PAIN: A DOUBLE-EDGED SWORD

Posted on 14 May 2021 By Pamela Hale

The mind detects pain. It can also amplify it. Our Principal Physiotherapist Sue Mayes talks about the psychological complexities involved in our perception of pain and how they affect dancers.

At a professional level, dancers live with pain. Not in the crippled-by-arthritis, blood-in-the-pointe-shoes way that many people imagine, but like an Olympic athlete, or anyone who is constantly pushing physical barriers to their limits. Our Principal Physiotherapist, Sue Mayes, says, “People in every job feel aches and pains. Sitting at a computer all day can be excruciating! But dancers are that extra step up because they are demanding so much more from their bodies. They’re training for many hours every day, they’re performing, they’re struggling with sleep because of the late hours they work – so they are at the extreme end of the spectrum. But that doesn’t mean that they’re damaging their bodies.” In fact, recent research into our dancers’ hip joints, which Mayes has carried out over five years in partnership with La Trobe University, suggests that they have suffered no adverse effects from their gruelling regimes – although they do benefit from the strengthening programs devised by Mayes’ team, which helps our company lead the world in injury prevention. Pain is another powerful ally in preventing injury. Mayes and her Artistic Health Team educate the dancers on the kinds of pain that are a normal part of their working lives – for instance, soreness and stiffness that vanishes with a morning shower or daily ballet class – and the kinds that are a warning bell. They encourage early reporting of every ‘out of the ordinary’ niggle so that it can be evaluated and nipped in the bud. But sometimes, as for every human, there is a psychological element to the experience of pain.

Photography Kate Longley

We tend to think of pain as having a direct correlation with injury: you hurt yourself, and the body lets your mind know about it. But the reality is far more complex. From an early age, Mayes had an insight into the symbiotic interaction of body and mind and its relationship to health. Her father was a doctor; he also trained rowers. There was plenty of talk in the Mayes household about the importance of belief, focus and positivity to health. She grew up with a respect for “the body’s incredible ability to heal itself”. Framing injury in the most positive way possible is a central part of her treatments. We live in the age of advanced imaging technology such as magnetic resonance imaging (MRI), and dancers can have a negative reaction to seeing their anatomy writ large in this way. “MRI is a fantastic invention,” says Mayes, “but it often reveals abnormalities and ‘damaged’ tissue that most people don’t even know they’ve got.” Life has infinite variety, and we all have just as many idiosyncratic bumps and blemishes and wrinkles on our insides as we have on our outsides, most of which cause us no trouble at all. “This is an era of over-investigation, and many athletes seek an MRI as a first stop in treatment. We here at the Ballet have resisted being caught up in that momentum.” The reason? “Although imaging is a useful adjunct, sometimes it can do more harm than good.”

Photography Kate Longley

Injuries are frightening for elite dancers, who have been working at their art form since they were small children. Getting injured can mean the lifestyle they are so deeply invested in abruptly changes. They may miss out on big roles they’ve worked for years to dance. The stakes are high. “It’s bad enough for a dancer to hear they have injured tissue,” says Mayes, “but if they see the injury blown up onto a big screen, 10 times its real size, any little bit of fluid glowing white on an MRI – you can’t unsee that image. It can make you perceive your body, which is in fact incredibly resilient and strong, as fragile. I had a dancer who had a cyst in her foot – it was miniscule, the size of a pinhead. She saw it glowing up there on the screen and said to me, ‘I feel like my foot is about to crumble and collapse.’ And it wasn’t at all. Imaging can have a very powerful effect on your mind.” Research suggests that people with prolapsed discs who see a scan of their injury recover less effectively than those who don’t, which supports Mayes’ theory. Lorimer Moseley, a clinical scientist investigating the psychological element of pain, is a pioneer in this field; Mayes’ team regularly recommends his book Explain Pain or his TED talks to recovering dancers. “We’re not telling dancers, ‘It’s all in your head’. The pain is certainly real, but there are so many factors feeding into it aside from tissue damage. Stress and anxiety can have a huge sensitising effect. Dancers will perceive more pain just prior to an opening night, and then once that stressful performance is over, the pain recedes. Fatigue is another strong factor.”

Photography Kate Longley

Sometimes if a dancer has had a bad injury in the past, then injures the same area, the trauma of that past experience and the dread of repeating it turns up the dial on their sensations. When Mayes and her team find that a dancer is reporting levels of pain out of proportion to their tissue damage, they look for the mental factors at play and help the dancer recognise and manage them. What Mayes tells dancers in this situation is, she says, just as relevant for the rest of us. “Pain doesn’t necessarily mean damage. Usually the best way to cope with pain is to get moving. When you stop moving, you stiffen up, the muscles around that point of pain are tensed and can even eventually weaken. Inactivity can also make you feel anxious or depressed. It becomes a vicious circle.” The secret is to frame it differently for yourself. “Of course, seek guidance – never ignore pain – but try to move and gradually build up your capacity and resilience, and have faith that your body has the ability to do incredible things.”

Photography Kate Longley