Dancing through pain

While a student at the School of Medicine, Mamie Air, M.D. ’09, was juggling her course load with the demands of performing ballet, jazz, and modern dance with Yale Dancers when she developed severe pain in her hip. Sitting on an exam room table at Yale-New Haven Hospital, she didn’t yet know that she would face surgery and the end of her dance career. Her urgent care doctor’s conclusion hit her, as it would any dancer, like a death sentence: “Well, obviously you’ve got to stop dancing.”

Since she began dancing at the age of 5, Air had performed through nasty blisters, overused joints, and agonizing tendinitis. Serious dancers will not be surprised by this catalogue of miseries. “Dance is a culture of resilience,” said Cordelia Carter, M.D. ’04, a sports medicine specialist at Yale Orthopaedics & Rehabilitation Services who has cared for dancers in the Boston Ballet. “Dancers are some of the physically strongest people I’ve ever worked with. There’s a lot demanded of them physically—and repeatedly—and I think that’s where the mental toughness comes from. There’s a culture of pushing through pain.”

Air, a double board-certified and fellowship-trained physiatrist in sports and interventional spine medicine in California, now cares for dancers. Her patients, she believes, have an inherent resilience fostered in highly demanding environments. “From a very young age, there is an unusual emphasis on physical accomplishment of extremely difficult technique, both quantitatively and qualitatively, mental focus, self-control, and an aesthetic which defies normal human anatomy and physiology,” Air said. “They function in a sport which demands diametrically opposed physical traits. They must be strong, yet flexible; muscular, yet skeletal; durable, yet delicate; and powerful, but gravity defying.”

Research has shown that up to 97 percent of dancers experience injuries in a given year, Air said. It is not uncommon for dancers to put off seeing a doctor for as much as 12 months, if they receive treatment at all. Air’s research, which has received national and international recognition, has also shown that fewer than 20 percent of dancers’ injuries may be evaluated by a physician. “Many dancers will—at least initially—dance through the pain, self-treat, or seek help from a colleague.”

All this capacity for endurance would seem to add up to a classic picture of resilience. But what happens when a dancer can’t dance anymore? Air, whose Yale medical thesis explored the psychological aspects of dance-related injury, says dancers face tremendous psychological distress when injured. “Pretty much all dancers know that ultimately they will retire from their dance careers. But you never actually think it’s going to happen to you. When it does, particularly if it is a forced or unexpected retirement due to injury, you go through a grieving process, if not identity crisis,” Air said.

While some dancers may lose their way in this process, others, like Air, look for a silver lining. She won a Fulbright scholarship to learn more about caring for injured dancers at the Medical Centre for Dancers and Musicians in the Netherlands. During her residency, she co-founded the Seattle Dance Medicine free clinic, which offers free medical care to injured dancers. While no longer dancing at the performance level, Air continues to call upon the qualities she developed as a dancer. “My injury made me a better doctor. And for that, I am grateful.”