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Dance Injuries


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#1 Alexandra

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Posted 01 January 2002 - 12:17 PM

I'm going to post this here and on the Teachers Forum -- I think we'll have different perspectives on this, but it's a subject of interest to everyone.

An article from Mirella's TuTu Review:

Dance Injuries - Inherent Risks or Improper Training ?

Theatrical dancing has always had its tragedies of physical suffering and mental anguish, and its occupational dangers. One thinks, for instance, of the young, 19th-century ballerina Emma Livry whose tarlatan skirt was ignited by a gas lamp during a performance, resulting in eight months of agony before she died from the burns. But the idea that the very practice of dance - in particular, of classical ballet - would come to be associated with injury is comparatively recent, a phenomenon of the past twenty years or so. In part, this may be owing to the dancer's own willingness in recent years to be candid about the subject. Mikhail Baryshnikov's ravaged knees, Edward Villella's tortured back, Darci Kistler's shattered foot have all been widely discussed in the media, frequently by the sufferers themselves. I am speaking now of injuries incurred entirely in the course of dancing - injuries and conditions for which dancing itself is deemed responsible.

The issue of injury in dance is such a recent concern that very little real study of it has surfaced until recently.

Much of the information seems to be anecdotal,
and many questions remain to be asked.

http://www.mirella-d...com/Issue2.html

#2 katharine kanter

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Posted 08 January 2002 - 12:49 PM

The two quotations below, were found in articles posted up on ballet.co.uk, and are relevant to this discussion, I believe.


Josephine Jewkes, ex-principal, ENB.


"More generally, we dancers believe that the trend nowadays is for a more aggressive style of movement (taken to the limits by Forsythe in ballet and DV8, Jeremy James and Per Jonsson to name but three in the contemporary world), but the human body meanwhile has not greatly changed; simply that those with less extreme facility are being challenged further by the examples of a few with acrobatic flexibility which was previously labelled 'unclassical'. This is now becoming the norm. (This is known as 'progress'.)"

***

(From I believe, a recent issue of the Daily Telegraph)

"Forsythe says one major inheritance from Balanchine is his use of the ballet position known as epaulement, which involves complex counter rotations of the body, including the shoulders, hips, hands, feet, head.
"As he says, "the mechanics of epaulement are what gives ballet its inner transitions. It's essential to a lot of my thinking." He takes this position one step further by what he calls disfocus. The dancers don't gaze out, but "stare up, roll their eyes back." Like a hypnotist might suggest, he asks them to "put your eyes in the back of your head." Their movement becomes "very water-like, shaky, unusual and serpentine". He warns: "Don't try this with too much furniture about."

Tony Geeves, who is I believe a physiotherapist at Queensland University in Australia, actually began a project about a decade ago, specifically on Dance Injuries. He has a number of important suggestions, including one that I believe could be adopted TOMORROW by everyone, everywhere:

eliminate grand plié, in class, in performance, just GET RID OF IT - except perhaps in second position - and you will eliminate the NUMBER ONE cause of over-stretching, and therefore weakening, of those absolutely vital ligaments.

I shall look up the URL for the various projects - believe that Ann Nugent started one in England three or four years ago as well.

#3 katharine kanter

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Posted 08 January 2002 - 12:53 PM

Here are some relevant addresses:

Dancer's Health/Safety Issues:

International Arts Medicine Association

International Association for Dance Medicine & Sciences

Ballet Dancer's Injuries, A review of Literature 1987 - 1997, Alain Guierre D.O.

Performing Arts Medicine Association

British Performing Arts Medicine Trust

Arts Lynx Health Resources

American Alliance for Health, Physical Education, Recreation & Dance

#4 Calliope

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Posted 08 January 2002 - 01:53 PM

"In part, this may be owing to the dancer's own willingness in recent years to be candid about the subject"


I think that is a key statement. Many dancers still don't discuss injuries and dance with the "minor" aches and pains.

Nutrition must play a key factor in the injury report as well, yet it wasn't mentioned.

