An In Depth Look with the Performance Medicine Supervisor for Cirque du Soleil

An In Depth Look with… James Knue, ATC

Describe your setting:

I work in a performing arts setting as the Performance Medicine Supervisor for Cirque du Soleil’s production of The Beatles LOVE at the Mirage Hotel and Casino in Las Vegas.  This setting encompasses caring for acrobats and dancers from around the world, many who have been Olympians in their respective sports. In addition to the daily medical care that is provided, our department is also responsible for the emergency planning and execution, performance enhancement and ergonomic analysis

Cirque du Soleil’s Performance Medicine Departments, which are at each and every production worldwide, provides athletic training services for the Artists with a staff of Athletic Trainers, Physical Therapists, Pilates instructors and massage therapists.

How long have you worked in this setting?

This is my 13th year working in performance arts.   I have worked in both the resident shows division (shows permanently stationed in one place) and with the touring show division traveling through New Zealand, Australia, Singapore, United States and Mexico.

Describe your typical day:

 When I am on the opening shift my day begins around 1:30pm. Once my opening duties are complete (safety/emergency box checks, review of physician progress notes and set up of performance medicine treatment area) the rehabilitation sessions for those artists who are injured and out of show will begin.  After  the long term rehabilitations are complete, the rest of the afternoon is spent with treatments, backstage and stage  staffing (similar to that of staffing an athletic practice) of trainings, meetings and filing reports such as the daily artist status update so that Stage Management can cast the show for that night.  

The late shift person begins around 3:00pm and performs treatments, emergency services and administrative duties as needed.   Shows begin at 7:00pm and we cover backstage and in the training room in case of emergencies occurring during the show.  Between shows we have an hour to do treatments, advise the coaches, stage management and the artistic director about the status on any artists injured during the first show and do any charting that has not already been done.  The early person leaves at the start of the second show.   The second show begins at 9:30pm.  The time during second show is spent as the first with duties backstage and in the training room if any injuries occur as well finishing up any charting not already done.  After shows final care is given for any injuries that occurred in the 2nd show.

End of show reports are prepared and sent as well as the prep and cleaning of the treatment area are done with the day ending around 11:30pm.  In addition to these duties there are monthly planning sessions for our emergency procedures trainings.  An afternoon every month is dedicated to working with the emergency response team practicing the skills and techniques necessary to safely extract the injured artist from their apparatus or props to safely transport them off stage and to the hospital if that is required. There are Artistic Team meetings, Safety Committee meetings, Performance Medicine department meetings spaced throughout the week and month.

What do you like about your position?

I have spent most of my career trying to push the envelope for athletic training and Athletic Trainers. Moving into the performing arts areas was one of these moves. Being exposed  to the theater world required learning a whole new vocabulary and perspective. I had to adapt what I had done for many years to this new world where there are no off seasons for rest and recovery, the artists perform the equivalent of a double header 5 days a week,  47 weeks a year.  There is no second team and every artist who is not on stage because of injury diminishes the visual spectacle and experience of the audience.  This challenges the Athletic Trainer to be efficient and effective in every treatment and encounter with the artist.  You have to reexamine the standard approach and find new and unique ways of applying the standard ideas to achieve your goal. The artists, our clients, are challenging their bodies in ways that expand what we consider normal human movement.  It is up to us as Athletic Trainers to raise our level to that of the performers and expand what we do to help them achieve this and make it sustainable.  These daily challenges make each day interesting.

Cirque du Soleil is an international company.  Where else would you get the opportunity to work with the best talent in the world from all over the world?  LOVE has artists from 18 countries covering 6 continents and another 5 or 10 countries represented on the support staff.  This cultural diversity creates a rich social and work environment that would be difficult to match anywhere.  This cultural diversity also challenges you in caring for the injured. You have to be able to be creative and sensitive to cultural differences and traditional healing practices. How do you sell treatments when compared to the traditional herbal medicines of a Mongolian contortionist who is concerned that her back pain may be career threatening or with a middle aged acrobat who has successfully treated their ankle sprains in the past with cabbage and honey poultices.  Each day is new, with different challenges and goals. The work is never boring or routine.

What do you dislike about your position?

The biggest challenge for me has been adjusting to the swing shift work schedule.  I am not a night person so working late and wanting to be up early for my kids each morning has challenged my sleep habits and made some days difficult to get through.

What advice do you have about your practice setting for a young Athletic Trainer looking at this setting?

There is nothing unique about working in the performing arts.  Treating an injured ankle on a dancer or acrobat is not substantially different from an ankle of a football or basketball player except for maybe the size of the foot.  What you need to learn is the vocabulary of the performer so that you can intelligently discuss their injury and their recovery and return.  You need to have strong clinical reasoning skills as well as a large vocabulary of treatment techniques and manual therapy skills that you can apply when you are presented with that different and unique situation.  As we all learned how to take care of a volleyball player by attending matches and practices spend some time in the theater world, volunteering your services if necessary, so that you learn that vocabulary and gain credibility with your knowledge.

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