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You might imagine a severe ballet injury as a sudden catastrophic drama; a catastrophe of tights.

It did happen. In 1978, New York City Ballet star Robert Weiss broke his Achilles tendon during a performance, and a loud "bang" sounded through various booths. He thought the floor had already made way under him, but in the audience, his friend Rudolf Nureyev understood the situation better, so he rushed backstage and rushed him to the hospital.

Rudolf Nureyev knew that the Achilles tendon had burst. In the second year he rushed towards Robert Weiss, he broke his ankle while jumping the Nutcracker. Credit: Getty Images

Then there is American David Halberg, an international superstar, an alumnus of the Bolshoi Theatre and American Ballet Theatre, and now the artistic director of the Australian Ballet. When he made his debut at the Royal Ballet in London in 2018—a highly anticipated moment long delayed by a career-threatening ankle injury—disaster struck.

He recalled on social media: “I felt my calf beating halfway through the first act. From then on, I felt severe pain as long as I stepped on it.” “I completed this with complete determination. Behavior, but I know in my heart that I cannot go on."

Career threats can also spread to dancers. In 2016, one of the rising stars of the Australian Ballet, Benedicte Bemet, took a rare opportunity at the end of the busy season to take on the main role.

"I'm a bit painful, but I think it can be controlled," she said of her black Achilles tendon. Fast forward a few months and she can barely walk. "I spent my Christmas holiday in a bit of pain. As everyone knows, tendons hate rest. I didn't realize at the time, I thought rest was good. Really, really angry."

As early as the 1970s, Weiss underwent surgery (fortunately for him, a Danish expert has been supervising his surgery by the audience). However, the operation is risky and may permanently restrict the dancers. For Hallberg and Bemet (her photo from the rehearsal in the video below), the recovery process is slow and complicated—though it is not surgery—and requires a lot of physical and mental reserves.

Why are ballet dancers injured so badly? How can dancers who might have had to wear pointe shoes forever recover from injuries now stronger than before?

Below: Benedict Bemette rehearses with other dancers at the Australian Ballet.

Yes. But maybe not because of what you might think. A study conducted in the United Kingdom in 2014 found that professional dancers are more likely to be injured than rugby players: 80% of dancers are injured at least once a year, affecting their performance, compared with 20% for rugby or football players.

According to the 2014 UK Survey of Suitable Dance, muscles and joints are the most common injuries. Other studies have found that overuse is the most common cause of injuries among female dancers, while men are more susceptible to sudden traumatic injuries. They found that young dancers are more likely to be injured than older dancers.

Why are professional dancers so vulnerable? Part of the reason is that their workload is so large: top companies perform many times more than sports teams each year. For example, a typical AFL season has 23 rounds; in 2019 (a typical year), the Australian Ballet arranges 289 live performances.

But Matthew Wyon, professor of dance science at Wolverhampton University and one of the leading experts in dance science, has another theory. This is not a likable person.

"There is considerable evidence that most ballet dancers are only slightly healthier than ordinary people on the street," he said. "I always call them'boy racing': they look gorgeous, but the engine is working overtime."

One way to measure health is the amount of oxygen consumed per kilogram of body weight: it refers to how efficiently you burn your muscles with fuel in the air. Long-distance runners and cross-country skiers scored in the 70s and 80s, and football players scored in the 50s and 60s. Sedentary people score less than 30 years old. The dancers' scores range from their 30s to their 40s. And, equally surprisingly, they are not that strong either.

"The better your dancers are, the less healthy they are. Because dancing no longer puts pressure on them."

"We have a chief dancer who just recovered from an ACL [anterior cruciate ligament] injury," Wyon said. "We are testing his good leg with his injured leg. [Good leg] output is about 35 kilograms; nothing."

In contrast, an average gym rabbit hardly sweats when doing four to five times this amount of leg lifts.

Why is this happening? Wyon believes this is because of the way the dancers train.

"None of their training made them stronger or healthier until they were close to performing. Ballet dancers are technically incredible. They have a sports economy that we have never seen in sports. But it means Dance no longer puts pressure on the body. They don’t have that physical adaptability. So, in fact, the better your dancers are, the less healthy they are. Because dance no longer puts pressure on them."

On the surface, the lifting and jumping performed by the dancers seem to require extraordinary power. However, behind the scenes, many things are done with perfect balance; instead of relying on muscles to raise your partner by aligning bones and locking joints, you transfer weight to the floor through your frame.