#5 Victoria Leigh

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Posted 08 January 2002 - 10:39 PM

I'm with Tony Geeves! Thank you for that information, Katherine! I have felt for a long, long time that grand plié in everything but second position could, and perhaps should, be eliminated smile.gif I eliminated 4th position grand many, many years ago, and then stopped doing all grand except second at the beginning of the barre and only putting in a couple of them later on. I would love to not do them at all, but unfortunately the students must still learn to do them and do them correctly because they will be expected to do them when they go anywhere else, and in auditions. I too believe that they are unnecessary and potentially harmful, especially with young students who do not have strong placement and control or those who do not have good rotation.

[ January 08, 2002: Message edited by: Victoria Leigh ]



#6 vagansmom

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Posted 09 January 2002 - 01:15 AM

I've always found Suzanne Farrell's contention that her hip problems were due to heredity, NOT dance, to be questionable. She was 38 years old when her hip began to cause her serious trouble and she had her first (of three, I think) hip replacement surgery when she was 41. Regardless of heredity, that's young.

Likewise, Darci Kistler's been dancing injured since she was what - nineteen? Too much on too young a body? I wonder what would've happened had her body been given a bit more time.

#7 katharine kanter

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Posted 09 January 2002 - 04:50 AM

The difference between the type of injury all ballet dancers have suffered, literally for centuries, namely twisting the foot or knee owing to fatigue or a moment's distraction, and the type of critical injury to large joints that has become routine OVER THE LAST THIRTY YEARS, cannot be an accident.

There is even a girl, now at ENB, whose BACK WAS BROKEN rehearsing a lift in New Zealand three years ago.

I will look up for this forum, and translate, an interview that the head of the Paris Opera School, Mlle. Claude Bessy, gave to a French weekly news magazine in 1986. She refers to the fact that dancers today are expected to dance in all "styles" (turned-in, turned-out, modern, Petipa, Balanchine, sometimes all in a single day's rehearsals) as the main cause of injury. She is scathing about the rash of hip-replacements at NYCB. Coming from Claude Bessy....

Read the advertisements for auditions in the European trade press. Most now say - and we are talking about CLASSICAL companies here - "danseur polyvalent ayant des compétences dans le moderne", which means, literally, "multi-purpose" dancer, able to do modern dance as well as classical.

Now, as the well-known French professor Juan Giuliano insists, one cannot use the musculature in the same way, for each time signature of the music. He was talking about classical music. Imagine, the impact on the musculature, and the whole neurological system, of a person trained as a CLASSICAL dancer to CLASSICAL music, expected to bounce round, or jerk, or whatever is one does, to electronic bruitings, or percussion or what not, that generally lacks even a proper time signature ?

We have all seen young people straight out of the top schools, with a good body and strong technique, start to develop chronic knee problems with six months of joining a major company, following work with so-called "modern" choreographers, calling for application of weight and impetus on the turned-in knee.

We have heard 22 and 23 year old dancers come out of a performance and say: "Sure makes you realise you ain't eighteen no more".

Dancers of 25, 26, 27 with first-class training, in good companies, have told me that they see themselves as "old", "finished", physically "worn out". Dancers of that age have told me that they wake up every morning in such stiffness and pain, that until they have finished class, they can scarcely move.

Charming.

The thing cannot be settled by taking a survey of every classical dancer on the planet. We have got to get scientific about this.

A decade ago, I decided to make a series of interviews with orthopaedic surgeons, sports doctors, and so forth, at various clinics in Germany and France. They were shewn film and photographs of current "international" style (the hyper-extension à la seconde, the hyper-extended arabesque, the hyper-extended grand jeté (opened to 180 or more degrees), the exaggerated en-dehors, the displacement slightly forward of gravity on pointe to get that "Guillem-Alessandra Ferri" look, instead of standing up ramrod-straight on point etc etc. They were then asked to compare with film and photographs of the same type of movements and positions, in the Bournonville School.

The doctors were apalled by the "international" school. They have geometrical instruments to measure the ambitus of movement, and what we are doing today, is so far out of any natural ambitus, that it qualifies in Carlo Blassis' book, as a freak-show. They found the Bournonville school far more natural - bearing in mind, that ballet is never going to be a stroll down to the corner to get a packet of ciggies.

