Physiotherapist Tim Buckley returns in this Spotlight Series episode to break down the most common dance injuries, how to spot the difference between normal soreness and actual injury, and why consistent training matters more than you think. From ankle sprains to shoulder issues, he explains what shows up most in different disciplines and shares prevention strategies that go beyond just "warm up better." If you've ever wondered when soreness crosses into injury territory, this one's for you.

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Tim Buckley is a Physiotherapist from Melbourne, Australia.  He has worked exclusively with elite ballet dancers, circus artists and orchestral musicians during his 19 year career and has spoken twice at IADMS conferences in Australia and the USA.

He was one of two full time physios with The Australian Ballet from 2006-2008 and toured Australia, China, England and France. He joined Cirque du Soleil in 2009 and toured Japan, South America and North America with ‘Corteo’ and ‘Quidam’, before settling in Montréal to work at Cirque’s international headquarters as the Supervisor of Performance Medicine.

Tim then toured again as the Head Physiotherapist on Cirque du Soleil’s production, ‘Kurios – Cabinet of Curiosities’ in 2014-15, before moving back to Melbourne in 2016. After another year at The Australian Ballet and completing a Masters of Sports Physiotherapy, Tim re-joined Cirque du Soleil where he worked as a ‘fly-in’ Head Physiotherapist on several touring shows including Amaluna, Volta, Crystal and Twas The Night Before, as well as in Montreal on various creation projects.

Tim is currently the Senior Advisor of Performance Medicine Operations for Cirque du Soleil, providing clinical support to the physical therapy teams on Cirque’s global touring shows. Tim is a consultant Physiotherapist for Acrobatic Arts Inc, providing input on the continuing development of their syllabus and programs.

Tim also co-owns The Academy, a circus training center in London Ontario, with his wife Meaghan Wegg.

www.theacademycircus.com
Facebook: The Academy Circus
Instagram: @theacademycircus 

Previous Acrobatic Arts Podcast Episodes: 
Ep 7 Acrobatic Arts Australia, New Zealand and Asia Division Managers Meaghan Wegg and Tim Buckley - https://youtu.be/_npmTPXgEtU
Ep Ep 28 Physiotherapist Tim Buckley - Dance Injuries, Pt 1 - https://youtu.be/IsaiS8OmebI
Ep 29 Physiotherapist Tim Buckley - Listener Questions, Pt 2 - https://youtu.be/e9OPbP9LhXg
Ep 71 Student vs Professional Training with Tim Buckley & Meaghan Wegg - https://youtu.be/C4nuWxfBrTo

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PODCAST TRANSCRIPTION

Loren  0:01  
Hey everyone, welcome to the Acrobatic Arts podcast!

Loren  0:05  
I'm Loren, and I will be interviewing some of the top leaders and innovators from the dance and acrobatic industry. If you are a teacher, performer, student, or a lifelong learner like myself, you are sure to find these episodes intriguing and full of inspiration, Acrobatic Arts is passionate about providing current and relevant information for everyone. So, please sit back and enjoy as we share our passion with you and the world. 

Loren  0:36  
Today's episode is part of our Spotlight series, where we revisit conversations that continue to resonate across the dance community. Today, we're taking it back to episode 28 with Tim Buckley. Tim is a physiotherapist from Melbourne, Australia. He has worked exclusively with elite ballet dancers, circus artists, and orchestral musicians during his career. 

Loren  1:00  
This episode focused on acro and dance injuries, and it actually turned into a two-part series, because there was just so much to cover. We asked Tim to give us a little update on what he's been up to since we last had him on the podcast. Tim is currently the senior advisor of performance medicine operations for Cirque du Soleil, providing clinical support to the physical therapy teams on Cirque's global touring shows. Tim is also a consultant physiotherapist for Acrobatic Arts Incorporated. Tim, together with his wife, Megan Wegg, owned the Academy, a circus training center in London, Ontario. They also created and manage Aerial Arts, which is focused on the safe teaching of aerial hoop and silks. 

Loren  1:46  
Now it's time to shine the spotlight on today's guest. Hi, Tim, and welcome back to the Acrobatic Arts Podcast. 

Tim  1:55  
Hi, Loren. Thanks for having me. 

Loren  1:57  
You are on season one of the podcast, episode seven, with your wonderful wife Megan, and we did want you back on as soon as possible, but your schedule was crazy busy with the ups and downs of the pandemic, and your family of four became a family of five. Congratulations on the new addition.