"They can pull it out as soon as they are monitored. This is just a phenomenon, and we are trying to explain it."

The "floating" appearance of a jump also depends on technique and takeoff ability: by raising and lowering arms and legs during the jump, the dancer's center of gravity can move the parabola required by the laws of physics, while their bodies seem to challenge science in mid-air. The same effect can also be seen in the residence time of a basketball player during a dunk.

Evidence of their reliance on technique can also be found in the almost weird abilities of dancers, who ignore fatigue when fatigue is important.

In an experiment, Wyon's team performed a dancer practice until they "cannot stand up at all," and then performed a double spin on the arabesque (they stood on their toes, with one leg hanging behind them). "And they can pull it off, even if they have difficulty dancing in the middle. Once they are monitored or data collected, they can take it out. This is just a phenomenon, and we are trying to explain it-it may It’s their way of training."

The technique seems to be honed through several hours of practice every day, and from a very young age, there are many flaws hidden. Wyon has seen a male dancer "like a stick insect" who can lift any female in the company-purely by ability. "His technique is very suitable for this, very beautiful. Once. But if you ask him to do it three times, he can't do it."

Below: Benedicte Bemet spins in David McAllister's Grand Pas Classique.

"They always train and dance at the limit," Wyon said.

The activity capacity of most people in daily life is close to 40% of their physical strength. Athletes and dancers work at approximately 80% of the baseline when "on the field," occasionally pushing themselves to the limit.

"So, they are always on the edge, rather than having any reservations," Wyon said. Once fatigue begins, "That's when the possibility of injury suddenly appears. Because he has no reserves underneath, it can protect him when he is tired."

With a flash, the dancer suddenly had to rely on tired muscles or tendons.

"They are really good at what they do, but once they are slightly beyond [they lack] physical ability, the ability to do other types of sports."

"There is a view that dancers will perform until at some point, they collapse...that's it."

Wyon says this explains why you tend to see an increase in dancer injuries after about a week or two of the performance time. Their bodies are not ready for these requirements. Companies bound by tradition have not considered, supported or prioritized injury prevention.

Dancers usually do not report early signs of distress or injury, and only resolve symptoms when they prevent them from performing. And the stakes are high. Until recently, injuries easily ended his career. Across the industry, there is a view that dancers will perform until at some point they collapse... nothing more.

Marilyn Jones was with her 4-year-old son Damien in 1977, who later became an Australian ballet star. Credit: Fairfax Media

When Damien Welch of the Australian Ballet retired from the company, he reported a list of accumulated injuries: he had six operations on his leg and two screws on his foot (he broke a fracture while jumping) , Back injuries and stress fractures.

He is the son of Australian dance celebrity Marilyn Jones. When she jumped off, the floor broke and Marilyn Jones herself injured her Achilles tendon.

But the Australian Ballet is one of a group of pioneering dance companies around the world. They have strengthened their in-house medical expertise and are leading the way in seeking better treatment, rehabilitation and, most importantly, injury prevention.

Dr. Sue Mayes is the Art Health Director of the Ballet Company. She has been working there since 1997-initially in the smallest room of the building, as the company's first full-time itinerant physiotherapist, and now leads the high-tech medical and physiotherapy business . Meyers was a dancer when she was young and became more and more attracted to medicine when she grew up. She carefully studied the complex and beautiful drawings of muscles, flesh, organs and bones in "Gray's Anatomy."

Meyers has seen various injuries, some of which are unique to ballet. Pointe shoes can cause an impact on the back of the ankle, as well as pain and irritation of the structures around the bones. She has seen a lot of torn calves because the dancer pushed away from the jump and felt obvious twitches in the muscles.

Dr. Sue Mayes is the Artistic Health Director of the Australian Ballet. Image credit: Kate Longley/Australian Ballet

Knee injuries are not as common in classical ballet as in modern dance. When the dancer is stepped on the ground, it has more twists and turns. About 30% of injuries in classical ballet occur in the lumbar spine: in women, the soft tissues of the lower back are impacted by actions such as bending into an arabesque; in men, from their partners’ lifting, catching, shaking, and twisting middle. Hip problems account for about 7% of their injury list.

Half of the injuries Mayes' team saw were feet and ankles: joint swelling, friction and load caused inflammation.

