Whose Job Is It to Make a Show Physically Sustainable?

From the perspective of a performing arts physical therapist.

Live performance asks performers to do extraordinary things with their bodies.

But when we create a physically demanding show, there’s a question we should be asking much earlier—and more often:

Can the bodies performing the show afford to do it eight times a week, week after week?

This is the heart of physical sustainability. After all, we want our amazing performers to keep delivering what we’ve created throughout the run of the show without their bodies accumulating injuries or working through mounting pain. Can we create extraordinary physical performances while also building systems that help the people performing them sustain that work over time? And whose responsibility is that?

Well, it’s everyone’s.

A Physically Sustainable Show Doesn’t Mean an Easy Show

Let’s get something out of the way first: I will not be suggesting that we remove everything physically demanding from live performance. There can be jumps and lifts and fantastic choreography. There can still be performers flying through the air while singing an E-flat and somehow landing in a split. The physical spectacle of live performance is also what makes it extraordinary.

But there is a difference betweenphysically demanding andphysically unsustainable.

In sports medicine, we talk a lot about “load”: how much physical and psychological stress we ask the body to tolerate. Load itself isn’t necessarily the enemy. In fact, we need load to become stronger and more resilient. The issue is whether the body has the capacity to tolerate the load being placed upon it, such that you get the result you are looking for. Research in athletic populations has consistently demonstrated a relationship between training load and injury risk.

This concept translates remarkably well to performance. One jump off a table might be fine. Jumping off that table, landing, rolling onto the floor, getting back up, followed by performing a partnering sequence, and doing this multiple times per show, eight shows a week, is something entirely different.

So the question shouldn’t only be:Can the performer do it?

Clearly, they can. We just watched them.

The better question is:Should they keep doing it?

The Creators

The job of the creative team is to create something magical. You are building a world and asking an audience to surrender themselves to it for a few hours. That sometimes entails performers doing extraordinary things with their bodies to captivate our imaginations.

But, to ensure that your creation can be reliably delivered, physical demand should be part of the creative conversation.

If someone repeatedly drops onto a knee, jumps from an elevated surface, performs a high-impact floor sequence, catches another human being, or repeats an asymmetrical movement dozens of times per show, that movement carries a physical load. Something that would really help both the performer and the creative team would be to consider who will be under that load and how it will affect them over time.  Moreover, it is important to consider that the exact same choreography may require very different demands for two different performers depending on their training history, technique, strength, and familiarity with the movement. Asking a highly trained dancer to partner their castmate is different from asking an actor with little movement training to perform that same sequence.

Identifying a particularly taxing or challenging sequence doesn’t automatically mean taking it out. It doesn’t even necessarily mean modifying it. Sometimes the movement will stay exactly as it is—but then we’ve identified a physical demand that can be prepared for and monitored, rather than waiting until three people develop knee pain and having to put out that fire while trying to keep the show running smoothly.

The Performance Health Team

If you’re the physical therapist, athletic trainer, physician, or another member of the performance health team, you may start seeing trends on your treatment table that are worth bringing to the management team’s attention. 

A member of the healthcare team’s role includes collecting information and communicating it appropriately. If five performers independently come to PT with anterior knee pain and all five report that kneeling or a particular movement sequence aggravates it, that’s useful information. De-identified utilization data can help management see patterns that might otherwise look like a collection of unrelated individual complaints.

Then we can problem-solve. We might suggest that padding gets added or a movement gets modified slightly, should all parties be willing. Maybe the choreography doesn’t change at all, but performers receive a targeted warm-up, strengthening program, or recovery strategy to better prepare them for that particular demand. Maybe we simply continue to monitor the pattern and see whether it resolves as performers adapt.

The performance health team can identify trends, communicate concerns, and help develop strategies to increase performers’ capacity. Productions, in turn, can make those resources accessible through physical therapy, athletic training, appropriate warm-ups, conditioning, recovery resources, and thoughtful modifications when necessary.

The goal isn’t to eliminate physical stress. The goal is to make sure the body’s capacity is keeping pace with the stress we’re asking it to absorb.

Management

Depending on the production, “management” may include general management, company management, stage management, producers, or others responsible for overseeing the people, resources, and day-to-day operations of the show. Management has an enormously important role in physical sustainability. They often serve as the funnel through which information flows. Performers, the performance health team, music staff, and members of the creative team may each be seeing a different piece of the same problem. Management is often uniquely positioned to hear those concerns, connect the dots, and create space for a larger conversation.

Maybe multiple performers are reporting pain after the same sequence. Maybe the PT is seeing a sudden uptick in knee complaints after floor choreography is added. Maybe the director is noticing that performers are consistently asking to mark a particular section in rehearsal, or the music director is hearing that singers are struggling to maintain vocal performance while executing an especially demanding movement sequence. Individually, those observations may not seem particularly significant. Together, they may tell us something important about the physical demands of the production. Because management is often hearing from all of these departments, they are uniquely positioned to bring the right people together, facilitate creative problem-solving, and, when needed, direct resources toward solutions that make the production more physicallysustainable.

Management can help create an environment where people feel comfortable raising such concerns, where those concerns reach the right people, and where patterns are recognized rather than remaining isolated pieces of information. They can also help create the time, space, and resources needed to respond when a pattern emerges. When creators, management, performers, and the performance health team can talk openly about what they’re seeing, sometimes surprisingly small interventions can make a meaningful difference.

Performers Have an Important Role

Physical sustainability is something we build together, and performers have a meaningful role in that process.