Tim  2:17  
Thank you very much. I appreciate that.

Loren  2:20  
We're so lucky that we could reconnect today and have you talk about common dance injuries, recovery advice, and if possible, provide some prevention tips along the way. So, before I start asking you questions, and maybe for the listeners that missed the first podcast, could you tell us a little bit about your passion for physiotherapy and the type of people you treat.

Tim  2:43  
Yeah, absolutely. So, I'm originally from Melbourne, Australia, and I now live in London, Ontario, which is about two hours west of Toronto in Canada. So, I'm a physiotherapist, originally trained in Melbourne. I've done both a Bachelor of Physiotherapy and a Master's of Sports physiotherapy, so in my time as a physiotherapist, which has been about 16 years, I've worked a lot with professional performance companies. So I spent a total of four years full time with the Australian Ballet in Melbourne, and I also started working with Cirque du Soleil back in January 2009 and worked on multiple touring shows with them all the way up through until March 2020 essentially when the pandemic closed the company, but during that time I worked on Corteo, Quidam, Kurious, Amaluna, Volta, Crystal, lots of different projects, as well as a period of about two years at the head office in Montreal, rehabilitating injured artists from around the world who were coming back to Montreal to get fixed up.

Loren  3:47  
That's amazing. I think we are in great hands, everyone. So, let's jump right in. Can you tell us some of the common dance injuries?

Tim  3:57  
Yeah, absolutely. I think there's a big difference in the style and the discipline of dance that you're training, and whether it's pure dance versus acrobatic dance versus circus arts. So, certainly in dance, one of the most common areas of the body that is injured is actually the foot and ankle. So, ankle sprains happen quite often, especially with dancers that are let's say rising on demi points or rising on points or jumping and landing, but then that can also change, so let's say with acrobatic dance we're taking that dancer and we're flipping them upside down and putting them onto their hands a lot of the time, so whether it's in planks, handstands, cartwheels, bridges, walkovers, and this then creates a lot more load through the wrists, the elbows, the shoulders, and the upper body. 

Tim  4:46  
If you then look over at circus, actually Cirque du Soleil did a review of their injury statistics and found that the most common area of the body that was injured in circus was the shoulder, which then makes sense because in circus you have a lot of climbing and hanging and swinging, so then the shoulder is placed under a lot of load, so again, depending on the discipline that the dancers are working is really determining the area of the body that tends to be injured, whether it's muscular strains, whether it's joint sprains, potentially even stress fractures, less often, but quite the range of things that we see.

Loren  5:21  
And I remember one time we were talking, and you also worked physio for the orchestra, is that correct?

Tim  5:28  
Yeah, that is true. So, during one of my periods with the Australian Ballet in 2016 that was, I was lucky enough to be offered a role of working with Orchestra Victoria, so that's the orchestra that provides the music for the Australian ballet. So that was a fantastic opportunity, and it was really eye-opening to see the differences between musicians who were sitting relatively stationary for a very prolonged period of time playing a ballet and the types of things that they were starting to get, you know, upper back, shoulder, elbow, even forearm from, you know, playing their actual instruments. So that was a great experience.

Loren  6:10  
Yeah, I just thought that was interesting. You never think of that until someone mentions it, that yeah, I guess, depending on the profession you choose, is where your injuries are most likely to occur.

Tim  6:22  
Right. Yep.

Loren  6:23  
Now, as a dance teacher and an acro teacher, how do you know if your students who are experiencing pain or discomfort are experiencing that pain from an injury?

Tim  6:35  
Yeah, and that's a really good question. And I do speak a little bit about this in Module one in our Acrobatic Arts Module One course, and the way I look at it is that there's going to be some normal adaptive soreness that comes from any sort of athlete or artist who's learning a new skill and exposing their body to new forces. As our body learns to adapt with, let's say, doing a handstand, our muscles are going to get sore, our joints are going to feel a little bit sore. Okay, and it's about differentiating what is normal adaptive soreness and what is progressing into an injury, for example. 

Tim  7:11  
So, again, just the way that I usually look at it is number one, the amount of pain, or how high grade or low grade the pain is that a person is feeling, so if it's from zero to three out of 10 in intensity, okay? If it's dull in nature, aching in nature, and if it goes away once you stop that activity. So, let's say if you're doing a handstand and you shake out your wrists and you sort of loosen the joint off a bit, if that dull soreness goes away, or if you go to bed that night and it's not keeping you awake, and the next day you feel relatively back to normal. Okay, this is pretty typical of adaptive soreness, and definitely delayed onset muscle soreness can be another thing where you just get some general muscle soreness throughout the muscle, you know, 24 to 48 hours after you've done something that your body is still working on, or that you haven't yet developed the strength and the tissue tolerance for that. 

