In 1983 the leading soloist crumpled to the floor in the midst of a Pittsburgh Ballet Theatre performance at the Benedum Center. As the other dancers continued to swirl in George Balanchine's "Square Dance" all around her, she made several efforts to stand, but couldn't. The audience held its collective breath. Only after several tries was she able to get up and hop into the wings on one leg. Shari Little had torn her Achilles tendon, a devastating injury for most dancers. The other performers finished the ballet without her -- a real-life scenario reminiscent of the movie "The Red Shoes."
The dancer was quickly whisked to the hospital in an ambulance. When she arrived and the doors opened, orthopedic surgeon Freddie Fu, who had just finished in the operating room, was there to greet her.
The dancer went on to perform some of her best roles after the surgery. Its success is credited to the speed of the operation, which was within minutes of the injury, so that the muscle did not curl up into the calf. She graduated to a principal position at PBT and then went on to become a soloist at Miami City Ballet, where she retired at age 36. Now she teaches classes in the Miami area and is a highly respected massage therapist, handling clients such as the Pittsburgh Steelers' Antonio Brown.
Ms. Little was one of Dr. Fu's early successes. While he was a pioneer in the emerging area of sports medicine, he quickly embraced the connection and singular importance of dance as well. He realized that it was an art form that didn't have the financial wherewithal to care for artists who often just had to dance "hurt," grinning and bearing it for the audience, or simply quit.
There was no middle ground.
A dance doctor
Orthopedic specialist Albert Ferguson was a guiding force for the young Dr. Fu, a Hong Kong native and Dartmouth graduate, a college where he was encouraged to attend medical school at the University of Pittsburgh by Jim Strickler, dean of Dartmouth Medical School and a Pittsburgh native. Dr. Ferguson, who monitored injuries at the Pittsburgh Pirates and at PBT, urged Dr. Fu to take over the care of the ballet company.
That was in 1983. Dr. Fu has been attending to the dancers ever since, physically, mentally and emotionally.
"It's artistic, it's athletic and I really enjoy the performances," he says. "Dancers are so proficient -- you need to be aware of your surroundings."
Sports medicine was in its infancy, and dance medicine was virtually non-existent, even though New York physician James Nicholas, best known for operating on Jets quarterback Joe Namath, had published a 1975 study in the Journal of Sports Medicine that examined 61 different physical activities. Ballet was named the most demanding, followed by bullfighting and football.
Dr. Fu took a break recently, sitting in his sunlit corner office at the UPMC Sports Medicine Center on the South Side, more than ready to talk about his own 30-year career in dance (medicine).
In his early 30s when he established the first UPMC sports medicine clinic in Oakland at the Iroquois Building, it quickly outgrew the space and made the move to Baum Boulevard and North Craig Street. From the start, he built a relationship with PBT.
He would take the elevator up to the dance company's old studios on Wood Street, a part of what was then called Point Park College. He visited the studios every week and would attend virtually every performance. But by the time executive director Loti Falk donated PBT's current building in the Strip District, Dr. Fu had expanded the medical staff, including specialists in nutrition, psychology and chiropractic.
He went on to conduct a full-day dance symposium at the new studios in 1985, bringing in specialists from all over the United States, including William Hamilton, the orthopedist who is still associated with New York City Ballet and American Ballet Theatre. Dr. Fu also became heavily involved with the sprung floor that was installed at the new Benedum Center in the late '80s, contacting iconic high performance floor designer Joseph Seals, a move that would greatly reduce dancers' injuries.
Nautilus machines and weights were the instruments of choice; but he continued surgeries, including the first ligament transplant in a dancer.
Ms. Little is still a fan. "I think about [Dr. Fu] all the time," she says. "He let me guide my own recovery." He also jokingly told her that the repaired tendon was stronger than the other -- and time has proven him right.
Hard work of recovery
After Tamar Rachelle was promoted to principal dancer at PBT, she started to fall prey to injuries. Beginning in 1991 and over the course of six years, she had two ankle surgeries and six knee surgeries, the last one the world's first meniscus transplant. Dr. Fu told her early on that the procedures on her knee wouldn't work. But Ms. Rachelle wasn't ready to give up. "He was still willing to go the course, because I had a real belief in my ability to make it back," she recalled.