An eight-show week is physically demanding in its own right. The repeated cycle of performing and recovering—week after week—creates cumulative strain on the body. As the physical demands of a show increase, so does that challenge. Each performance may require tremendous physical capacity: strength, power, muscular endurance, cardiovascular fitness, recovery capacity, and the ability to repeatedly produce movement under fatigue—and then come back the next day and do it again.

Some of that capacity can be developed during the rehearsal process. But rehearsal time is finite, and its primary purpose is to build the show. There simply may not be enough time within that process to develop all of the physical qualities a performer will ultimately need to sustain the work. That means some physical preparation has to begin before the demands of the job arrive.

We already accept this concept in so many other areas of a performer’s career. You take voice lessons because you want your voice prepared for what may be asked of it. You take acting classes. You take dance class. You get new headshots. You find the right audition outfit. You spend time and money developing the pieces of yourself that help you walk into a room ready to do the job.

Building physical capacity belongs on that list.

Your body is part of your craft. Developing strength, endurance, power, and overall physical capacity can be viewed as another component of professional development—not simply something to think about once pain or injury appears.

And physical preparation isn’t only about reducing injury risk. It can help you be better at your job.

Don’t Train for the Show You Have. Train for the Show You Might Get.

(Or as the saying goes: “If you stay ready, you don’t have to get ready.”)

You may not know what your next show is going to ask of you. Maybe you’re going to dance. Maybe you’re going to partner. Maybe you’re going to climb a staircase while singing. Maybe you’re going to carry another actor. Maybe you’re going to spend half the show on your knees. 

You cannot specifically prepare for every possible demand, but you can build a bigger physical toolbox.

You can get stronger. You can improve your aerobic capacity. You can develop power and muscular endurance. You can become more comfortable lifting, pushing, pulling, carrying, jumping, landing, hinging, and changing direction. Then, when rehearsal introduces a new physical demand, your body isn’t meeting that demand from zero.

That matters because training does something that avoiding load never can: it increases capacity.

There is substantial evidence for this concept in sports. A systematic review and meta-analysis of strength-training injury-prevention programs found that strength training was associated with a meaningful reduction in acute and overuse sports injuries, with greater strength-training exposure associated with greater injury-risk reduction.1

The research in dancers is growing, too. A recent systematic review and meta-analysis found that strength and conditioning interventions significantly improved lower-body power as well as upper- and lower-body strength and flexibility in dancers.2 Translated onto the stage, those are qualities that can contribute to bigger jumps, stronger lifts, greater control, and the physical reserve to maintain performance as fatigue sets in.

Another systematic review looking specifically at physical fitness training and dance injury found that eight of the ten included studies reported improvement in at least one injury-related outcome, including injury rate, time between injuries, pain, missed dance activity, or injury count. The authors were appropriately cautious – the existing dance literature is still small and much of it is methodologically limited – but the direction is encouraging.3

We may not yet have perfect performing-arts research, but the evidence increasingly supports viewing physical conditioning as part of a performer’s professional preparation—not simply as an optional extracurricular activity.

Sustainability Is a Team Sport

The most physically sustainable production isn’t necessarily the one that asks the least of its performers. The most physically sustainable production isn’t necessarily the one that asks the least of its performers. It’s one in which the demands are understood, the performance health team is paying attention, and management creates room for communication, collaboration, and adaptability.It’s the one where those conversations are supported with appropriate resources, and performers have opportunities to develop the physical capacity to meet what is being asked of them.

Because physical sustainability doesn’t have to mean making theater less spectacular. Done well, this not only has the potential to prevent issues, it may even allow us to ask performers to do even more extraordinary things—and give them the preparation, communication, resources, and support to keep doing them.

That isn’t the choreographer’s job. It isn’t management’s job. It isn’t the physical therapist’s job. And it isn’t solely the performer’s job.

It’s something we build together.

References

• Lauersen JB, Andersen TE, Andersen LB. (2018).Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine, 52(24), 1557–1563.

1. Ngo JK, et al. (2024).Strength and conditioning in dance: A systematic review and meta-analysis. European Journal of Sport Science, 24(6), 637–652.
2. Dang Y, Chen R, Koutedakis Y, Wyon MA. (2023).The Efficacy of Physical Fitness Training on Dance Injury: A Systematic Review. International Journal of Sports Medicine, 44(2), 108–116.

Main image: Photo by Kazuo ota on Unsplash

Marissa Schaeffer

Physical Therapist -UNITED STATES

Marissa Schaeffer, PT, DPT, MBA, OCS, CSCS (she/her), is the owner of FlySpace Physical Therapy (www.flyspacenyc.com). A graduate of the SUNY Purchase College Conservatory of Dance, she earned her doctorate in physical therapy from Columbia University and her MBA from Quantic School of Buisness and Technology. Marissa previously served as a senior therapist at Alvin Ailey American Dance Theater and now leads all of FlySpace’s backstage and onsite contracts, including coordinating physical therapy services for touring companies. She directs FlySpace’s ongoing partnerships with St. Ann’s Warehouse, Theatre for a New Audience, and Steps on Broadway, and through FlySpace has supported countless dance companies—including HopeBoykinDance, Parsons Dance, and GALLIM—as well as multiple theatre and musical theatre productions, most recently Pirates! A Penzance Musical, Queen of Versailles, Anna Christie, Rocky Horror Show and others. In addition to presenting at performing arts medicine conferences, she has published research in academic journals and contributed to Dance Magazine, Dance Teacher Magazine, and Dance Studio Life.

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