Tim  8:08  
On the flip side of that, injury pain generally speaking tends to be more high grade in nature, so four out of 10 and above, you know, is more going to be sharp or knifing in nature, so you're actually feeling a very distinct pain in a particular area of the body. It doesn't tend to go away when you loosen off and cool down, and then it might be throbbing and keeping you awake at night, and then the next day you might wake up with some swelling around the joint, or aching, or it feels really stiff and sore. Those kind of indicators are much more suggestive that there is an injury starting to brew or starting to happen, and those are the kind of warning signs that you would want to go and get it checked out by a physiotherapist or a doctor.

Loren  8:51  
I generally say if it still hurts in two weeks to go see a professional. Is two weeks too long, or does it depend?

Tim  9:00  
Yeah, I think I think it's a good benchmark to have. Certainly, injuries can crop up faster than two weeks as well, depending on the workload and depending on what the dancer is actually doing. So, I would say you wouldn't necessarily just want to wait for a set period of time. It's really about monitoring how that injury is behaving. So, is it getting better with rest? Is it staying stable from a day to day basis, or on a let's say seven day basis? Is it relatively stable and not getting worse? Does it warm up with activity? Is another good sign. So, if an injury doesn't warm up anymore, and it gets worse with activity, again, that's a warning sign that something may be happening that you would want to get checked out. So, I think rather than going for a strict timeline to get it checked, I would just monitor those signs of how an injury is behaving to dictate whether you know you want to get that checked out by a professional sooner rather than later.

Loren  9:57  
Great, thank you for that. And how can injuries be prevented in general?

Tim  10:04  
Yeah, so generally speaking, it's definitely a topic that is hotly researched, and people are keen to find out ways that they can prevent injuries, because injuries themselves result in time off from whether it's a recreational pursuit or whether it's time off from paid work as a professional performer, it also creates costs for companies who are hiring professionals, because then there's, you know, retraining and replacing of things, so injuries are absolutely a pain, but they're also something that create a lot of collateral sort of damage or issues, right. 

Tim  10:41  
So people want to prevent injuries again. In our module one course, we speak about a really important way of preventing injuries, is sticking with the progressions in the syllabus. Okay, so what that means is always having a dancer progressively work their skills in a way that is sequential. Okay, and they're building up their, their skills, and they're working through the progressions of a syllabus, like acrobatic arts, for example, because what happens with that is not only is a dancer developing the technical skills required, they're taking along with them a balanced flexibility and strength program that's built into that syllabus, so they're building that flexibility and their strength at the same time as developing their bridges, their bridge kickovers, their back walkovers, their front walkovers, all of these skills that we see in acro dance. 

Tim  11:31  
So certainly following a progressive syllabus with a qualified coach is number one. Another really interesting sort of concept that's come out recently is the idea of having a consistent workload with athletes, and this is something that I certainly see clinically, in that there's some research now that's really showing that a trough in an athlete's workload, which is a dip in their workload. Okay, so for example, Christmas break, or taking, you know, three to four weeks off of training, having that trough in the workload may give the dancer or the performer a temporary feeling of their body, you know, feeling better because there's not, there's less work and load going through it, but then we see that when they come back out of that trough, usually in the first sort of week to two weeks, we actually see a spike in injury rate. 

Tim  12:24  
Okay, and I certainly saw that in my time at Cirque du Soleil, where when we pulled down the big top, traveled to a new city, and set up a new big top in the new city, there was a little rest period there, and in the short term it was great because you had a rest on your body, but we would really see a spike in injuries coming in around week two in that new city, so the message there is that it's often better to keep a very consistent workload, so if you're going off on a break to actually give your dancers and your performers a conditioning program that they can keep up with over the break, so whether you give them a homework sheet or they're still working on the strength portion or the flexibility portion of their syllabus to avoid that trough in the workload, because we now know that that can actually cause a greater incidence of injury when they return to work. 

Tim  13:14  
One other thing on that, on that topic, which is quite current, is that in the clinic I'm seeing that with the pandemic, so kids have gone through repeated bouts of lockdowns and having to switch to Zoom classes, and some kids have even dropped out of dance, and as things have started to reopen, certainly in the clinic, we're seeing a spike of injuries from recreational athletes that are coming in, from people who have gotten back into sport after being off for a while. Okay, so again we're definitely seeing that trend just clinically from the pandemic and the lockdowns that we've experienced.

