Optimising dancer performance and health with research

Dancers of The Australian Ballet are like high-performance athletes. They repeatedly put their bodies under great stress, which means that their musculoskeletal tissues are vulnerable to overload and injury. They also face unique psychological and emotional challenges while they balance professional and personal priorities, and build sustainable careers.

We’re using our research findings to improve ballet training, injury rehabilitation, and wellbeing and development programs. We aim to reduce injury rates and successfully rehabilitate injured dancers. The ballet-related research findings are also being used to create better outcomes in other elite sports and for the general population.

We propose that the findings from our research in musculoskeletal health and overall wellbeing could be applied to a range of sporting areas, professions, research fields and the wider public, including:

• dancers (beginner to elite)
• athletes
• sports (including cricket, tennis, netball, football, soccer and swimming)
• general public
• surgeons, clinicians, radiologists, and physiotherapists
• sufferers of joint pain and osteoarthritis.

Research

Our current research explores musculoskeletal health and wellbeing in dancers.

Current projects

• Mental fatigue: Research suggests mental fatigue can impair mood, alertness, accuracy and even physical performance. Professional ballet dancers are pushed to the limits daily, rehearsing, performing and learning new choreography. This will be the first study to explore whether mental fatigue is a problem for professional dancers. (Masters project: Matt Wirdnam)
• Foot study: As with the ankle, the rate of injury to the foot is high in dance. Emerging evidence suggests foot muscle function is linked to symptoms and performance. This body of work will evaluate foot muscles using MRI and ultrasound and test The Australian Ballet’s exercise program in dancers, athletes and people with foot conditions. (PhD project: Ana Azevedo)
• Pelvic floor conditions: Pelvic floor conditions (e.g. urinary incontinence) can impact wellbeing and participation in sporting and artistic activities. This is the first study to investigate the prevalence and impact of pelvic floor conditions in Australian performing artists. (Masters project: Jess Frydenberg)
• The Australian Ballet’s Education and Outreach Program Impact Evaluation: Investigating the social impact of the program on participants, including health, wellbeing, social inclusion, educational outcomes and First Nations engagement [Katy McKeown (Head of Education and Outreach, The Australian Ballet), Professor Russ Hoye (Dean, School of Allied Health, Human Services and Sport, La Trobe University) and Dr Pam Kappelides (Senior Lecturer, Sport Management, La Trobe University)].
• Achilles tendon: The Achilles tendon at the back of the ankle helps dancers jump and run. In this study, scans using a special type of ultrasound, and clinical tests like calf endurance and different ankle tests that help differentiate common posterior ankle pain, are being collected throughout rehearsals and performances for The Australian Ballet’s Swan Lake season. The study will explore the posterior ankle response to Swan Lake. (PhD Student Bruna Tessarin, Primary supervisor Dr Ebonie Rio, co-supervisor Dr Sue Mayes)

Completed partnership projects

• Dancer wellbeing: This body of work involved the development of a ballet-specific wellness app, exploration of wellness profiles between dancers and athletes and the trial of a Mindfulness-Acceptance-Commitment (MAC) intervention for dancers.
  • Main findings: Overall, dancers were positive about the wellness app, but identified some barrier to ongoing use. Poorer wellness for stress and fatigue for both dancers and athletes were recorded during performance compared to rehearsal/training periods. On average, dancers recorded lower sleep quantity than athletes. The brief mindfulness intervention did not demonstrate any significant changes in wellbeing, but dancers reported that the sessions were valuable, and advised their ability to dedicate time to mindfulness ongoing would be challenging. Dance companies and dancers could consider monitoring apps and mindfulness interventions, as they have demonstrated benefit (intervention) in other groups and are safe, but sustainable integration into the company program is recommended.
• Posterior Ankle Impingement Syndrome: The study investigated the clinical and magnetic resonance imaging (MRI) findings in Posterior Ankle Impingement Syndrome (PAIS), and whether the findings differed between those with and without PAIS, and between dancers and athletes.
  • Main findings: MRI findings were not related to any clinical test. The prevalence of imaging findings did not differ between those with and without PAIS. MRI findings associated with PAIS were common in dancers and athletes participating at full capacity. The findings will educate dancers and health professionals about the current lack of evidence to support the relationship between imaging findings and clinical presentation in PAIS. These findings will help health professionals put MRI findings of dancers’ ankles in context, leading to better clinical decision-making.
• Protect Your Hips: See the exercises that the elite dancers of The Australian Ballet use to strengthen and protect their hips.

Over the years the Artistic Health Team at The Australian Ballet has developed a suite of hip strengthening exercises. Strength is essential for dancer performance and injury risk reduction and strengthening through range can help promote and support flexibility. Watch now to see the range of exercises routinely prescribed to all dancers at The Australian Ballet and tailored to suit each dancer’s ability and requirements.

• Hip health: Investigating how the health of hip joints in elite ballet dancers change over time (Dr Sue Mayes AM, The Australian Ballet)
  • Main findings: Most people would assume dancers’ hips are at risk of injury and that hip arthritis and total hip replacements are inevitable, due to the extreme movement required for ballet. We discovered that professional ballet dancers’ hip health is very similar to athletes and dancers’ hip health did not change over five years. Ballet dancers’ hips appear to cope with the extreme loading over many years. The findings suggest that ballet can be promoted as a safe form of physical activity.
• Hip hypermobility: Investigating the relationship between joint hypermobility and hip joint health in professional ballet dancers (Dr Sue Mayes AM, The Australian Ballet).
  • Main findings: Hypermobile dancers are at no greater risk of reporting hip pain and injury or retirement over five years, and cartilage defect prevalence was much lower in hypermobile dancers than non-hypermobile dancers. Joint mobility can be measured clinically and guide the education of dancers. Hypermobile professional ballet dancers can be reassured that they may be at no greater risk of hip injury.