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Team Zarely: Lisa, you have been working with professional ballet dancers and world class athletes for over two decades. How did this story start exactly?
Lisa Giannone: I started working with professional dancers in approx. 1998 when I rehabbed one of the world renowned principal male dancers of SF Ballet who had completely torn, and had repaired, his Achilles tendon…often a career ending injury for a dancer or jumping athlete. That successful come-back began a steady flow of ballet and other dancers to me at my clinic, Active Care, in SF. Prior to seeing ballet dancers, I have always seen professional athletes from all sports, with a specialty in NFL and NBA as well as Olympians and boxers. Over the years I have treated pro, collegiate, Olympic and serious recreational athletes of all sorts using a mechanics, bioengineering, specific targeted exercise approach to get folks back to their desired level of activity and beyond at as rapid and safe a pace as is possible. My background in biochemistry and physiology with graduate work in biomechanics (as a student and graduate of UCLA) is what has molded and influenced my approach to treating sports and orthopedic injuries, as well as inspired me to open my own clinic in my mid 20’s so that I could develop a unique approach of my own to address the full rehab and performance recovery of athletes with ortho injuries.
LISA GIANNONE, FOUNDER OF ACTIVE CARE STUDIO, AND DAVIT KARAPETYAN, PRINCIPAL DANCER WITH SFB (SAN FRANCISCO BALLET)
Team Zarely: Which ballet companies are you currently collaborating with?
Lisa Giannone: Primarily, I work with SF Ballet as their rehab and conditioning consultant and have done so for at least 16 years. I also work with LINES ballet and Smuin Ballet (both are SF based) as a regular consultant. I have strong referral relationships with other ballet companies around the USA and in Europe and routinely receive young dancers as patients from ballet schools in the area and beyond. As well, I serve the SF Ballet School as their conditioning specialist, teaching conditioning/injury prevention classes in house.
Team Zarely: Wow! That surely is a useful class! What are the most common ballet-related injuries?
Lisa Giannone: Ballet injuries are mostly caused by use/overuse… many reps in one place of action. They are in the category of “wear and tear” and commonly have a relationship to the degree of range that the body works in and its built in instability (or laxity). From these patterns one can see stress reaction of bone, ligament sprains both chronic and acute, degenerative cartilage and joints (including meniscus tears, cartilage defects and wear), instabilities of the shoulder and hips, cartilage tears to the same and a variety of tendonopathies. The most common pathologies are of the knee, patellofemoral cartilage wear and tracking, patellar tendonitis (slightly greater in men than women), hip cartilage/labral issues (slightly more in women than men), foot and ankle ‘ititis’ of various tendons, FHL, posterior tib, first metatarsophalangeal joint degeneration (at young ages often), spine issues of the disc or facet joints (more in men for sure) and some shoulder instability in both sexes. There is an array of other pathologies specific to the dancer body but these are the ones I will see very routinely.
Team Zarely: Is there any difference between ballet and professional sport injuries?
Lisa Giannone: Many typical sports injuries are related to the high rates of force which is involved in an acute setting. That’s not what you normally see in dance. In sports, there are more abrupt movements, with cutting, sharp direction changes and impact. However, the two do share the pathologies related to repetitive use, that is tendon and soft tissue strains that need recovery to allow full function and compressive issues like meniscus, cartilage and bone stress/breakdown. Both specialties, pro athletes and ballet dancers, must regain optimum function of the injured tissue and be able to incorporate it into full, high load, duty for a successful return to their craft. In sports, the need for high force production is greater than in dance where the goal in re-training the body is more targeted toward endurance and perfect control.
Team Zarely: Preventing injuries is always better than curing them. What are the cornerstones of the preventative care you introduced to ballet dancers?
Lisa Giannone: After all these years I understand intimately what are the physical requirements for professional ballet dancers: not only ballet specific positions, patterns, class and choreography, but what are a pre season, in season, touring load demands of the body. In general, the doses of stamina training is key as ballet can lack that kind of stimulus and one needs stamina not only to complete and repeat a piece but to endure the season with physical durability and resistance to breaking down. Having some cardiovascular vigor is essential to that even if ballet is done in short bouts – there is an overall endurance component that gives improved health and tolerance.