Loren  13:52  
Wow, that's some great information, and I will definitely be implementing that in my classes. So, thank you for that. Now, what kind of exercises should dancers do to support their efforts in injury prevention in the studio? So, how can we, as dance teachers, help our students?

Tim  14:09  
That's a great question. And I think, again, it's about keeping a consistent workload and a consistent training load, so monitoring how many hours per week your dancers are doing and training and really trying to keep that workload consistent. Another thing that can actually trigger injuries is a rapid change of anything, really. So, it can be a rapid change in the quantity or the intensity of work that a dancer is doing. It can be a rapid change in floor surface. So, let's say if your dancers are only used to training on blue mats, and then they head off to competition and start tumbling on a wooden stage that they're not used to. It can be a change in footwear. Okay, so we see that in runners who, let's say, they all of a sudden get a new pair of running shoes, that can be just the straw that breaks the camel's back to tip their body over into an injury. 

Tim  14:59  
So it's about consistency, and it's about trying to avoid rapid change and throwing things too quickly at a dancer's body. A nice sort of benchmark for that is, let's say, if you are building up a dancer's workload and they are taking on more hours, generally increasing by 10% per week is a good guideline to use. So, again, avoiding a rapid ramp up in their workload, so that their bodies can develop the tissue tolerance and the strength to be able to handle that new workload more progressively over time.

Loren  15:32  
Tim, I'm just thinking of how studios set up their schedule for the week for their dancers. Are you saying that it might be better to have them come more consistently throughout the week for lessons rather than try to do it all on one night.

Tim  15:48  
Well, I think that's a tough one. It really depends on how each individual studio sort of operates with their families, you know, but I think the message there is to keep your dancers consistent in terms of what they're doing, how often they're doing it, and just avoiding those, you know, rapid changes and rapid spikes in workload, because our bodies will adapt naturally to what we're exposing it to, and a lot of the time traditionally we've described injuries as overuse injuries, and that's sort of traditionally what you'll see in textbooks, but one of my sort of clinical placements that I did for my Masters of Sports Physio was at the National Institute of Circus Arts in Melbourne. A wise sports doctor, Dr. Kathy Yu, who was there, she actually calls them injuries of being under-prepared, so under preparation injuries, and it really stuck with me because overuse injury doesn't really work with amateur and professional athletes, because they're using their body every single day, so it sort of becomes a little bit redundant, because they're using it constantly. 

Tim  16:50  
If you flip the thinking and look at injuries as under preparation injuries, it actually makes a bit more sense, because essentially what it implies is that we're doing something to the body that we haven't properly prepared for, and therefore the way to prevent those injuries and get around them is to prepare better, right? So, whether it's through consistent strength and conditioning, whether it's looking at that consistency and workload and the quantity of training that they're doing, whether it's jumping ahead and trying skills that a dancer is not ready for, because they saw it on the internet and they want to try something that was on YouTube, right? And not following a structured syllabus. So, again, just being more cautious of preparing our dancers better, and you know, avoiding those injuries of under preparation.

Loren  17:39  
Yeah, I love that. That makes a lot of sense, especially for most of our studio dancers. So, that's great. Now, treatment has had some controversy over the years, too. And, depending how old you are as a teacher, the debate between ice or heat for injuries. What is your take on that?

Tim  18:00  
Great question, so I think either or, and there are different uses for either of those in the different situations. So, first of all, heat - I would say heat is, you know, arguably less debated than ice is. So, heat is going to physically warm up the tissues that you're applying it to. It's also going to cause vasodilation, which is a dilation of your blood vessels, which is then going to increase the blood flow to that area. That's why your skin goes pink when you put a heat pack on. Personally, I love heat. I know that if I use a heat pack on, you know, a sore neck or a sore back or a sore body part, it just.. it feels better. It loosens it up, it warms it up. So, heat, I think, is a really great thing. You can get microwave heat packs, you can get plug-in heat pads these days, and again, it's, it's a really nice way of, you know, just warming up the body area. I would say you wouldn't want to substitute a good quality full body warm up for just using a heat pack. 

