a big role, as well as myriad exercises devised by the team’s combined brain power. This year, a huge new medical facility is being constructed at The Australian Ballet’s headquarters in Melbourne, with a consulting room and gym and work-out areas.
Another important development has been the analysis of repertoire. At the start of each year, members of the medical team view video footage of the forthcoming choreography, noting the particular stresses and strains of the technique. They then devise a program of exercises to help prepare and support the dancers’ bodies through the movements.
Other areas of focus have been a slow progression into workload following breaks or injury recovery and the encouragement of injured dancers to include a psychologist in their treatment. Very important is an open door policy, so dancers feel free to consult about even minor complaints. According to Mayes, in the past dancers tended to hide or disguised pain or minor injuries in case they would lose out on performance opportunities. “They had a tendency to gobble anti-inflammatories,” Mayes says. Now they are encouraged to declare their niggles straight away. “If you catch injuries early, and then very gradually get them back into training, they may not miss out on very much.”
As a result, the turn-around in injuries has been “phenomenal”.
“We’ve had no hip arthroscopies for 12 years now, where we used to do a couple a year,” Mayes says. “[In comparison] the number of arthroscopies throughout the world has escalated. Not one dancer has injured the hip and been unable to perform for six years.
“As far as ankle surgery goes, we've only had four in 14 years. Again, these used to be very common -- you'd have two or three a year, easily.
“We’ve also had a dramatic decline in the stress fracture rate. We've had one second metatarsal stress fracture since 2002. Currently all bone injuries are very low.
“The rate of ankle sprain is similar [to the past], but they’re minor compared to previous injuries. Our calf tears have also reduced significantly since we introduced the calf rise endurance into class.” [See box.]
Such is the Medical Team’s success, major sport organisations and Olympic athletes are turning to it for help. Collingwood AFL footballer Ben Reid is one of them. He turned to Paula Baird following desperate attempts to fix an injured calf (that included actovegin (calf blood) injection program and shock treatment in Berlin) and was impressed at what he saw. “I remember watching these girls who weighed about 40 kilos and I’m closer to 100kg and they were making me look like a weakling, really,” Reid is quoted as saying in the Herald Sun.
“I would be doing some of the same exercises, and I’d be shaking. It was all about holding certain positions for extended periods of time to get stronger.
“They were in there for eight hours a day, working on their body, it was phenomenal. I really looked up to them.
“And Paula has been (pauses), well, the stuff I’m doing now I don’t think I would be doing if it wasn’t for her.”
Similarly, North Melbourne AFL footballers Sam Wright and Ben Jacobs turned to the company for help after having been off the field last year with potentially career-ending foot injuries. “They are now back in training”, Mayes says, and hopeful of returning to action this year.
Cricket Australia is another sport that is benefitting from the AB’s program, and is presently collaborating with the Australian Ballet on ankle injury research. “They know that that's our forte and that we’ve had great success,” Mayes says.
For David Hallberg, the treatment began with one-on-one daily sessions (three hours in the morning; two in the afternoon). Baird-Colt began the process with Hallberg, supervising a program of meticulously designed and targeted exercises that, he writes, seemed to have nothing to do with ballet. Megan Connelly was instrumental in correcting his ballet technique and gradually building him to performing at full strength.
One of the main strengthening exercises he was prescribed was “walking up and down a stairwell on a half demi-pointe” to the beat of a metronome, beginning with just 12, and slowly increasing the number and speed over many months.
“The team’s initial and overreaching goal was to give me the education I needed to be able to troubleshoot any physical hiccup myself,” he writes. “I had no prior education in this regard. Like many dancers in New York, I had always expected to have someone else fix me. . .. This ‘fix me’ mentality also led to surgery. Americans view surgery as the fix … In Melbourne, the team’s philosophy was that surgery was practically never an option (they’d signed off on only five ankle surgeries in 13 years).”
“We support them to become the masters of their own bodies,” says Mayes. “We give them the tools. We don't want them to be dependent on the physio team.”
Hallberg returned the stage in 2015 in Sydney as Franz in Coppelia. “His naturalness and ease, along with his musicality, made the heart sing,” wrote critic (Deborah Jones. So far his ankle is holding – he recently made his debut with the Royal Ballet in Giselle in March and is listed for a full schedule at his home company this year.
It would have been a tragedy if a talent as rare as Hallberg’s had ended before its proper time. He is a very public example of how fragile a dancer’s career can be; how easily brought to a premature end by a wrong twist or move, a misalignment or fatigue. At The Australian Ballet there is a team working behind the scenes to ensure such devastating endings are no longer commonplace, and are instead becoming as rare as great talent.
- KAREN VAN ULZEN
This article was first published in the April/May 2018 issue of Dance Australia.
Pictured above is principal physio Sue Mayes. Photo: Kate Longley.