How they healed: five dancers on coming back from injury.

Injuries are the bane of a dancer's existence. They are an occupational hazard, and in a long career, virtually every dancer will sustain an injury that threatens to keep them off the stage. With today's finer diagnostic techniques, medical specialists, physical therapists, and alternative techniques, there's a growing body of knowledge available to help an ailing dancer. DANCE MAGAZINE spoke to five dancers about their injuries, their options, and their eventual recoveries.

Injuries have a life of their own. Often they don't announce themselves in a lightening bolt of red-hot pain but rather in an annoying, almost undefinable sense that something isn't quite right. The case of Marissa Comer of Festival Ballet Providence is indeed a cautionary tale. It was December of 2004 when she felt a pain in her shin. "It's Nutcracker, you're going 30 miles an hour, performing five or six roles, and you just sort of forget about your body," Gomer says. "I knew I was having this pain, but I didn't feel it was enough to prevent me from doing anything, and I kept pushing back the doctor's appointment that I had made."

Gomer avoided confronting her situation for two months until she finally had "a huge bump in the middle of my shin." After a day of bone scans, her doctor, Lyle Micheli, director of the division of sports medicine at Boston Children's Hospital, wouldn't let her leave his office without a cast and crutches. She had a severe stress fracture to the front of the tibia. She wore a plaster cast for six weeks, with crutches, then an air cast boot for another three months, then a second air cast that allowed her to put a little more pressure on her leg. For 10 hours a day, she used a bone stimulator, an electronic device that stimulates growth in a specific area. Finally she was able to start rehabbing. She was out for six months.

The fact that Comer danced on her injury for two months without medical attention worsened her situation. Now, with Dr. Micheli monitoring her, Comer works to evaluate "good pain, bad pain, weakness. It's really hard to know when to back off."

For a young woman of 24, Gomer encountered a surprising problem, diagnosed through a bone density test. "My bones are certainly weak. I didn't know that dancers were supposed to be taking at least 1500 milligrams of calcium a day and a vitamin D supplement. I thought that taking my multivitamin or Caltrate was sufficient."

KT Nelson, co-artistic director of ODC Dance/San Francisco, suffered essentially the same injury, but in the early 1980s. The answer for her then was a European technique. "They decided that when you get into a chronic [situation], the body responds faster to traumatic [injury], so they re-broke my leg." She also notes that at that time, dancers weren't considered athletes. So the treatment plan did not include keeping the rest of the body toned or addressing the imbalance that may have created the injury in the first place. "As a result," she says, "you often got re-injured on the way back." A year of Pilates, hardly commonplace at the time, saved her. "With Pilates, you can keep the body active through the healing process, trying to strengthen and even the body out."

During her dancing career, Nelson, now a choreographer, also had a bulging disc in the lower back with attendant nerve damage. Her philosophy has come to be: "Western medicine for addressing the problem and diagnosing it, Eastern or alternative for healing or long-term health." Not coincidentally, ODC's doctor, orthopedist Richard Coughlin, who's worked with the Oakland A's and the Warriors, is starting an injury prevention clinic at ODC's new building (see "Dance Matters," October 2005), with free access for dancers. On staff, too, are an acupuncturist, a body worker, and a Pilates instructor.

But it's Dr. Coughlin to whom Nelson turns to first. "He is gifted as a diagnostician," she says. "There is nothing so incredibly useful as having the bottom line. Rick is the one I go to, and then I fan out." She is emphatic. "Keep an open palm for the possibilities of healing. Your body will heal so that you cannot feel [the injury] ever again."

For Jamy Meek of Hubbard Street Dance Chicago, his was an injury to the knee, the part of the body that some dancers refer to as "nature's mistake."