She made full use of the sports facility, training on an exercise bike and spending hours alone in the Sports Center's swimming pool. After the final operation in 1997, he came to talk to Ms. Rachelle. Dr. Fu held her hand and said, "This is it." With the support of then-artistic director Patricia Wilde, she prepared for one last "Romeo and Juliet." Partner Steven Annegarn took extra time to rehearse with her and the physical therapists moved an exercise bike to the Benedum Center so that she could keep her legs warm offstage during the performance. With a few adjustments to the choreography and the help of some steroid packs, the ballerina had her dream farewell, a coveted closure that most dancers don't have the luxury of experiencing.
Therapy and training
PBT's incoming artistic director, Terrence Orr, had been a ballet master at New York City's American Ballet Theatre and was amazed at the health support system when he arrived in Pittsburgh in 1997. At that time, ABT only had one therapist.
In Pittsburgh, Dr. Fu remained head of the program and a PBT board member, but the staff had grown. There were therapists backstage at every performance. And "the doors were always open," noted Mr. Orr.
One of the experts was Kathleen Nachazel, assistant director of the Sports Medicine Center and still PBT's athletic trainer since 1996. "I've never given that up," she says.
In the '90s, minimally invasive surgery allowed dancers a faster recovery time. But alternative methods were embraced as well. Functional training replaced the machines and weights, according to Ms. Nachazel. Dancers were given balance boards that combined with ballet exercises and Dr. Fu donated the first Pilates machine.
Nutritionist Leslie Bonci was added to the staff. Besides lecturing, she would actually cook on site to demonstrate healthy recipes and snacks. With renovations at the PBT studios, the UPMC support staff moved into its own training and therapy room.
Artists as partners
The dancers and the health staff began exploring the delicate balance between art and the singular physicality inherent in ballet: coordination, balance and technical hurdles among them. From backstage at the Benedum, therapists watched from the wings, trying to become more familiar with ballet technique. Occasionally they began to offer suggestions on prevention.
But for some of the dancers, there were still trust issues.
The Sports Center initiated pre-season testing in order to address fitness issues before they became a problem. It would pinpoint any weakness and determine the dancers' physical conditioning, including range of motion, strength, balance and a brief assessment of technique.
Both sides had to overcome the question of how much information would be given to the administration. In the end, the dancers would maintain their privacy with their medical team.
It was the first step toward empowering the artists.
Newly hired at the time, dancer Julia Erickson walked into the new UPMC Center for Sports Medicine on the South Side in the spring of 2001 to have her confidential pre-season screening, about the time that "wellness" would become the catchword of dance medicine.
During PBT's 2006-2007 season, principal dancer Ms. Erickson started having knee pain. She hoped that it would cool down over the company break at the end of the season. But it didn't because the injury was a structural inflammation. In July she went into the hospital.
"I felt safe going into surgery," the dancer said of Dr. Fu. "I felt like a sports star." She was back on stage doing the Arabian dance in "The Nutcracker" by December. The medical support became a safety net.
In the meantime, Vonda Wright became an assistant professor at the Sports Medicine Center and team doctor for PBT. She brought 17 years of ballet training to her job and could use French terminology when discussing an injury with the dancers. And she could understand the mechanics of a landing from a grand jete combination.
The health pros can now break down the individual physical demands on dancers' bodies and injuries can be properly evaluated and treated, but at the same time, the emphasis has turned to preventing injury in the first place.
When an ache begins to surface, senior physical therapist Erica Coffey and her staff, one of whom is always present at the PBT studios, can also defer to artistic director Orr or one of the ballet masters for a technical opinion. But when there are multiple complaints, the culprit is usually found in the choreography, which can torque the dancers' bodies in a troublesome way. Or a new ballet might use repetitive movements that strain certain muscles, for example, producing tendonitis in the left foot. Ms. Coffey is herself a former gymnast and accompanied PBT on its Israeli tour last year.
Today's dancer takes complete charge of her physical instrument. "The ball is in the dancer's court," Ms. Erickson said. She calls nutritionist Ms. Bonci "a rock star."
Now the dancers learn about foods that reduce inflammation and ways to include proper amounts of calcium, protein and carbohydrates in their diets, just to keep them performing at the top of their game.
Ms. Erickson took it a step further, taking full advantage of the tools that were available to her. Along with fiancee and former PBT dancer Aaron Ingley, the budding entrepreneur has created a health food bar, called Barre, and was able to get feedback from Ms. Bonci early in its development.
Dr. Wright reflected on the changes in the medicine-dance relationship: "Ballet is not a revenue sport. To have the full breadth of services as professional sports teams do is an amazing asset. It hasn't always been easy, but Dr. Fu has a real legacy as he thinks about the next 30 years of his career."
Jane Vranish: firstname.lastname@example.org. She blogs at pittsburghcrosscurrents.com.