Mitigating injury risk with Niall MacSweeney and the School’s dedicated Healthcare team

There’s nothing that matters more to us than our students’ well-being. We’re proud that our Healthcare team isn’t simply following the latest research on injury risks in ballet, but they’re writing it.

We spoke with our Physical Development Lead, Niall MacSweeney, about his PhD on injury risk in pre-professional ballet, and the first of his published papers on the subject, ‘The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review‘.

This first study is a review of the existing research in the field to provide insight that may benefit practitioners in organisations similar to ours and to highlight future research opportunities within this specialised population.

The studies’ findings are presented around major themes of injury risk which emerged from the review: age and maturation status, anthropometric and body composition, strength and power, joint mobility and range of motion, specific dance function, and cardiorespiratory fitness.

Can you tell us a bit about your background and how you came to your unique PhD study?

I’ve been at the School for five years. Before that, I was working as a strength and conditioning coach in a sport. As an aspiring coach, I worked in a wide range of environments including universities, parasports and with aesthetic athletes such as ice skaters and dancers. This gave me a wide range of experience and helped me to apply my knowledge in less conventional environments.

After beginning the role part-time in 2017, I am now the full-time Physical Development Lead. Physical development at the school encompasses Pilates instructors, strength and conditioning staff, our data scientist and our rehab ballet instructor. The PhD came about a couple of years ago—this is the start of my third year— with St Mary’s University. I wanted to challenge myself to become a better coach and I also felt that a lot of the questions I wanted to answer would be crucial to provide the best possible service to our students.

Ballet has unique demands. What research is missing in the healthcare research space at the moment to make sure that dancers’ needs are met?

I think one of the challenges with research in ballet is, potentially because of the lack of arts funding, that a lot of organisations don’t have the kind of resources that we have. If you compared it to sports, even the resources we have are minimal, tiny, compared to what you might see at a football club.

This is a real challenge when you want to conduct good research, as you might not have access to the number of high-level dance students that you need to draw meaningful conclusions. Alternatively, you might be one physio trying to conduct research on a whole school or company. Ultimately without the right resources, it is very difficult to conduct a high-level research project. For example, we have the luxury of being able to collect data over multiple years, but if you’re a physio with a touring dance company, you might only have six weeks to conduct your research, which is bound to be heavily influenced by external factors to the tour itself. These are not ideal conditions to produce high-quality research. That was one of the things that came out in my study, that researchers are doing really interesting work, but some of the methodology used wasn’t as high quality as it could have been, ultimately due to the circumstances surrounding the projects.

The study made various recommendations for future researchers including ‘using standardised and replicable screening measures, understanding longitudinal changes in both modifiable and non-modifiable physical characteristics, and investigating how dancers with specific characteristics perform during their regular dance activity.’ So the more that bigger institutions can integrate healthcare teams within the organisation or create links with university research programmes, the better quality and more robust data you’ll be able to collect.

You identify some characteristics that may influence injury risk for pre-professional ballet dancers. How can the School’s Healthcare team keep the risk of injury low for the students?

In terms of the staff, we’re lucky that we’ve got quite a unique multidisciplinary staff for this type of environment, the physical health team and the physical development team, who are trying to put strategies in place that mitigate injury risk and, where possible, support our dancers to improve in general. And then, of course, we’ve got mental health support, councillors and clinical psychologists.

The review I’ve conducted highlights some key areas which may influence injury. These are areas that our team is already well aware of but it confirms the areas that we are interested in are also what has been studied in the research. For example, we know that growth and maturation might be an area that might lead to certain types of injuries. Using this information, we can then make a plan for what to do to try and modify the risk of injury during those stages when dancers are having their growth spurts. I am hopeful my next studies might examine these factors in a little more depth so that we can continue to provide the best support for our own dancers but also share some of our findings with the wider dance community.

What happens when a student gets an injury?

Initially, they might be seen by one of the nurses or most likely a physio. If it was more serious they might go for a scan to examine what the specific injury is. Our doctor will then examine this and, alongside the physio work, provide the best possible rehab support. They will then coordinate the physical development staff, nutritionist, nurses and psychological staff to try and provide the best possible multidisciplinary support.

It is important for the students to understand they can still improve whilst they’re injured. It could be an opportunity to maybe work on some other things they wouldn’t have time to do otherwise, whether that means doing more upper body work with strength and conditioning or more turnout work with one of the Pilates instructors. They’d also work closely with our rehab ballet coach who’s crucial to keeping their ballet technique ticking over while they perhaps aren’t able to do the full ballet class with their year group.

It’s a holistic, supportive environment where the physios and other members of the team would stay very involved throughout and have regular check-ins with one another. It’s so important to us to have an exceptional rehab process because we know that if you get injured once you’re more likely to get injured again and we want to do everything we can to avoid that. Injuries are a normal part of every dancer’s career but we prefer to try and see how we can use it as an opportunity to change focus and instil good habits for their professional career rather than a solely negative experience.

What influences do you hope your research has on organisations like ours?

Ultimately, our goal is to keep the students safe and maximise the potential of the incredible talent we’ve got here. If someone is injured, then they aren’t able to carry on training as consistently, or at the level that they want to. They might not be able to practice allegro for a certain amount of time, which might influence their performance in the end. We want them to be able to make the most of the opportunity the School gives them with the Artistic team.

What I want to do as I progress through my studies is provide insight into how we can best support our dancers, and how to keep them healthy so that ideally they can be the best versions of themselves. My research is also heavily focused on growth and maturation: thinking about how, whilst the students are changing physically, to keep them healthy and free from injury whilst still pushing the boundaries in terms of talent development.

Do you have any general advice for dancers to keep themselves safe from injury?

The biggest thing is your lifestyle. It’s the things everyone talks about. It’s quite boring but easy to get wrong. Obviously, getting rest and recovery. Making sure that you’re sleeping well and eating well. Especially for dancers because it’s their passion, even at an amateur level you can easily be training every night of the week. If you’re using that much energy, you need to be taking in that much energy as well. Those are the fundamentals. Beyond that, the most consistent thing that’s proven to reduce injury risk is strength training. It doesn’t have to be about the heavy weights, it’s all about what’s relative to you. But strength training is great at reducing overuse injuries, which are common in dance. A recent review from Laursen found on average strength training reduced injuries by 66% (Lauersen 2018).

What would you say is so special about the School’s healthcare provision?

I think we’re really lucky in terms of the resources that we’ve got compared to other organisations and we have excellent buy-in in terms of support at the School. Even in big companies with more resources than us, healthcare staff might be working in different buildings or different departments from the artistic staff, whereas we work closely together. Also, I think working with these aspiring children, everyone has a nice kind of nurturing nature. So there’s a feeling of, ‘how can we do the best for these individuals?’ which ultimately is very rewarding.