These results were published. Some readers in the profession were in an uproar. "You are not allowed to say this !" they cried. Where have we got, where an informed scientific opinion is felt to be "too polemical", or "unfair" ?

Amongst the delightful effects of the hyper-extension, apart from hip replacement, is stress fracture of the hip joint. Moreover, there is a sort of covering or membrane over that joint, and today, this is often found to be torn or ripped.

Do we really wish to allow people to go on suffering like this, for what Karole Armitage (a priestess of modern dance who has just taken over the formerly classical Ballet National de Nancy) calls the "frisson" of extreme physicality ?

Is it "enjoyable" or "pleasurable" to watch a youth or girl of 21 or 22, having their limbs turned inside out, stretched out of the socket, bonged, twanged, and who knows what else, whilst knowing full well than two to three years down the line, that young person WILL NO LONGER BE DANCING ? After ten years of arduous study at school ?

Empty-headed choreographers and musicians, empty-headed artistic directors, using their living pawns to CREATE AN EFFECT.

Dancers are subject to stern discipline at a very early age. As a result, they tend to be the most obedient persons on the planet. Obedience to "creators" who, in my book, are irresponsible madmen, is turning the classical dancer into an endangered species.

Those of us who have no vested interests, must blow the whistle on this nonsense.

[ January 09, 2002: Message edited by: katharine kanter ]



#8 Calliope

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Posted 09 January 2002 - 08:47 AM

But isn't all of this "known" by a dancer going into a field? Their bodies are their instruments, surely they don't expect not to get injured? They are in this way no different than athletes.

The men seem to have far fewer injuries than the women. Especially notable is in the stress fracture area. Females are slightly more susceptible especially when factoring in diet. Seeing as anorexia is more prevalent in female dancers, this only complicates the matter (I'm not saying every dancer who has a stress fracture is anorexic or bulimic) but the bone mass decrease associated with it as well as amenorrhea only complicates the problem. Plus the associated rest that needs to go with the healing of a stress fracture. The competitiveness for the limited roles is very intense.
New studies have been published linking ligament tears in the knees to female hormones, which is why even in non-athletes, doctors are seeing major increases in the amount of surgeries being needed.

But I think something Victoria alluded to is important and that's for teachers to recognize that certain positions should not and cannot be done by students until a strength is developed.

#9 Victoria Leigh

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Posted 09 January 2002 - 09:14 AM

[quote]Originally posted by Calliope:
But isn't all of this "known" by a dancer going into a field? Their bodies are their instruments, surely they don't expect not to get injured? They are in this way no different than athletes.


I'm not really sure it is, Calliope. A classical dancer's training really does not include the kind of brutality that is taking place in some contemporary works today. Even if they see these works as they grow up, I'm not sure they realise how different they are from what they are learning in class, and how damaging they can be. The emphasis on excess rotation and extension is known, but not the kind of movement being used in many of these newer works.

Also, I think most dancers are eternal optimists (which is not always a bad thing smile.gif ) and just don't think it will happen to them. They do not expect injury. Because of that obedience factor that you mention, which is very true, they trust the teachers and the choreographers.

Two principal (female) dancers retired this year, at 30 and 31 years old, primarily because of reaching the point where the years of injury and pain got to be too much. And their careers were both in what is considered to be a primarily classical company. Besides the contemporary works, which most likely caused a lot of the problems, they were, IMO, frequently overworked. And, as dancers do, they most likely overworked themselves in many cases. I blame my own serious injury, that put me out of commission for 2 years in the middle of my career, more on my own obsession for overworking than on anything having to do with the work itself at that time. There were other factors involved, especially in terms of medical knowledge and type of care at that point in time, however, I did not help things at all. frown.gif

But the points about the work today are most valid, and as a teacher I just have to wonder where this is all going and where I am leading these kids. No matter how much I work at keeping the technique as safe as possible and developing them slowly and carefully and correctly, what happens when they actually start performing with a company? Scary. But they want to dance, they are driven to dance, and would I have let anyone take that away or change my mind because I might get injured? No way! smile.gif

#10 katharine kanter

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Posted 09 January 2002 - 09:35 AM

In our time, animals in the Zoo are better looked to, than ballet dancers.

