Resources

Implementing a Wellness Program in the New York City Ballet

by Linda Hamilton

Introduction

Professional ballet dancers experience a high rate of musculoskeletal injuries compared to dance students, due to demanding choreography and a taxing schedule of tours, rehearsals and performances.1-3 To reduce physical disability, companies, such as the Boston Ballet, have adopted pre- and post-season screenings as a primary strategy in injury prevention, leading to a 13% decrease in total injuries over a five-year period.4,5 In this company an ‘injury’ is defined as any dance related medical problem, whether or not it involves treatment or expense. Our study attempts to reduce the number and duration of debilitating dance injuries claimed on workers’ compensation insurance in the New York City Ballet, using the following three-phased approach: to identify specific risk factors associated with dance injuries during rehearsals, performances and lay-offs; to establish a Wellness Program derived from the injury patterns in these professional dancers, with the ultimate goal of injury prevention.

Methods

Annual on-site medical and rehabilitative services were increased in the New York City Ballet for physical therapy and massage. Chiropractic services were also made available during the company’s Spring and Winter seasons, as well as an orthopaedic clinic before performances. In addition, the dancers completed a confidential survey about their health, injury history and conditioning activities during lay-offs, rehearsals and performances. Further information was gathered over a four-month period, with particular emphasis on the dancers’ work schedules two weeks prior to becoming injured. Injured dancers were asked if they had experienced a number of potential sources of stress during the preceding month (e.g., new choreography and mental strain). Interventions based on these findings were then tailored to the dancers’ needs in a twelve-month pilot programme, resulting in the current Wellness Program. To asses the program’s efficacy, works’ compensation records were used to document claims filed by dancers who were ‘totally out’ (i.e., unable to rehearse/perform) and time lost to disability.

Results: Pre/Post Interventions

An analysis of workers’ compensation records since the onset of the Wellness program indicates that the dureation of physical disability dropped by 46% with additional on-site services and interventions aimed at injury prevention. Thus, injured dancers appeared to benefit from receiving immediate and continuous medical care, as well as from interventions that addressed specific risk factors identified in the injury survey. In the latter case, these problem areas included poor physical conditioning, particularly during the off season, which predisposed dancers to new injuries with the sudden increase in workload as the season commenced. A heavy dance schedule was also a risk factor for young dancers with amenorrhea (the absence or stopping of the menstrual periods for three or more months), who were prone to overuse injuries and stress fractures. Finally, the use of stress management modalities (e.g., yoga and/or psychotherapy) distinguished dancers who remained injury-free from those who succumbed to physical disability during the course of a ballet season. A breakdown of each year follows for further clarification.

During the first year of our programme we focused on increasing on-site medical and rehabilitative services and gathering information form the injury study. A pilot programme was then instigated over the following tear to address potential problems, with continual on-site services. Dancers were advised to get in shape prior to the onset of the season. Initial interventions were also offered during the six-week rehearsal period. These included: yoga and aerobics classes to increase overall conditioning; fitness screenings to identify physical deficits; and bone density evaluations, with nutritional and hormonal counselling.

Only one-third of one-half of the dancers participated in the pilot programme, due to scheduling conflicts and lack of compliance from the older dancers. To increase participation, introductory seminars, on injury prevention and stress management, were given during a regularly scheduled company meeting. Apprentices were also required to undergo a mandatory evaluation by the company’s orthopaedist, who referred them, when necessary, to the physical therapist to correct such potential problems as tight hamstrings. The number of major workers’ compensation claims was low for this period except at the end of the season when excessive overtime rehearsals increased dancers’ fatigue.

Based on the results of the pilot programme, a concerted effort was made during the next year to adapt the Wellness Program to the dancers’ busy schedule by offering them complimentart memberships at the New York Sports Club. Those who participated in the fitness screening also received a personalised training programme to improve deficits in strength, flexibility and aerobic capacity. To increase overall compliance, interventions were often scheduled during paid rehearsal time, and were considered mandatory for all apprentices and first and second year corps dancers (who are most prone to overuse injuries). Apprentices were also required to undergo an orthopaedic evaluation as soon as they began working for the company. The result was that fitness levels improved dramatically, leading to fewer workers’ compensation claims, and less lost time than prior to the onset of the program.

Discussion

The New York City Ballet’s Wellness Program is proving to be an effective method for the prevention and treatment of dance injuries. In addition to the overall decline in major workers’ compensation claims, weeks of physical disability have greatly decreased. The success of this programme rests on addressing specific risk factors associated with injuries in dancers. For example, the rate of new injuries at the beginning of each season has declined substantially, as these dancers changed their habits and made a concerted effort to get into shape during the lay-off. Cross-training at the New York Sports Club has also increased their overall fitness levels. Last but not least, this programme has constantly evolved to better meet the dancers’ needs. Presently, a mandatory nutritional evaluation is required for each apprentice. All young dancers, including all first and second year corps members, must also attend educational seminars on nutrition, stress management and injury prevention. Our next step is to increase the involvement of older dancers, who may be more resistant to change. While the Wellness Program has unquestionably impacted workers’ compensation premiums, its effectiveness in preventing serious injuries will need to be evaluated over a longer period of time.

References

  1. Krasnow, D., Mainwaring, L. and Kerr, G. (1999). Injury, stress, and perfectionism in young dancers and gymnasts. J Dance Med Sci, 3(2):51-58.
  2. Hamilton, L.H., Hamilton, W.G., Warren, M.P., Keller, K. and Molnar M (1997). Factors contributing to the attrition rate in elite ballet students. J Dance Med Sci, 1(4):131-138.
  3. Hamilton, L.H. (1998) Advice for dancers. Emotional counsel and practical strategies. San Francisco, CA: Jossey-Bass, p.148.
  4. Solomon, R., Micheli, L.J., Solomon, J. and Kelley, T. (1996). The “cost” of injuries in a professional ballet company: A three-year perspective. Med Probl Perform Art, 11:67-74.
  5. Solomon R., Micheli, L.J., Solomon, J. and McGray, E. (1999). The “cost” of injuries in a professional ballet company: A five-year study. Med Probl Perform Art, 14:164-169

Originally published in Dance UK  magazine, Issue 52 – Spring 2004