Collaborative center at Cedars-Sinai in medical treatments that keep injured dancers on their toes
With one hand grasping the ballet barre, Matthew Leonardi stands in first position. His reflection in the mirror peers back at him as he bends his knees to grand plie. The 17-year-old isn’t training at one of his world-class ballet centers, but rather he’s in a small makeshift studio inside a Cedars-Sinai Medical Center building. It’s just one of the many aspects that makes the Cedars-Sinai/USC School of Theatre Dance Medicine Center unique.
The two institutions were united by Cedars-Sinai’s Dr. Glenn Pfeffer and USC dance professor Margo Apostolos who co-direct the center with the goal of offering specialized medicine to dancers. “It’s a very remarkable collaboration for dancers because we bring together a very heterogeneous evaluation. There are many opinions,” Pfeffer says.
“We have doctors who like to dance, love dance, making the diagnosis. We have Dr. Apostolos who sees all the patients, looking at their problems from a dancer’s perspective, which is so unique to have that. And then we have physical therapists who are very specialized in the treatment of dance injuries. So it’s a great team that really love what they’re doing.”
They see patients of all ages, including those who have long since hung up their dancing shoes. The type of injuries vary depending on age, with young dancers often developing knee or ankle pain due to a weakness in their biomechanics.
Active dancers most commonly have knee injuries — meniscal tears and anterior cruciate injuries. And they see older patients who often have hip arthritis as a result of their dancing, or back and shoulder problems in male dancers from lifting ballerinas.
Pfeffer specializes in the foot and ankle — he is also the director of the Foot and Ankle Program at Cedars-Sinai.
Whether it’s a broken foot or problems with their turn out, he says, the young dancers benefit greatly from this kind of specialized center.
“We don’t change the direction too much but we do shift the needle a little bit, and that little bit in some of these kids can make the difference between a professional career and giving up dance in college,” Pfeffer says. “So it’s gratifying because the earlier you start, the more you can avoid future problems.”
It especially made a difference for Leonardi who had unknowingly been dancing with a broken bone in his foot for at least two years, despite going to numerous doctors and orthopedic surgeons complaining of pain.
His X-rays would come back normal and he was told to ice it or stretch. Nobody believed there was a real issue.
But there was. And it began affecting his dancing. He couldn’t point his foot like he needed and his teachers were cautioning it would ruin his dance career.
The San Bernardino native has been living in Tustin to study ballet at the Maple Conservatory of Dance. He has trained with the San Francisco Ballet and in Moscow with the world-class Bolshoi Ballet Academy.
This summer he will be participating in intensive programs with the School of American Ballet in New York and the American Ballet Theatre in Orange County in hopes of being offered a full-time training position in the fall.
Leonardi leaves in late June for what could be the start of a professional dance career, but as of the beginning of this year, he still didn’t know what was wrong with him or how to fix it.
“He’s going on to a professional career at the highest level and with good health, skill and a bit of luck he will be on the stages of all the major cities in the world one day. But he was being held back,” Pfeffer says.
“He has a commonly missed problem — which is something I actually see a lot of. He had a small extra bone in the back of his ankle, it’s called an Os Trigonum and it’s just a small bone the size of a pea, but it’s the real story of the ‘Princess and the Pea.’ Or it’s the pebble in your shoe that stops you, not the mountain.”
Not only did Leonardi have an extra bone in his ankle, but it was broken into little pieces which Pfeffer has removed.
It’s not uncommon for people to have this bone and in many cases it doesn’t cause an issue. But because Leonardi is a ballet dancer pointing his foot often and with great force, that extra bone would get smashed in the back of his ankle between his leg and his foot causing what is called Os Trigonum Syndrome.
Leonardi’s mom, Valerie, says she remembers Pfeffer telling her after the surgery that the tendon, which is usually white, was bright red from irritation caused by the bone fragments.
Few doctors are familiar with Os Trigonum and the problems it can cause for dancers, and so it’s often missed in MRIs, says Pfeffer. When Leonardi’s ballet coach recommended he come to Pfeffer, it was a stroke of luck.
“This was really such a critical time period for Dr. Pfeffer to find what’s wrong and correct it so that he’s able to have a career,” says Leonardi’s mother.
Thanks to Pfeffer and Apostolos’ vision to create this Dance Medicine Center, Leonardi has been cleared to start dancing again, less than four months after surgery.
Pain-free, he will be getting himself back in shape to continue pursuing what is not only a potential career, but his passion.
“When I start dancing it feels like I’m free,” Leonardi says. “Just jumping in the air feels amazing, like I can fly. I can express my emotions through it.”
Making his job more gratifying is Pfeffer’s ability to relate. He, too, was a dancer but had to give up his ballroom dreams because his foot was causing him an incredible amount of pain.
As with Leonardi, nobody thought anything was truly wrong with him. It wasn’t until 30 years later that Pfeffer was diagnosed with a tarsal coalition that impaired his motion in that foot by 50 percent.
Pfeffer believes his personal experience has made him more invested in helping these dancers, no matter their age.
“When we started I thought we would only see active professional dancers, whether it was tap dance or ballet,” Pfeffer says. “But I’m very gratified that we see a huge spectrum now, from the little seed all the way up to the fully bloomed flower. Or in some cases a flower that’s started to wither. But we help them all, it’s very satisfying.”
Featured in here , May 2012.