"This is really common for dancers and athletes," Metz explained. "Your joints will swell, and then the swelling will escape and enter the tissues. They form these little balloon-like structures."

She said that whenever Meyers performed an MRI on dancers, she would find a "one-page list" of abnormalities around the joints, although many did not affect the performance.

But back injuries are much more dangerous. "In my time, there are two or three reasons why dancers have to complete [work], one is a herniated lumbar disc," she said. The other main reason is that dancers have children.

Below: Miwako Kubota and Benedicte Bemet share an ice foot bath after the show.

A lot of progress has been made in the treatment of simple or trivial injuries, but the more significant changes are the reduction of injuries at the end of the career and the reduction of the need for risky full-scale surgery.

Mayes recalled that when Bemet came for treatment, “she had this tendinopathy around her heel. They might take a year to [repair]. They were really scary. Every time you bend your ankle or put weight on the ankle , Will feel very painful."

Bemet is already overloaded. She has reached a state where she can't even bend her knees-knee bends, which is the most basic movement of ballet.

Repair is not cortisone or surgery. If you do such an operation, the dancer's feet will lose some range of motion forever. This in turn will affect other joints.

This may sound simple, but it is a revolution in ballet... They are trying various techniques to rebuild the dancers from the inside out.

"We [always] will see if we can do this non-surgically," Meyers said, "because dancers like that swan neck, that super long shape. If you even lose five degrees , It will be obvious to the eyes and harder to work. Therefore, we avoid surgery at all costs-we have done very few operations in the past 10 years."

For a year, Bemet had to perform simple, repetitive daily exercises, including Pilates, small jumps, or jogging in the stairwell, to restore the strength and function of her feet.

This may sound simple, but it is a revolution in ballet. Instead of sending the dancers to the hospital, they are experimenting with various techniques and painstakingly rebuilding the dancers from the inside out. Mayes and her team published research that looked at each joint and each injury, and assessed which specific types, frequencies, and strengths are best for returning dancers to the stage.

Sue Mayes and dancer Sara Andrlon. Image credit: Christopher Rodgers-Wilson, courtesy of the Australian Ballet

However, if there is no so-called "quick repair" surgery, dancers must have strong mental power and patience. In the past four months, Bemet has hardly improved. All she showed in her strength exercises was increased strength; the pain was not relieved.

"We just set these small short-term goals," Metz said. "Rehabilitation is a painful roller coaster of emotional and physical abilities.

"Dancers are nourished by performing on stage; if they lose this opportunity, they lose the opportunity to express their art. Their careers are relatively short, and there are always young dancers who make progress in the team. If the dancers If they miss a year, they may miss performance or promotion opportunities.

"During the long-term recovery process, they may lose self-awareness. If they cannot recover from the injury, they may have nothing."

"In the past, because they grew up in a ballet school or a ballet company and spent their entire lives, their identity was just a'ballet dancer'. In the long-term rehabilitation process, they may lose their self-awareness, lose their identity, and if they do not recover from their injuries Come here, they may have nothing."

Long-term rehabilitation is exhausting. Staying motivated is hard work, and dancers may lose hope.

"They may start to question whether it's worth it," Meyers said. "They question whether they can dance again. If they come back, will they be as good? They miss the friendship. They will feel isolated and helpless."

In 2012, 18-year-old Bemit was rehearsing backstage for "Swan Lake". Image Credit: James Braund

Bemet said that the dark ages are "still a part of me." "Before that, ballet was my way of identifying myself. It was a place where I reflected my self-esteem, value, and self-worth. Take it away... I was totally lost and very frustrated, especially because of the truth. It took a long time to get any signs that it will heal."

In the memoirs, Hallberg (who suffered the same injuries as Bemet, but worsened due to failed surgery) reveals his psychological crisis during the rehabilitation of the Mayes team. While recuperating in Melbourne, he spent a few hours on a park bench and drank six packs of Carlton Draught, "a typical drunk, the kind everyone would be afraid of and try to avoid".

He shaved his head, smoked a cigarette, and slept until noon.

In January 2021, David Hallberg took a photo with the head of the Australian Ballet Guo Chengwu and Ako Kondo. Image source: Simon Schluter

But a common characteristic of great ballerinas is determination. They did not reach the top by chasing shortcuts.