My own view is that the Artistic Director has a responsibility, to ensure that he is working solely with choreographers and ballet masters who know a fair old amount about anatomy. He must give them specifications, as though he were talking to building contrators: "Look you, Sir, I don't want my people shredded. Otherwise, you're shredding their careers, and several hundred thousand francs of tax-payers' money, per dancer wrecked. If you're as creative as you say you are, you can make a ballet worth looking at, without having my lot do double-flips backward landing on a table."

Young dancers absolutely do not know what they are getting themselves in for. They start dancing when they are eight or nine. They live in a sheltered artistic environment, protected from lurking predators, and from distractions in the outside world. Their teachers are, if not nice, at least amiable, with them, and their physical needs are properly attended to. There are doctors, nutritionists, anatomists and physiotherapists and what not, skulking down every corridor. The lads are not even allowed to pick up the girl, until the skeleton is properly formed !

Then, one year later, they are in a company, doing double-flips backward, rushing about the stage in one-arm lifts with women who are five-foot-ten and big-boned, or dancing Mr. X's choreography at speed. Many are knocked out of the profession within their first two to three years with a company. Most of the rest will throw in the towel by the time they reach 27 or 28.

I fail to see how one may deplore the lack of ballerinas, or the quiet boredom distilled on today's stage, without bearing in mind the fact that, saving a few notable exceptions, there is no-one prominent left, over the age of thirty. When Sarah Wildor resigned from the RB this season, a frequently-heard remark was that it was "normal" that she be pushed aside by "much younger" dancers. Miss Wildor is, I believe, 27 !

Had Makarova, or Fonteyn, or others in that class, stopped dancing at 30, or been physically exhausted by 35, we should have little indeed to say about their dancing. And had they stopped advancing technically by the age of 27, well...

The things many choreographers see fit to inflict upon dancers, in utter disregard, I would even say, contempt, for their health, safety or future career, would, in legal terms, probably qualify either as assault, or even aggravated assault. Assault is a criminal offence, in addition to being, civilly, a tort. I know Americans are exceeding litigious - perhaps the ballet studio might be fresh terrain for the American legal profession to explore ?

It may be that Artistic Directors should be encouraged to see themselves as Keeper of a zoo full of highly exotic, costly beasts from far-off places. The Animal Rights Lobby could be called in.

The human body is a variety of machine. A fragile, delicate machine. Only people who know precisely how the machine works, should be allowed to operate it. Everyone else is a rank amateur, and should be kept away, back there, well away from the exotic animals' enclosure.

#11 Estelle

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Posted 09 January 2002 - 09:53 AM

[quote]Originally posted by katharine kanter:

I will look up for this forum, and translate, an interview that the head of the Paris Opera School, Mlle. Claude Bessy, gave to a French weekly news magazine in 1986. She refers to the fact that dancers today are expected to dance in all "styles" (turned-in, turned-out, modern, Petipa, Balanchine, sometimes all in a single day's rehearsals) as the main cause of injury. She is scathing about the rash of hip-replacements at NYCB. Coming from Claude Bessy....


I have read such comments by Claude Bessy in numerous interviews- and I think things probably have gotten worse from that point of view since 1986, at least at the Paris Opera (more modern works in the POB repertory every season...)
For example, I've been told that the number of injured people in the company was likely to increase quite a lot each time they were performing some works by Forsythe. In his recent creation "Pas/parts" a few seasons ago, there was no second cast for some of the roles, and the choreography had to be changed at the last minute because of an injured performer...

I agree that it is worrying to read that dancers in their early 30s are already considered as "old" and have bodies crippled with injuries...

#12 katharine kanter

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Posted 09 January 2002 - 10:23 AM

Things certainly HAVE changed at POB. Noëlla Pontois would never be an étoile today. And the public has changed. A taste for extreme sensations, heretofore confined to the circus, or to the Crazy Horse Saloon, is around and about.

I recently came across a review, where a French critic found heavy fault with Elisabeth Maurin, one of Nureyev's last étoiles, for not picking up the leg ! Leaving aside the fact that the étoile in question is but five foot one, it may well be that a person of her taste and artistic judgement - renowned, moreover, as a technician - has simply decided that here was one more trick that the world can do without.