"I was in rehearsal at the end of a day. My knee just felt funny, like it was tired," he says. "I didn't have any idea that something was wrong. I got home that evening, sat down to watch TV and have some dinner, and went to stand up and couldn't. My knee was swollen. I took ibuprofen, iced it, went to bed and woke up, and it was worse." Meek went on tour the next morning but could manage only one duet in a series of performances. "I could barely maneuver through class, much less do choreography." From the road he put in a frantic call to Dr. Jeffrey Sawyer at Chicago's Rush Presbyterian St. Luke's Medical Center. When Meek returned, an MRI confirmed a tear of the meniscus.

Meek was 33; there were options. "The doctor suggested that if I just wanted to dance for another year," he says, "we could do pain management. But I wasn't ready to retire. I opted to have it cleaned up so I can continue going for many more years, hopefully." Three months after surgery, Meek returned to the company full-time. For Meek, there was a genetic component. Both his father and grandfather had suffered the same injury. "It was probably going to happen at some point but it [likely] happened faster because I'm so active."

Diagnosis isn't always swift. Gavin Larsen, of Oregon Ballet Theater, did a pirouette combination in class one spring day and seconds later couldn't do a demi-plie. It seemed initially as if she'd simply pulled a muscle or strained a tendon. "There were a lot of pain killers, serious therapy, and a three-month layoff." But, she says, it would still flare a few days after she began to dance again.

Six months later, an MRI revealed a tear in the posterior tibialis tendon of the left ankle, a tendon injury so unusual that most specialists see it only once in a career. By that time, Larsen had two tears, and surgery trimmed both areas of the tendon. She had a hard cast, a walking boot, and a month of crutches. Even wearing normal shoes "felt like a milestone." Two weeks after surgery she eased into physical therapy and gentle soft tissue work with physical therapist Patricia Koehler. Three months after surgery, she started doing barre on the back of a chair in her living room, and at four months went back to a real barre. Five months out from surgery she was in rehearsal.

Her situation was "murky," she says, because "apparently to tear the posterior tibialis is extremely difficult to do and very rare." However, she retained a persistent sense that something was amiss. She stresses, "It's important to be insistent and vocal with your doctor."

Alan Good was 35 and dancing with the Merce Cunningham Dance Company when he came down with a septic ankle, an infection (staphylococcus aurea) that required surgery and hospitalized him for two weeks, followed by intense physical therapy. Good worked with physical therapist Michael Fox of Sports Therapy and Rehabilitation in Manhattan, among others. Good says that Fox "had this almost game-like joy about the putting together of two heads--the patient and the therapist--to try things out. He had a glint in his eye and a smile on his face, and he listened well."

He returned to the company after about three months (see sidebar). "Each class was a gauge of what I could do, what I felt afraid of doing, what provoked new pain, and what produced an old pain that itself was waning. As the weeks progress the pain gets less and less and you advance yourself carefully through the class."

As Gavin Larsen puts it, "Dancers should not always see an injury as a negative thing. Every time I have to deal with something new, I learn not only about my body but about myself as a person and a dancer. The paradox is that you can often come back from an injury a smarter dancer, and a better one."

Amanda Smith, a longtime contributor to Dance Magazine, is on the faculties of Coe College and Hofstra University.

RELATED ARTICLE: The emotions of injury.

by Alan Good

When you get injured, emotions come in a pattern. The first is shock, being stunned. The second is horror as you see the ramifications of what's going on. There's physical pain, too. Then come shame and embarrassment. You have to struggle to get past each of these, and now you feel simply doomed. Then you have haunting thoughts: Will I be able to dance again? How? Will it resemble what I used to do? What will remain of my roles? Or my relationship with my boss? What happens if I'm not able to compete with the other dancers? Will I get a part in the new piece? How will I be able to contribute? What's going to be left of my links to the company's mission, the choreographer, all my duets, my relationship with my peers out there? We're soldiers together. We bend our noses to the grindstone, and we push like hell, and we drink and eat afterwards, and we laugh. It's a ritual that we all do, and it's joyous. Don't take that away from me.

There's still this bug-eyed fear that you're never going to recover. It leaves you drugged, wild, Bacchanalian, denying.

