Background
Demanding performance schedules in the modern professional circus can result in artists having minimal time for injury rehabilitation and strength and conditioning for injury prevention. Nonetheless, injury rates are high. As an example, the rate of injuries amongst acrobats in Cirque du Soleil has been recorded as 11.2/1,000 exposures, and lower limb injuries accounted for 34.6% of all injuries reported in the 5-year period from 2002 to 2006. Hence managing injury risk to reduce injury rates is of importance.
The challenge though is that performers in Cirque du Soleil touring shows usually perform between 7 and 10 shows per week over 4 to 6 days. Performers have up to 12 hours of show-specific rehearsals in addition to their own self-directed training. A 2-week break generally precedes each 9- to 14-week performance period. Depending on the nature of the show, weekly travel, including interstate and international, may reduce available training time. This poses logistical difficulties for performance coaches and medical staff when implementing preventive exercise interventions.
Study aim
The primary aim of the study was to examine the feasibility of implementing a 9-week calf endurance program in a running Cirque du Soleil touring show. The secondary aims were to investigate the effect of this additional training load on calf endurance and self-reported acute and overuse work-related lower limb problems. It was hypothesised that implementation of a calf raise exercise program may reduce the prevalence of lower limb work-related health problems reported by performers.
Methods
Twenty-nine professional Cirque du Soleil circus performers were recruited (mean age 31.28 [SD 4.99] yrs). Performers completed the Oslo Sports Trauma Research Centre Overuse (OSTRC) questionnaire each week for 18 weeks. In the second 9-week period, performers completed one set of single-leg calf raises to fatigue on each limb, once per day, every workday. Health problems between each 9-week period were compared. Feasibility was measured via program adherence and an end-of-study survey. Calf endurance was assessed by measuring the number of single-leg calf raises to fatigue.
Calf raise exercise: correct and incorrect technique and common errors
Results
Adherence was high throughout the program, with 93.5% of all exercise sessions completed. Endurance increased by a mean of 22.62 (SD 27.99) calf raises. No significant changes in the prevalence of self-reported soreness and injury were found: 51.9 (95%CI 44.4, 57.5) of the population reported lower limb injuries during the pre-intervention period and 52.5 (95%CI 49.2, 55.8) during the intervention. Similarly, no significant changes were found in severity scores: 20.7 (95%CI 17.7, 23.7) pre-intervention and 20.9 (95%CI 19.4, 22.4) during the intervention.
Participant responses to the end-of-study survey (n=28)
Conclusion
Professional circus artists routinely perform with work-related lower limb health problems. There are many challenges involved in introducing regular strengthening programs in a touring, performing professional circus troupe, whether as part of a rehabilitation, fitness, or injury prevention program. Despite a heavy touring schedule, this study provides evidence that a preventive exercise program can be feasibly incorporated during a performing run, with gains in calf endurance, good adherence, and without increases in injury prevalence or severity.
The full article can be accessed here (paywalled)
Charlotte Ganderton, Michael Henry, Andrew Walker, Paul McGinley, Evert Verhagen. Implementation of Calf Endurance Training in a Touring Group of Professional Circus Performers: A Feasibility Study. Med Probl Perform Art 2021;36(1):54–60.