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The show must go on

As Christmas pantos and matinee shows open their doors it’s time for elaborate headdresses, high heels and spectacular routines.

Janet Wright goes backstage to speak to the physios who make sure that it’s all right on the night

Handbags and gladrags

Not many physios regularly treat men suffering from tendonitis because they wear four-inch high heels. But it’s all in a day’s work for Ed Blake, whose Harley Street clinic treats the cast and crew of West End musicals.

‘Musicals do have an amazing ability to create injuries that aren’t the norm, for example through men wearing drag,’ he says, listing an ever-increasing number of shows in which men wear the frocks: Rocky Horror Show, La Cage Aux Folles, Hairspray, Bombay Dreams... On top of the ankle sprains, forefoot soft-tissue injuries, tendon inflammation and neuromas caused by stiletto heels, performers have to contend with tight corsets, big wigs and headdresses too.

Spectacular costumes can be a particular issue for singers. ‘Heavy wigs or headdresses can cause cervical spine joint irritation and headaches. And that affects voicing quite significantly,’ Ed says. ‘So we have to be aware of any laryngeal restriction developing because of muscle restriction in the neck.’

Luckily, today’s performers don’t have to suffer too much for their art, at least not in the big West End productions Ed’s Harley Street clinic deals with. ‘Production companies have very much got the performer’s health as a priority,’ he says. 


Costumes are custom-made and can be further adjusted to each performer’s needs. Choreography is made as safe as possible, with the help of specialist advisers.

 ‘We see every production that we’re associated with,’ says Ed.

‘You need to study the choreography and be aware of the costumes. Most of that time would generally be spent in rehearsals, when they rerun numbers. It’s easier to study the choreographic demands when they are repeated. And you’re watching without the distraction of lights and all the music.’

The type of injury he sees depends largely on the choreography – high-impact, for example, or with fast turns. ‘Joseph and the Amazing Technicolor Dreamcoat is high-tempo modern jazz choreography, so we see dance-specific injuries,’ he says.

Thankfully, this year’s Christmas production at the London Palladium, The Sound of Music, is not as high risk. ‘The Sound of Music is very different, with a much lower injury rate than most West End productions, because the only dance is a Viennese waltz.’

He enjoys the theatre atmosphere, and gets a buzz from the pressure to help people back on stage fast without letting them compromise their health. Physios play a complex role, he says, because performers often want to go back to work prematurely. ‘It’s a good system, where you’ve got therapists working on them, trying to return them to work as quickly as possible – but safely.’

There’s nothing like a dame

If Cinderella’s ugly sisters hurt their feet as they squeeze into her glass slippers at Southampton’s Mayflower Theatre this Christmas, they won’t have to limp far for help. Local physiotherapist Dean Cook is just a phone call away.

His role in theatre started in an appropriately dramatic fashion.

‘I had a desperate phone call from the company manager of a touring show to see someone late on a Saturday evening,’ says Dean, who has his own clinic, Dynamics, just outside the city. ‘He was very concerned about one of his dancers having an ankle injury and whether it needed an x-ray.’

Dean raced to the spot, did a rapid assessment and got the performer back on stage for Monday. From then on, he has been the man the touring company managers call if any of the cast or crew gets hurt in Southampton.

‘Actors and dancers are very passionate about what they do – it’s drastic for them if they can’t go on stage,’ he says. ‘But they know their own bodies, they know if something isn’t right. They won’t leave something to see how it gets on, they want to have it looked at immediately.’

Panto playfulness

He is often asked to see a performance of the musicals and pantomimes at the Mayflower, to get a better idea of what people are doing (the rehearsals are over before the tour starts). ‘It’s very interesting to be back stage,’ he says. ‘And with pantomimes in general, there’s quite a bit of playfulness.’  

These days no one risks spinal pain in their role as the back legs of a horse in the sort of pantos shown at big theatres like the Mayflower. They are more sophisticated, with spectacular dance routines, lasers and special effects.

The downside of pantomimes, compared with regular musicals, is the heavy schedule, with frequent matinees. There’s a higher risk of overuse injury, and cumbersome costumes can add an extra strain. The short season also means performers are even more anxious not to miss a day.

‘You try to work with the company and make suggestions,’ says Dean. ‘For example – if this dancer comes back to work, is there an opportunity to make a few adaptations – perhaps slightly different steps, or if there’s a lift causing problems could it be taken out or done by someone else? You build quite a rapport with the touring company managers over the years, and they respect your assessments.’

