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A Look Behind the Scenes at Cirque du Soleil: Lessons for a More Prophylactic Approach to Reduce Competitive Gymnastics Injuries

Last November we to attended Cirque du Soleil's production of Alegria during its stop in Tucson.  While watching the show and the amazing feats of athleticism by the performers, I wondered "what type of sports medicine infrastructure do they provide?" After all, it's not as though you can find an abundance of people walking the street who can substitute for an injured performer at a moments notice. 

According to a 2007 publication from the American Physical Therapy Association, each production includes a team of two to three physical therapists, physiotherapists, athletic therapists, or athletic trainers-as well as massage therapists and Pilates or yoga instructors on a part-time basis.  Obviously such a support staff would be outside the realm of the club gymnastics level, but I would still ask the following questions:  What is your gym’s sports medicine injury prevention and treatment infrastructure?   Most gyms have mechanisms in place to handle emergencies (otherwise the insurance carrier wouldn't let anyone in the building), but is the gym doing everything in its power to reduce minimize the deleterious effects of daily wear on the body?  What should the standard practice or "standard of care" be in the gymnastics field? 

Every injury results from a deficit in some realm of the performance system.  That deficit could be from factors such as safety equipment, coaching, injury prevention methods, pyschology, or any combination.  Even those "unpreventable" accidents often have some definable root, such as a lapse in concentration caused by fatigue.  Just as we wouldn’t expect medical professionals to have specialized knowledge of how to coach skills, we can’t expect all coaches to have the type of specialized knowledge in conditioning and physiology that experts in those fields have.  The above article from the APTA provides information on the cross-pollination among performance support fields that takes place at the highest levels of sport.   It is important that mechanisms exist to bridge the gap between rehabilitation and performance to create a more effective support infrastructure with the ability to offer prophylactic injury resistance mechanisms.  Consider this quote from the Director of Health Services with Cirque du Soleil:

"If a physician has cleared an artist to perform, and he or she is safe to perform the act, then it would be a discussion between the artist's coach, the artist, and the physical therapist to determine what the workload would be in any given week-especially if the artist is dealing with the challenge of having a small injury that, if it wasn't treated appropriately, could become a larger injury, or if there are fatigue issues, or a chronic problem that needs to be addressed by rehabilitation or a strength and conditioning program."

At Cirque du Solieil, profit motives obviously drive the need for a robust support staff (“The show must go on!”).  At the extreme, too many missed days would send them out of business.  If a grassroots gym’s profit was directly tied to missed days perhaps there would be more investment into injury prevention beyond the new safety equipment, the design of which often obscures more fundamental causes of injury. (Reminds me of the old economist’s joke: What’s the best way to reduce car accidents?  Replace the airbags with footlong spikes on the steering wheel).  Finding ways to reduce the number of missed training days benefits everyone and demands a team approach from the coaching fields, medical fields, and strength and conditioning fields.

For additional reading:

Injury Patterns and Injury Rates in the Cirus Arts: An Analysis of Five Years of Data From Cirque du Soleil.   Am J Sports Med. 2009 Jun;37(6):1143-9. Epub 2009 Mar 13. 

(Injury rate of 9.7 per 1000 athlete exposures in Cirque du Soleil vs. 15.2 per 1000 athlete exposures in NCAA Women’s Gymnastics)

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