Secondly is the need to be “in one’s key muscles”, or activate fully those muscle groups that support the skeleton up and lengthened against gravity. I do not call this strength work, I call it “neuromuscular training” and its something I do a TON of… That is knowing how to find in one’s self, and activate wholly (both independently and as a part of whole movement) the key muscle that motors and supports the joints and the body in general. This should be part of the preventative exercise program of every dancer and, of course, adjusted to their particular body type, strengths and weaknesses.
Team Zarely: What are your general recommendations for sports, fitness?
Lisa Giannone: My general recommendations are that you must prepare your machine above and beyond what you do to train your skill. That is, the body is your machine and must work at an optimum level and be tuned, turned on, activated in all ways that support the forces and loads you will be subjecting it to. There is the magic in rehabbing and training different body specialties, understanding what your body needs to do in order to optimally perform its craft. Once identified, make sure you know how to support those actions with proper supportive exercise and training. One can not train to be a superstar always just by repeating the same patterns over and over – supportive training must be included in a wise, durable and winning career. This IS what the proven pros do.
Lisa Giannone: It is fiction that activating muscle and building strength, equals getting tight and short muscles. There are ways that one can somewhat shorten a muscle by working it but it takes special and ‘inconvenient’ training that does not occur routinely when one performs wisely designed exercises. Using a muscle for the benefit of protecting, stabilizing and motoring a joint is so much more complicated than throwing heavy weight around to get big. Getting big and bulky is in and of itself a certain type of training designed to get that result. This has NOTHING to do with how one should or would “strengthen” as a dancer. “Strength training” for dance is all about the neuromuscular activation, the learned ability to sustain a solid contraction and the ability to use that muscle to motor the joint through the full range of motion required for the craft.
Team Zarely: People often look for simple answers to complex questions and diet is definitely one them. What are your recommendations on healthy diet for ballet dancers?
Lisa Giannone: Ah! This is such the hot and tricky topic – weight control is a math equation… energy in vs energy out… one must be aware and conscious of that and the best results in weight control are realized when one assures that energy out/the energy burn (or calorie burn as its commonly known) must be greater than, or equal to (if one is attempting to maintain weight) the calories/energy in. While it is thought to be somewhat taboo to count calories, some thought about what you put into your body and what its content is cannot be avoided. One must understand what foods are protein, carbohydrate or fat, what sorts of volumes of each carry what amount of calories and how one must balance the volume of those to make the energy match, or deficit, for the purposes of weight control or loss. There’s no way to cheat the system and the less one thinks one can, the better.
The flip side in dance is it’s so much about body shape and size that it is at the forefront of every dancer’s mind. While thin is good and desired, one must maintain enough weight and calories and size (not over size), to be sure good health is maintained. The risks with too thin are related to bone loss and stress and general tissue breakdown based on some level of malnutrition.
The good news is one CAN have it all – the body shape and size one desires, without a life of total restriction. The real key is enough cardiovascular, intensity based, alternative exercise, in addition to your dance “job”, to burn and use excess calories. This gives one the freedom to not starve but to eat consciously and normally. Understand that protein stores in a lean fashion, carbohydrates do not and fat certainly contributes the most inefficient, high storage calories… you can shape your own body by eating wisely and exercising vigorously a minimum of 4 to 5 days a week on top of dance. The way you feed yourself should not be punishment and restriction but should be conscious and educated and match your energy output.
Team Zarely: Lisa, do you cook?
Lisa Giannone: I absolutely cook, am Italian… Beyond that I am interested in eating good, tasty, homegrown, seasonal foods. I grew up in a grocery store in rural California and the rest of the family were farmers. I was exposed to eating from the ground, seasonally and in as fresh a form as possible. Don’t get me wrong I am not an uptight eater, but I am picky. Again, eating food in as pure a form as possible and made by myself so that I know exactly what goes into it – this is the way I can control the fat loads. I use very little fat when I cook and have all kinds of great tricks to make something good, lengthen it, moisturize it, without using fats.
Team Zarely: And what is your ideal breakfast?
Lisa Giannone: I always eat in the a.m. and avoid eating much at all during the day – just enough to keep me from being hypoglycemic and usually involving dried fruits, nuts, a little carb bite. But breakfast is always healthy grain-based toasted bread or a bowl of cereal I almost never stray from that.
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