Beneath the painted ceiling of the Palais Garnier, a short walk from the passage known as the “necklace of pearls,” sits an office that looks like any ordinary doctor’s practice: a desk, an examination table, a few chairs. Only the setting is unusual. This is the headquarters of the Paris Opera’s health unit, and its director, sports physician Xavière Barreau, is the only full-time doctor of her kind in the institution.
Since the unit was created in 2015, the results have been striking. Workplace accidents fell from 167 in 2015 to 71 in 2024 — a drop of 53% — while injuries declined by 40%. The team has grown to around 20 practitioners, including physiotherapists, osteopaths, masseurs, two physical trainers and two psychologists.
A Unit Born From an Audit
Barreau’s arrival was not her own idea. Benjamin Millepied, who directed the Paris Opera Ballet from November 2014 to August 2016, had commissioned an audit from American physiotherapist Michelle Rodriguez to assess the dancers’ needs. He also had the hard floors of the rehearsal studios replaced to help prevent injury.
Millepied approached Barreau at Insep, France’s national institute for sport and performance, where she was working with junior national taekwondo teams. “I already had a fairly holistic approach to athletes’ health, and I had trained in a lot of areas, particularly nutrition. Maybe that’s what appealed to him,” she recalls. His brief was simple: provide care for the dancers.
What she found was a service in which one physiotherapist and one osteopath, plus a freelancer, were responsible for around 150 people. “The dancers had very little medical follow-up, and many were seeing osteopaths outside,” she says. She began with two half-days a week, hoping to focus on prevention. Instead, she was confronted with a backlog of existing conditions.
Earning the Dancers’ Trust
Some dancers were sceptical that a doctor with no background in dance could understand their needs. Barreau’s answer was that a sports physician knows the body and its injuries in general terms. “A dancer can have lower back pain, calf injuries, ankle sprains — trauma common to any athlete,” she says.
Over time, however, she identified pathologies specific to dance: injuries linked to the technique of the danced gesture, to the wearing of pointe shoes, and to the intense work of the feet and ankles. She also found lesions of the hip’s external rotator muscles that are almost unknown in other sports. Star dancer Ludmila Pagliero has described suffering such an injury late in her career — a tear of the fascia lata that felt, she said, like a knife wound. Rehabilitation was long, but she returned to the stage.
Contemporary dancers tend to suffer knee and wrist impacts, while classical dancers face ankle and foot trauma and osteoarthritis. Stress fractures of the tibia and the second metatarsal are among the most serious conditions the unit treats.
Prevention From the First Season
From 2015, Barreau introduced a full medical assessment at Insep for each new member of the corps de ballet — eight to ten people a year — including an electrocardiogram, cardiac ultrasound and a stress test to measure respiratory function. Body composition analysis and bone density scans are also carried out, followed by individual consultations to discuss the results and raise awareness of issues such as nutrition. She also works with the doctor at the Opera’s dance school in Nanterre, convinced that guidance must start early.
Physical preparation remains optional, something Barreau regrets. She notes that many dancers only discover its value after a first injury, when a month or two off can be used to teach basic practices that prevent more serious problems later. Younger generations, she says, are more receptive.
Recovery tools include cryotherapy in a chamber that drops to minus 110 degrees Celsius for three minutes, offered three times a week at both the Palais Garnier and the Opéra Bastille after performances. “It promotes muscle relaxation, with a calming effect and improved deep sleep,” Barreau says.
Nutrition, Pregnancy and a Changing Culture
On nutrition, Barreau is pragmatic: there is no specific dancer’s diet, only a need to understand food groups, combine them properly and spread intake across the day. She warns about REDs — relative energy deficiency in sport — which can be deliberate, in the case of anorexia, or involuntary when workloads are too heavy. Eating disorders, she says, typically emerge between the ages of 10 and 14, long before dancers join the company, and are very difficult to treat once established.
The unit also reflects a broader cultural shift. Barreau estimates the ballet is 55% women and 45% men, and says pregnancy is no longer taboo. “When I arrived, dancers were starting to think about having children at 40, at the end of their careers. Today we have women of 28 or 30 with one, two, sometimes three children,” she says. Jumping is typically stopped by the fifth month of pregnancy, but barre work can continue almost to term, alongside pilates and swimming. Postnatal care focuses first on the perineum, then the abdominals, before progressive strengthening of the deeper muscles.
Workload, Not Bad Luck
Asked about the leading cause of injury, Barreau does not hesitate: an excessive workload combined with muscular fragility. New members of the corps de ballet are unused to the volume of classes, rehearsals and performances, and she keeps a close eye on them during their first two or three years. She now discusses scheduling regularly with ballet mistress Sabrina Mallem, something she says would have been unthinkable when she arrived. Pain, once a taboo subject in a profession with short careers, is increasingly discussed rather than endured in silence.
Dancers at the Paris Opera retire at 42. Barreau’s goal is for younger generations to leave in good health — something she says was not the case a decade ago, when she saw dancers depart with advanced osteoarthritis, including two who needed hip surgery.
She has never dealt with an injury as severe as the one suffered by the character played by Marion Barbeau in Cédric Klapisch’s film En corps, though the production did consult her team on its medical protocol. Each summer, she advises dancers to take a genuine break and stay out of the studio for two weeks, and she would like them to have a two-week pre-season return programme like high-level athletes. She has submitted the proposal to management. “It’s complicated,” she says.
Renovation work at the Palais Garnier, scheduled to run for years, includes a planned reorganisation of the health unit into more suitable premises. For now, the team continues its work under the Chagall ceiling, one appointment at a time.