Tim  18:58  
Okay, so it definitely doesn't remove the need to do, for example, the cardio section or a physical warm-up section of your class, because we want to get the heart rate up, and we want to actually, you know, switch on the mind, switch on the body, and prepare for class. But certainly, a heat pack can be a nice thing, just to, you know, warm up and loosen up stiff body parts. Ice, on the other hand, there is a little bit of, you know, flip flop that happens in terms of whether we should be using ice or not. Just last week I read a sort of sports injuries guideline document, which was very recent, and it definitely speaks a lot about the use of ice for acute injuries. There has certainly been some research in recent years that questions the use of ice and the need for ice, and whether we're actually causing the benefit that we think we will, but I think with ice a lot of the time it's a routine that athletes or dancers have had for many years, and I think that's totally fine. If let's say you roll your ankle and your first instinct is to go and grab an ice pack and put it on your sprained ankle, because it reduces your pain that you're experiencing, feels better, cools it down. I think that's a good thing, you know. So, I think it's not worth discounting ice. 

Tim  20:10  
Certainly, I wouldn't ice something before activity. Okay, that's probably not the best option. By freezing up a joint or freezing up a muscle, you're certainly not going to get the range of motion or the power that you're hoping for immediately pre activity, so again, in my sort of work as a physio, I will always say to an athlete to make sure that they have at least 90 minutes before they're about to perform if they're going to choose to put an ice pack on a body part, so if you know that you've got to perform in 30 minutes, hold off on the ice, keep the body part warm, and then ice after your performance. Okay, but if you know that you've got 90 minutes or potentially two hours, there is enough time to put an ice pack on something for, let's say, 10 minutes, and then rewarm that body area, and you shouldn't see any reduction in your performance.

Loren  20:59  
When should a dancer go see a physiotherapist?

Tim  21:03  
So, I think definitely go on your hunch, in the sense of if something looks like it's becoming injured, if it's niggling, if it's not warming up, it's not getting better over time, it's it's getting worse progressively. Absolutely, go on your instincts and go and get it checked out by either a physiotherapist or a doctor. What you don't want to happen is to sort of wait and see, and something that could have been prevented early on actually sort of snowballs and develops into a full-blown injury, you know. So, a good example of that is actually bone stress. It's the kind of thing where, when you repetitively load a bone, there is a spectrum of injury that actually starts to happen, so, and it often starts with just a little bit of swelling in the bone. If that's not attended to quickly, and it's very simple, all you need to do is rest that bone, and it will actually reverse, but if it's not attended to, that can propagate into initially micro fractures, so a little stress reaction, stress fracture in the bone, which can then propagate into a macro fracture, which is actually a full blown fracture line in the bone, not to scare everybody with stress fractures, but it's just an example of getting onto things and attention, giving things attention early on. 

Tim  22:21  
You know, muscle cramping and muscle tightness is actually a really great example, too. So often, muscle cramping is a warning sign that a muscle is not coping with the load that you're putting through it, and the muscle is saying, "Hey, I'm struggling here, and then often a muscle strain will occur after that. Okay, especially because dancers or athletes will feel the need to stretch a muscle that's cramping, and then by stretching a muscle, you can actually further reduce the power output from that muscle, which can then, you know, set you up for a muscle strain later down the track. If, however, you caught that early on, you refocused on, you know, let's say a short period of offloading that muscle from whatever it's struggling with, and you focus on some strengthening of that muscle, you know, you can then sort of avoid that spiral of cramping and then eventual muscle strain, potentially.

Loren  23:14  
Tim, you've provided so much information for teachers and everyone. We started something new on the podcast. We got the podcast listeners to actually email in questions, and I know that we don't have enough time right now. Is there any way you could come back and we could have another interview in about a week or two?

Tim  23:36  
Absolutely, yeah, I'd be really happy to come back. Sure,

Loren  23:40  
Great. We will have a part two then, and we will ask all the podcast listeners questions at that time. There's some really good ones, so don't miss it. All right, Tim, I will say goodbye for today, and thank you so much for coming. And I can't wait to ask you all the questions from the podcast listeners.

Tim  23:59  
You're very welcome, and thanks for having me. 

Loren  24:01  
If you enjoyed today's conversation, be sure to subscribe and follow, so you never miss an episode, and if you know a dance teacher, student, or parent who would love to hear this discussion, send it their way. Sharing the show is one of the best ways to support the podcast. 

Loren  24:31  
Until next time, find power in your strength, freedom in your flexibility, and know that we are here to support you on your acro journey. 

Loren  24:42  
Thanks for listening, everyone, and have a great day!