Be that as it may, hope may be at hand. A new generation of rebellious dancers may be upon us.

Perhaps the rosy dawn may even rise, on the day when dancers shall have written into their contract: "And I shall be called upon to perform no movement or movements likely to cause me persistent suffering, actual bodily harm, or mental distress, nor any lewd or indecent public acts, on pain of X thousand francs damages per day of sick leave, and on pain of X hundreds of thousands of francs damages should there be permanent prejudice to my career, etc."

Speaking of hope: There was an odd little moment at a recent performance of La Bayadère in Paris with Aurélie Dupont, one of the younger étoiles, as Nikiya. Mlle Dupont is not exactly my cup of tea, being, as she is, somewhat of a over-brisk, practical sort of person, and a deaf ear to music, but she's a damn good dancer, technically, as well as being terribly pretty. She has authority, without being harsh, and she commands respect. And here is one girl, I might add, who is NOT anorexic.

Like all the girls brought up under Claude Bessy's iron hand, she can, of course, glue the leg to the ear and make that telephone call.

But, there was Mlle Dupont, carefully extending her lovely, curvaceous limb, and - a hushed silence - that leg stops at 115 degrees à la seconde, moves to arabesque, also at 115 degrees. First time in donkeys years that anyone had seen that, unless Mlle. Maurin was on, without the leg being hoisted down from 180 degrees à la seconde, bang, down to 110 degrees en arabesque.

Ripple of shock through the room. Brain waves reeling "Could someone be disobeying the Eleventh, Guillem, Commandment ?"

But it happened. And we have lived to tell of it.

[ January 09, 2002: Message edited by: katharine kanter ]



#13 katharine kanter

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Posted 09 January 2002 - 11:45 AM

Quotes relevant to this thread, from an interview with the London magazine Dance Now (a 1994 issue) with the Danish professor,principal and mime artist, Flemming Ryberg:

"Nowadays, both choreographers and teachers are demanding from the body more than it can take, by pushing us to over-stretch, to go for too much speed, and too much gymnastics.(...)

"(...) Nowadays, I don't think they use the plié really. To understand how to jump, look at the animals: they go down deep on their haunches, they jump, and they land softly. Today we land – one shouldn't say like a cow, but we do land so hard on the floor ! That spoils the knee and the ankle and the hips too.

"I think it comes from the modern Russian style. I was trained in the Vaganova style by Vera Volkova, which was soft and more natural. But today everything has to be so technical ! You have to finish in your position very hard, and show it so flashily that everyone will say: "What a technique !" That is not dancing !

"I don't think that Bournonville with all his jumps will spoil the knee or anything else. Of course, before you dance, you have to think of warming up the body, and then you can jump all Bournonville's steps. It has never spoiled the Danish dancers. Now they ARE spoiled, because they have changed technique: they have Russian technique, they have Balanchine, they work in all different techniques, which call for much more leg extension, and much more turn-out. That makes it far more difficult: nowadays, you have to think very carefully about every movement you make, otherwise, by the age of thirty, you can't dance any longer.

"I was dancing double tour en l'air and such things on stage, until I was 47 ! And if they had asked me to continue – well, I was dancing on stage only once a month, and that was too little to keep in shape – but I could have continued, because I was good, since I always warmed up before doing anything. The muscles and the skeleton must be prepared for what you are going to do.

"Another reason there are so many injuries now, has to do with how the steps should move. In Bournonville we move a lot. It goes, it floats, you move, you do not "sit" on a step when you land. And it goes up and down in the plié, go softly down on the floor. You have to go through your foot all the time.

"At the moment, dancers think too much on the technique, on the turnout. To turn out the skeleton really has to work at it, because the muscles and the skeleton must be coherent at all times. You can't turn the foot, without the knee. You have to turn the whole thing. If your knee tends to look ahead, while your feet look sideways, then, as soon as you plié, the knee twists wrongly. The knee must look over the toes. When young people start, they have to be taught the plié very carefully, i.e. how to turn out in a real way.