You start to get help. There's a horrible feeling that you don't even know you have, that lifts when a doctor tell you a diagnosis. Immense relief! You now hold an image of what's going on inside you. The joy of getting connected with a doctor, getting a pill from him, a diagnosis, his or her white coat, 30 minutes of being listened to, and then passing judgment, the prescription--that whole ritual works amazing things on human beings. The shamanistic power is not really acknowledged in Western medicine.

The rest of the company, they pass you by, they respect your space. Crowing around you is a dome, an aura. Sitting on the sidelines of rehearsal, you work with your theraband. There's a feeling of building strength, not just the local strength of the injury, but almost a brat inside you, an autonomous little creature that needs calming down, soothing, coaxing, asking it to take its place with the other muscles. The rest of you participates in this, gathering a singleness of purpose.

Like all good professionals, you want to be pushing at the edges of what you can do. But you're limping out there, and you don't have large, fast, sudden moves in your palette any more because of pain and prudence. Now the palette looks different, and what comes out are rhythm, focus, timing, poetry, silence. Those are profound things in performance.

The injury teaches you. In some cases, you petition and bargain with your body, and your body can emerge stronger than before. It sends a cavalry to the rescue that you didn't realize you had. And all of a sudden--or all of a gradual--you're jumping again.

Alan Good, a dancer choreographer in New York City, danced with the Merce Cunningham Dance Company from 1978-1994.

RELATED ARTICLE: Financing your injuries.

You may not realize the medical risks of leaping across the stage or rehearsing long hours when you're exhausted. Yet when dancers perform their jobs, they are putting their bodies and careers on the line. When an injury occurs, the practical question is, Who pays?

In many cases, workers' compensation covers part of your medical bills and lost salary. "But," says Gavin Larsen of Oregon Ballet Theater, "there can be serious hoops to jump through."

Workers' compensation is a legal right for all workers. It's basically insurance that pays the medical costs for those who become injured or ill on the job, and the premium is paid by the employer. After the worker files a claim, the state's Workers' Compensation Board determines how much money must be paid. The board also rules on whether certain medical tests or surgery are necessary. Larsen says, "Getting an MRI or other expensive tests can be tricky if the workers' compensation case manager doesn't see a need for it."

Pacific Northwest Ballet company manager Dwight Hutton says any major injury incurred while dancing or performing can be covered by workers' compensation. Twisted ankles, torn ACLs, and back pains are all legitimate.

The process for filing a workers' compensation claim depends on the severity of the injury. James Fayette, the New York area dance executive far the American Guild of Musical Artists (AGMA), explains, "If you get hurt and you're still dancing, they [the Workers' Compensation Board] ask you to file a claim so that there is a history of the injury. But they don't necessarily open a claim." Creating a history ensures that for future injuries--or recurring injuries-there will be complete records of all past occurrences.

If an injury holds you back from dancing, you should file and open a claim. Workers' compensation will pay most if not all of the medical bills, plus a maximum of $400 a week towards salary. Hutton says that PNB dancers receive two-thirds of their salary "and that is only if they can't work."

If the level of compensation is below the dancer's salary, Fayette says, some companies will supplement the workers' camp amount. Even with the insurance and supplements, however, a serious injury inevitably affects the dancer's income. "I don't think there is any situation where they're getting 100 percent of their benefits," says Fayette, who was a principal dancer with New York City Ballet for many years. "You're going to be out of money when you're hurt."

Being a highly bureaucratic system, the Workers' Compensation Board's approval can take weeks and weeks. Larsen warns of the delays between payments and medical needs. "My surgery was scheduled way before it was approved by workers' camp," she recalls. "And we had a scare a week before the surgery date when it still hadn't been approved."

Whatever the pitfalls, dancers shouldn't feel shy about filing a claim. The sooner you take care of your injury, medically and financially, the longer you will be dancing.--Emily Macel