Bemet recalled: "This is a hard, time-consuming, and meticulous job." "You have to do it (practice) at the same time, at the same time, and in the same order every day. It's too complete, but I'm a little perfectionist. I am very happy to do everything they say to do. It swallows my pride and conceit, knowing that I have to start from the beginning, learn how to stand in the first position, learn how to fold again, all these things I take for granted.

"You have to go back to the baby ballet and become that blank canvas and receive information about your technique. But when you are so broken, you will do anything. If they say,'Stand on your head', I Will say,'Of course, I will do it'."

She returned with a better dancer and a stronger spirit-this experience allowed her to love and devote herself to art again-but her body is also stronger. She is no longer a boy racer.

Benedicte Bemet and Brett Chynoweth performed Counterpointe in Sydney in April. Image source: Courtesy of the Australian Ballet

Meyers is still working hard to make her ballerina healthier and stronger to prevent injuries. One of the battles is against the dancer's fear of power.

"They don't want to inflate," she said. "We want this long and thin ballet aesthetic."

It took a long time to prove that a stronger dancer would not look like a Hulk in the end. Everything is in your way: Popeye muscles develop from high loads and a lot of repetitions, while dancers work with high loads and low repetitions or low loads and high repetitions, resulting in support and protection of joints without bulging The muscles came out of their tights. Meyers can prove to them that they get fewer injuries, which is also very helpful.

Wyon said that new research shows that based on the technology developed by Mayes and others, a good, strength-based prevention program can almost immediately cut chronic damage in half.

In addition, they conducted a study of blind people, where observers did not know which dancer had been doing power planning, and proved that healthier dancers dance better.

Another battle that Mayes is still fighting for is against stretching—especially the unfathomable bends and stretches dancers can accomplish, whether they should or not.

"It's still a bit controversial," she said.

You don't actually want a calf that is too elastic. When joints move in all directions without muscle control, injuries can occur.

Ballerinas like to sit apart for a few hours. They wear it as a badge of honor and feel good, especially for a body that has been hit hard by professional needs.

But, Mayes said, for example, you don't actually want a calf that is too elastic. When joints move in all directions without muscle control, injuries can occur.

In addition, studies have shown that stretching muscles actually reduces their power output.

Meyers pointed out that this is also a lesson learned by Olympic sprinters.

"You have seen sprinters stretching their hamstrings before a race. It is almost inevitable that one of them will tear their hamstrings during a race. But in recent races, they switched to a dynamic warm-up: Jogging and keeping the body warm. Immediately before the game, to keep their heart rate, all their muscles are warm, their bodies are active, but they don’t have any extreme ranges of motion."

Especially young dancers must be trained in stretching exercises. Wyon found himself spending a few hours on Instagram telling young dancers (or usually American cheerleaders) who like to do extreme stretching exercises, "This is bad, you shouldn't do that".

"They try to force their bodies into these strange and wonderful positions, but they stretch ligaments instead of muscles and tendons," he said. "This means that our slack is increased, which means that we are more likely to be injured unless we increase the strength of the muscles around the joint to be able to control and support it. You will experience these knee tremors when they feel tired , They will not be able to control their bodies."

Brett Chynoweth and Benedicte Bemet will perform the black swan duet at Swan Lake in October 2021. Image Credit: Eddie Jim

In the 15 years since the Australian Ballet changed its injury treatment and prevention plan, it has never lost a dancer due to an injury. "This is great," Meyers said.

"We have women dancing in their 30s and men dancing in their 40s. This is unheard of in our company."

When they leave the company now, few dancers leave with injuries that bother them.

"Dancers who retired before we actually adopted all the strategies had hip replacements in their early 50s. We don't know (if we change) in another 10 years, but I hope."

Mayes also hopes that the work they have done will help dancers long after retirement.

"Dancers who retired before we actually adopted all the strategies had hip replacements in their early 50s. We don't know (if we change) in another 10 years, but I hope."

She can now look into the eyes of her dancers and tell them that no matter what it is, she can solve it.

"We always said at the beginning,'You will recover from this injury. This will not only keep you where you are. If you commit to this rehabilitation, you will come back better than ever. "

Bemit did it. She fought back, she recovered, and she returned to the stage. Soon after, she was promoted to chief artist.

The Australian Ballet’s gala evening was held in Sydney from November 25th to December 3rd, and Melbourne from December 9th to 18th.

If you want to know the expert background of a certain issue or news event, please send us an email to explainer@smh.com.au or explainer@theage.com.au. Read more explainers here.