"The first year I had Erik Bruhn as my teacher, I was twelve years old, and I only was allowed to do first, second, third, and a little fourth position in the first year. If you are not turned out enough for the fifth position, the knee will be spoilt. If you train every day and give a little more, then you do a third position. You should not go into this blocked position of fifth before you know exactly where you can place your hips and your turnout.

"If you start too early you see a lot of children who are spoiled and it is very difficult to correct them later. They can't jump really. It is difficult to land turned-out from a jump, if you do not have the real feeling for the knee being in the same alignment as the toes, as though you were ski-ing ! If we remember this, there will be less knee injuries."

#14 Estelle

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Posted 09 January 2002 - 11:47 AM

[quote]Originally posted by katharine kanter:
Things certainly HAVE changed at POB. Noëlla Pontois would never be an étoile today. And the public has changed.
Could you elaborate, please (perhaps in another thread, as this has little to do with the present thread)? Do you mean for reasons of style, or technique, or of body shape? I have never seen Pontois dance, as I became interested in dance just before her final retirement (she danced her last performance at the age of 50, in 1993), and have seen no video of her. She was very popular as a principal dancer (and my mom was a fan of hers when my parents lived in Paris in the early 70s). I find that her daughter, Miteki Kudo, who presently is a sujet of the company, is a very charming dancer, and regret that she hasn't been given more opportunities to dance.

[quote]
A taste for extreme sensations, heretofore confined to the circus, or to the Crazy Horse Saloon, is around and about.

I'm afraid it's not restricted to the POB, and not restricted to dance- there are so many movies which focus mostly special effects and "extreme sensations" too...

[quote]
Perhaps the rosy dawn may even rise, on the day when dancers shall have written into their contract: "And I shall be called upon to perform no movement or movements likely to cause me persistent suffering, actual bodily harm, or mental distress, nor any lewd or indecent public acts, on pain of X thousand francs damages per day of sick leave, and on pain of X hundreds of thousands of francs damages should there be permanent prejudice to my career, etc."


Unfortunately, that seems as unlikely to happen someday as, say, dancers being better paid than musicians... wink.gif

[quote]
She has authority, without being harsh, and she commands respect. And here is one girl, I might add, who is NOT anorexic.


I remember reading several interviews of her in which she mentioned having had some weight problems and eating disorders (and she said that one cause of the problem was a problem of lack of self-confidence).

Still about the injuries: Victoria mentioned the fact that the dancers are often too optimistic, believing that injuried won't happen to them. I wonder if also there isn't another problem, which is considering that not dancing because of an injury is a sign of weakness, and that "the show must go on" and a "serious" dancer should keep on dancing even with injuries. Probably that's partly because of necessity (the careers are short so they can't miss an opportunity, and also most dancers are not well paid and can't afford to stop too much), but perhaps it's also a problem of way of thinking and of respect for one's body. Ballet dancers always seek perfection and are used to work hard, and it might be difficult to tell the difference between a "temporary" pain which usual in the training, and a more serious injury which can be health-threatening.

[ January 09, 2002: Message edited by: Estelle ]



#15 Alexandra

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Posted 09 January 2002 - 12:08 PM

Many good points. "extreme technique" and style grazing were both coming into their own by the 1970s, when I started watching dance, and I remember at the time there were a lot of articles criticizing company directorships for the number of injuries. The difference seemed instantly noticable and was commented upon -- harped upon. Glen Tetley and John Neumeier were the Devils then. (I've seen Neumeier works rehearsed and it was frightening. One man was nearly knocked unconscious by a sharp blow to the chest -- right over the heart. Several "moves" had been changed. "Oh, we don't do that any more after X hit Y in the eye," etc.) Like many Bad Things that came into dance in the 1970s, we've gotten used to it now. (Well, some of us have; I haven't.)

On injuries generally, beyond technique, there may be a psychological component as well. I did an interview with a Washington Ballet dancer years ago who felt that some of her injuries had been caused by nerves, or fear of dancing. Twice when she had to do a part she felt she was not suited to, nor ready for, she became injured in the last rehearsals. She said that made her look for it in others and felt she could tell when someone was going to be injured: they were stressed, or frightened, or reticent about doing a big role.


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