Dean rarely sees any major accidents, as safety problems have been ironed out before the shows go on the road. But he advises any physio interested in working with dancers that they’ll need good manual therapy skills to deal with the common soft tissue injuries.

‘You’ve got to be quite flexible because you need to work late in the evening and at short notice,’ he adds. ‘I suppose you have to enjoy working that way.’

Break it down

Toby Sullivan didn’t take long to find a rapport with the stars of hip-hop musical Into the Hoods, which has just finished a season in London’s West End. ‘I like to do a bit of break-dancing myself – mainly at weddings,’ he says.

Picking up some new moves was just one of the benefits of working with the lively young cast. ‘It was fantastic,’ he says. ‘I hadn’t done anything like that before. The nearest I’d come was working with a rugby team. It was a great show with good music and the cast were fun – a very sociable crowd.’ It wasn’t his interest in dance that got him the job, though.

‘They were specifically looking for a sports physio rather than one who specialised in dance,’ he says. ‘There were a few classically trained dancers in the cast, but effectively they were all athletes.’

The level of activity meant there was a constant flow of injuries among the 20-strong cast, mainly low-back, neck and shoulder pain. Somersaulting and ‘flipping off the wall’ through eight high-intensity shows a week, their muscles would tighten with little chance to recover before the next bout.

Toby’s experience with a rugby team paid off here, as he mobilised and strapped injured joints, did a lot of soft-tissue work and taught preventive exercises. As always, the dancers were very keen to get back on stage as soon as possible. ‘It was quite an intense three months,’ he says.


Singer George Sampson, winner of the Britain’s Got Talent contest, joined the show for the final month of the run. ‘That completely changed the audience demographic,’ Toby recalls. ‘Suddenly there were hundreds of screaming girls outside the stage door.’

Like other physios in the theatre, Toby worked with the choreographer to modify an injured dancer’s moves. Surprisingly, though, the biggest hazard wasn’t the acrobatic break-dancing but the Lindy Hop – a dance craze from the 1940s.

‘It was a new dance for everyone,’ Toby explains. ‘The boys would lift the girls above their heads and twist them around. It caused a lot of problems. They started off with six couples doing this, and ended up with one.’

And if Into the Hoods returns next year, as dance fans are hoping, Toby will be ready to spin into action again.

Skate, rattle and roll

Kate Alder’s first full-time job took her on a hectic 15-month tour with the roller-skating musical Starlight Express. She came home with invaluable professional experience and a fund of unique memories.

‘I saw some amazing places and met some incredible people,’ says Kate, who now lives in Leicester. All cast members were trained dancers who, after passing an audition, spent eight weeks at skating school. Like Kate, they loved the show because it was so different from their usual work.

But with eight shows a week plus three or four rehearsals, Kate saw lot of overuse injuries and muscle fatigue: her training in sports massage proved time well spent. The commonest injuries were to the lower back, pelvic area and especially the knees.

Whether in small traditional theatres or Wembley-sized stadiums in Scandinavia, ‘the set was quite small and they were constantly going in circles, so there were a lot of forces going through their knees’, says Kate. The skaters’ bent-kneed stance, the speed of movement and the need to avoid collisions added to the pressure.

Most at risk were the knees, with the vastus medialis obliquus muscle having to be kept in top form to ensure correct patella alignment. Having a full-time position with the company allowed Kate to spend extra time with those whose build put them at particular risk of injury.

‘One or two of the skaters were slightly knock-kneed,’ she explains. ‘That is the opposite of the ideal alignment for skating, which would be bow-legged.’


When the show was travelling around Britain, weekends meant a rush back to visit her boyfriend in the Midlands. Time off abroad offered a chance to camp in the Arctic circle or drop in on ‘the real Father Christmas’, while making close-knit friendships that are set to last a lifetime.

‘Touring was brilliant, wonderful – I wouldn’t have missed it for the world,’ says Kate. At the same time, she missed the professional support of other physios, the chance to drop in on a colleague and discuss a complex case. Now happily employed by the NHS in the University Hospitals of Leicester, she’s enjoying being part of a team.

This doesn’t rule out the possibility of being lured away by a new challenge one day. ‘I’d like to work in rugby,’ she muses. ‘You have a team of physios along with the team of athletes.’



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