DISLOCATED shoulders, ruptured tendons, torn ligaments, foot fissures, fractures ... sprains, strains, bruises, bunions.
In the world of professional dance, potential disaster lurks in every picture-perfect pose and plie.
The required aesthetic of line and the illusion of absolute corporeal control that define this visual art form come about through passion fueled by muscle, buckets of sweat and bullheaded determination.
In real life, studies show, the otherworldly beings who beautify the world's stages with seemingly effortless stretches, extreme turnouts, leaps and lifts are engaging in an activity as challenging as any high-level contact sport.
As a result, dance medicine has steadily outgrown its sports medicine niche identity in recent years, due to increasing awareness of ballet's hard-core physical and mental challenges. The first study of its kind, published in the Journal of Sports Medicine in 1975, ranked the demands of ballet ahead of 60 other physical activities, including football.
Professional ballet artists -- and modern, stage musical and folk dancers too -- learn that injuries, be they career blips or career blasters, come with the territory.
Here's Alvin Ailey American Dance Theater veteran Matthew Rushing, 32, ticking off a litany of past woes:
"I started off with a hip injury. After that, I had a back injury, back spasms, then a herniated disk, a minor sprain on my ankle, then a tear in my calf."
Or consider the "compounded frustrations" of American Ballet Theatre luminary Ethan Stiefel, 33, who recently resigned as Irvine-based Ballet Pacifica's artistic director because of the company's funding difficulties.
A week after Stiefel returned to the stage in 2005 following arthroscopic surgery on one knee, his other knee required more-invasive surgery. Less than two months into full recovery, bone spurs in both knees fragmented.
After six months of "eating anti-inflammatories and hoping things would settle," Stiefel had to pull out of this year's world premiere of Benjamin Millepied's "Closer" at New York's Joyce Theater as well as his spring performances at the Metropolitan Opera House.
"They have to basically open up the knees and cut into the patella tendons and remove these fractured pieces of bone," Stiefel said by phone from New York a day before undergoing his latest surgery April 5. Yet he hopes to return to the stage in six months or less.
Classical ballet companies, weighing injury totals against the number of dancers who perform each year, report a 67% to 95% annual injury rate -- some unfortunates account for multiple hurts, while others escape relatively unscathed. That's according to statistics documented in "Injuries in a Modern Dance Company," a five-year study published in the American Journal of Sports Medicine in 2003. It was co-written by Alvin Ailey staff physical therapist Shaw Bronner, director of research at the Long Island University-based ADAM (Analysis of Dance and Movement) Center.
Some typical causes: grueling contemporary choreography, the vagaries of stage surfaces (mitigated by portable flooring), toe shoes, bare feet (stubbed toes, split soles), hyperextensions and turnouts, stumbles, falls, bad catches, smack-down collisions and, No. 1 on the list, overuse.
"We estimate that most professional dancers and students on a professional track probably do over 2 million little jumps a year," says Richard Gibbs, San Francisco Ballet's staff supervising physician, who works with a team of orthopedic surgeons, therapists and physical trainers to keep his company healthy. "That's a lot of wear and tear."
A more diversified workout
THE good news is that many serious injuries are no longer the career death knell that they were only a few decades ago.
The landscape has altered with a shift in focus to dance medicine as a field related to but apart from sports medicine. Along with new research and advances in medical treatment and technologies, that shift has led to an emphasis on preventive therapies, some as basic as cross-training, once a ballet no-no.
Traditional thinking held that exercise outside dance class was harmful. Gibbs, a general practitioner and former ballet dancer who left ballet for medical school in his 30s, offers an example: He was taught that dancers should never get on a bicycle.
"We now know that it doesn't hurt you at all to do light weight training, a lot of Pilates," he says.
At the Ailey, cardiovascular conditioning, general strengthening and stretching have become the norm. Bronner, who is looking toward industrywide injury surveillance as a follow-up to the 2003 study, helped Rushing recover from his most serious injury, an ankle sprain, with a regimen of weight lifting, swimming, Pilates, floor exercises and yoga.
"It was key in my healing," Rushing says. "The more I did cross-training, the easier dance became. Even cooling down after you dance -- we've all known about that, but we haven't always done it. I didn't start doing it till I actually got injured."