March 15, 2023

Athletic Therapists at Work: National Ballet of Canada

When you picture Certified Athletic Therapists at work, typically it’s on the sidelines of intense team or contact sports, or maybe even in a clinic treating occupational injuries. How often do you picture them backstage at the Nutcracker?

Certified Athletic Therapists are experts in injury assessment, rehabilitation, and prevention, providing immediate care and reconditioning for all active individuals. This includes ballet, an especially physically grueling performing art, but despite this level of physical intensity, a profession we may not always expect to find athletic therapists at work.

To understand the role of athletic therapy in professional ballet, we spoke to Certified Athletic Therapist Paul Papoutsakis from the National Ballet of Canada. Paul has worked with the National Ballet of Canada for nearly 20 years, spanning most of his career since getting certified.

What inspired you to begin working with ballet?

I was working at a sports medicine clinic in downtown Toronto, and through them, right upon graduation, I started treating many higher-level elite athletes on the teams in the city. I studied acupuncture and received my doctorate of acupuncture designation. From there, I started working alongside a therapist for the ballet, who would ask me to perform acupuncture while she treated them.

Through that experience, I was able to build rapport with her and the dancers, which would eventually be my door into the industry. In the meantime, I was able to travel on tours with the Stars On Ice skating show, further developing my experience in this area. Not long after that, the therapist who initially brought me in to perform acupuncture left the ballet and recommended I take over her position. I had a passion for learning more about ballet and the type of athletes that they felt would be a good fit to join the company, and thus began my journey with The National Ballet of Canada.

What are some common injuries you deal with at the ballet?

The most common injuries would be foot and ankle injuries; we’re talking sprains and tendinopathies, as well as stress reactions or stress fractures, the chronic type injuries. We do see some acute type injuries, but they're few and far between such as a ruptured achilles and ACL tears on stage. We also see some lower back and mid back injuries, and hip and pelvis injuries up there too. But the most common is the ankle, due to the specific movements and pointed shoes. You're jamming the full plantar flexion, your tendons are getting rubbed, you're getting your talus jammed, and then add repetitive jumping six to eight hours a day.

What does rehabilitation or prevention look like for these athletes?

The first thing we do is look at the amount of time the athlete has outside of dance, so we can plan according to their busy schedule. The typical day for a dancer includes over an hour of classes in the morning, which includes a lot of jumping and squatting motions, followed by rehearsals in the afternoon which typically last at least 6 hours. From there, we look at the type of injury we are dealing with. If it’s an acute injury, they won’t be following this typical schedule so we have more flexibility regarding when to schedule treatment. For chronic injuries or injury prevention, we have to strategically plan when in their day is best to work with them.

We always pride ourselves that we're not just reacting with rehab. We want to be a “prehab”, working on strength through various exercises to prevent injuries before they happen. Of course, injuries still occur, but the dancers typically come back sooner because they're already in great shape. Before any injury occurs, we assess dancers to check their range of motion, strength, and cardio. With that information, we can then advise where they are in deficit and how they can be more aware so they can work on it.

There’s no one size fits all approach to injury rehabilitation and prevention. We take a unique approach with each of our dancers.

What do you enjoy most about working with the ballet and these dancers?

I like the personalities and the passion they have. They care so much and are always striving to improve. Because they are always pushing themselves, it inspires me to push as well. Because they have such high standards for themselves, I have to always come up with new ways of convincing the dancers that this is the right thing to do; I have to show them why it's going to help them get better on stage or return to the stage.

What advice would you give to ballet students or professional dancers who don't work with a Certified Athletic Therapist?

Never ignore the value of strength. When you see a dancer sitting in the splits, with a strap, getting themselves further and further, as impressive as it is, it's not smart when you're trying to have a long career. Without athletic therapy and strength conditioning, you can only rely on your joints, the nerve structure, the joint capsule, and the whole joint place, and not the muscles. So you sit back on hyperextended knees, you jam your ankle, and then you wonder why your joints are wearing out.

Working with someone who understands the extremes and the limits when you're a dancer is essential. When a dancer comes to a Certified Athletic Therapist, we take the time to understand their movements so that we can help develop the program for that dancer's needs. It's a whole-body approach.

This is the biggest thing we've been doing at the National Ballet School: helping dancers get started. We have a full-time Certified Athletic Therapist on staff there so that the next generation of dancers can see how important strengthening is for ballet.

Is there anything else you'd like to share about being a Certified Athletic Therapist?

I'm a huge advocate for Certified Athletic Therapists. As part of a team with other healthcare professionals, we have a passion to get people doing what they love, pain-free, and strong. We all have different areas of expertise and bring different skills to the table, and if you’re open to learning, we can learn from each other.

If you're going to be a great Certified Athletic Therapist, physiotherapist, chiropractor, or massage therapist, you have to care to get someone better. You have to be open and put the ego aside and put your best forward for clients.

Thank you Paul for sharing your experience as a Certified Athletic Therapist with the National Ballet! To learn more about what a Certified Athletic Therapist can do for you, find one in your neighbourhood on website. Make sure to stay up to date with CATA by following us on Instagram, Facebook and LinkedIn!