How doctors and physical therapists are working to keep dancers on their toes

Imagine watching the Boston Ballet dancers perform “The Nutcracker” night after night — from back stage.

Female and male dancers push their bodies to the limit under the lights, graceful until the moment they’re out of audience sight. Then they slump onto a physical therapy table, get treated for their aching hips and ankles before twirling off again.

Dr. Matthew Fazekas watched this regularly as physician for the Boston Ballet & Boston Conservatory: “You get to see the show from a different perspective. You don’t see the pain that can accompany the performance when you’re sitting in the audience.”

Now Fazekas works with young dancers at Joe DiMaggio Children’s Hospital in Hollywood, diagnosing their ailments and devising treatment plans. His patients are typically under 18 and suffer from injuries caused by repetitive movements and overuse in the lower body.

At first, Victoria Moraga, 16, didn’t know she was injured. After a solo performance in February, Victoria was exiting the stage when her right hip gave out, causing her to collapse. It wasn’t until an MRI scan revealed a tear in her hip’s cartilage that she knew something was seriously wrong.

“I’ve been having pain in my hip for a year, but I thought it was a normal pain that a lot of people get,” said Victoria, a junior at Somerset Arts Conservatory in Pembroke Pines, where she is a part of the dance program.

Now she isgetting physical therapy twice a week for three months to recover from hip surgery. Physical therapist Whitney Chambers at DiMaggio’s U18 sports medicine department massages her scar tissue and leads her through exercises to strengthen her core and hips.

In the beginning, Victoria didn’t think her pain was bad enough to seek medical help, which is common among dancers, who don’t want to stop training and performing.

But dance injuries — like sports injuries — require treatment, often physical therapy to get back to full strength. Common injuries include stress fractures, Achilles tendon flare-ups, knee and ankle issues, torn ligaments, shin splints, hamstring pulls and snapping hip syndrome.

Dr. Farah Tejpar at Cleveland Clinic Florida in Weston has treated dancers who worry that too much rest will ruin their chances to compete. But that’s not usually the case.

“We’re not here to keep them from their art form,’’ Tejpar said. “Our objective of the program is to educate the community that something like this is out there, and there are physicians who have a sense of what it takes to be a dancer and what they need.’’

And, she adds, doctors and physical therapists can work with the dancers to prevent future injuries by spotting their weak areas and strengthening them.

Twenty-year-old Tiffany Raymond tore her ACL twice — the right knee when she was 13 and the left when she was 15. While preparing to perform the role of Clara at Southwood Middle School’s “The Nutcracker,” Raymond rehearsed a jump and felt her right knee jerk in the opposite direction. It took six months of intense physical therapy to get her back on stage.

“It was difficult, and it definitely hurt in the beginning. My muscles had shrunk so much in that short time and I had to retrain myself,” she said.

The second tear happened at another rehearsal for a national dance competition with Coral Reef High School. This time, she heard her left leg make a popping sound.

“It was scary. I was doing turns on one leg when I heard it. I knew I would dance again, but it was scary because this time I knew what I would have to do,” the Florida International University junior said.

At age 18, Raymond stopped dancing, and now she is studying biomedical engineering at FIU to help athletes like the specialists at Nicklaus Children’s Hospital who helped her.

Mindy Green, a therapist at Nicklaus Children’s Midtown outpatient center, believes in preventive care so Raymond and other dancers are protected.

“Any time that individuals are involved in high levels of activity, putting in multiple hours a day a week and repeating the same types of movement, there are chances for injury,” she said. “Dancers especially are prone to injuries in their knees, feet and ankles. Snapping hip syndrome is a medical condition very specific to dancers.”

Snapping hip syndrome is a condition in which flexing of the hip is accompanied by a painful snapping sensation and even a popping sound. While harmless under normal conditions, it can cause joint pain and damage over time, she said.

Through its screening program, Nicklaus Children’s goes to schools or private studios, where therapists conduct evaluations of dancers’ injury risks.

Green can determine if a dancer has adequate strength, balance and range of motion to safely begin pointe — dancing on the tips of your toes. Therapists can also improve range of motion, neuromuscular control to enhance performance and reduce risk of injury.

“Injuries are a part of the art. When they occur, dancers need to find someone who really understands what they do to receive effective treatment,” Green said.

This story was originally published July 22, 2017 at 12:01 PM with the headline "How doctors and physical therapists are working to keep dancers on their toes."