Pittsburgh Ballet Theatre soloist Christine Schwaner said she remembers the exact moment she suffered the first serious injury of her career, a bad left ankle sprain she sustained in a fall at 1:30 p.m., Dec. 16, 2008, during a rehearsal of "The Nutcracker."

"I slipped on the floor," she said.

"When I did that one, I did it good. When I fell, all my weight went on my ankle."

Surgery was advised, but Ms. Schwaner said no. Instead she took two months off and did physical therapy. But more than two years later, the ankle still hurts at times.

"I have pain on heavy [rehearsal] days but can control it well," she said.

And working through pain is something every professional dancer does.

"I've never been seriously injured," said principal dancer Alexandra Kochis in the PBT training room, discounting a sprained ankle that hurt her for a year. "But something is always sore, strained. It's rare I don't come in here during the week for something."

The moves they do on stage are graceful and look effortless, but ballet dancers are finely tuned athletes, subject to injuries just like football or hockey players. It's the hazard of a profession that requires them to be in motion for hours every day.

On days they're not performing, PBT dancers take class, perform or train at the company's headquarters in the Strip District from 9 a.m. to 6 p.m., with an hour off for lunch. On a performance day, they may rehearse in the morning; take a class at 5 p.m.; and a few hours later perform on the Benedum or Byham stage, Downtown.

"During the Nutcracker season, if they're not performing, they're rehearsing," said Kathleen Nachazel, senior manager of UPMC Sports Medicine and athletic trainer for PBT.

Even young student dancers get hurt, she said, although the kinds of injuries kids experience are different than those of adults.

"The youth dancer, they typically have injuries related to the fact that their skeleton is immature," she said. "They're still growing -- a lot of them are in the middle of a growth spurt -- so they tend to be weak and inflexible, which leads to injury."

This also is a time when female dancers are initiating pointe work, or dancing on their toes. This can lead to knee pain caused by the kneecap rubbing against the end of the thigh bone.

"Bones grow so quick, and muscles and tendons don't grow as quickly, so they're very tight and very weak," she added.

Ms. Nachazel said young dancers also suffer fractures to the fifth and second metatarsals, or foot bones. The former sometimes occurs when a dancer rolls an ankle; the latter is a repetitive stress, or overuse, injury.

In adult dancers, she said, "you deal with hypermobility -- joints are really loose and really flexible -- though men can still be a little more tight. So with adult dancers you work with core strength, and they have a lot of injuries due to overuse.

"They have very high demands on their body, a lot of rehearsals and very high expectations. And I think in the ballet world, they really try to push the limit. The choreographers really try to push the limit on the body."

There are injuries common to adult dancers starting in the foot and moving all the way up the leg.

In the foot and ankle, Ms. Nachazel said, common problems are plantar fasciitis, an inflammation of a thick band of tissue that connects the heel bone to the toes; Achilles tendinitis; and FHL tenosynovitis, an inflammation of the flexor tendon in the foot and ankle.

Men can experience pain at the front of the knee, which develops because the IT band -- a band of tissue that runs up the leg from the knee to hip -- and the thigh muscles are very tight due to repetitive jumping.

In the hip, a lot of dancers have what's called "snapping hip." There are two things causing it: Either the IT band or a tendon in the front of the hip becomes really tight because of jumping or moving the leg forward and backward, a classic ballet move.

"I think a gymnast may have comparable injuries," Ms. Nachazel said.

Bradley Wong, a student with the PBT graduate program who dances in some of the performances, said he has been injured "more times than I can remember -- four or five times." The injuries have included a torn ankle ligament, a back injury, knee pain (cause undetermined), and "numerous" sprains of both ankles.

Alison Kappes, a member of the corps de ballet who is retiring to complete her psychology degree at the end of this season, had arthroscopic surgery on a knee a couple years ago and missed seven months of time.

"For some reason it took me a long time to recover," she said. "My [thigh muscles] shut down; it didn't recover as fast as some people do."

Such layoffs are deadly to professional dancers and add to the pressure of wanting to perform their best.

"Because your body is your occupation, your body is job security, you've got to make sure you stay healthy in order to work," Mr. Wong said.

Most of the dancers interviewed said staying fit was the best way to stay healthy, and that means augmenting their rehearsals and dance classes with other forms of training. They have a workout room that includes such equipment as free weights, an elliptical machine, a stationary bicycle and stability balls.

"I warm up and stretch before class and then stretch when the day's over," Mr. Wong said. "I do a little cross-training, some weight-lifting and the elliptical machine."

Ms. Kappes augments PBT work with regular exercises and walking her two dogs, a papillon and a shepherd mix. Ms. Kochis does Pilates, swims and does resistance band exercises. Ms. Schwaner likes to walk, particularly when she's back in her native Brazil, and also does Pilates.

Ms. Nachazel, meanwhile, watches for movements that might lead to injury. "If someone is using repetitive poor technique, we like to correct it before an injury," she said.

She talks to the dancers -- and lectures the students, who also are screened for tightness or weakness at PBT's summer camp -- on injury prevention and treatment. Also available to PBT dancers from UPMC Sports Medicine are Aimee Kimball, director of mental training; Leslie Bonci, director of sports nutrition; and physical therapist Erica Coffey.

Freddie Fu, UPMC orthopedic surgeon, is the official team physician of PBT.

From the Pittsburgh Post-Gazette, published March 21, 2011

Pohla Smith

photo:Bob Donaldson