Some unsung stars of the American Repertory Theater’s recent production of dance thriller “Black Swan” were the backstage team of physical therapists led by Melissa Buffer. 

Read more Why do political insiders fear giving voters more choices?

The show was “a very intense production due to all the dancing” and because it had 24 actors, said Buffer, 43, and the founder of Cambridge’s Artistic Athlete Health Collective. 

Melanie Moore, who played the demanding lead role, “received services outside the typical need,” said Buffer, who often brings in a massage therapist, and will consult with acupuncture, dry needling and chiropractic practitioners. “Black Swan” included a whole mental health team as well.

Buffer oversees physical therapy for the American Repertory Theater (A.R.T), as well as other local theater companies, and works with individual dancers, theater performers and circus artists. 

Buffer started dancing as a child and discovered dance medicine while in college at Northeastern University. She then pursued a degree in physical therapy in graduate school, during which she did a clinical affiliation with a physical therapy office, Performing Arts Physical Therapy, located in New York’s theater district. Every afternoon they went to the theater to spend a couple of hours getting performers ready for their show. On days with matinees, she was there between shows, too. Her later training included cases with the late Lyle Micheli, a pioneer in the field of dance medicine, and with the Boston Children’s Hospital dance medicine team.

The focus of her work is prevention; “very few dance-related injuries are acute,” said Buffer. Before a show opens, she and her team evaluate everyone in a company. They look at the requirements for each track, or role, and make suggestions for how performers might prepare for the show. They might also suggest modifications. For example, they might suggest a wider toe box in footwear or make recommendations for how long certain shoes are worn. All such modifications are made in consultation with the director and the choreographer. 

Injuries can still happen. Carmen Rizzo, a long-time client who recently had solo shows at Cambridge’s The Dance Complex, as well as a show at the Foundry, earlier this year woke up with a painfully swollen ankle the day before a show opened. Unable to walk properly, she warned the director that an understudy might need to step into her role. Then she reached out to Buffer. “She was able to pop it [her ankle] back into place and I had no further problems. It’s so much quicker and easier to see someone who actually knows what’s going on,” Rizzo said, referring to Buffer’s understanding of the challenges faced by dancers. 

Read more Sometimes progressives have to register as Republicans

Claire Lane of Detritus Dance, currently an artist-in-residence at Mount Auburn Cemetery, is another long-time client of Buffer’s. After Buffer recently observed a rehearsal of a show Lane was preparing for, she provided a warm-up plan that included breathing techniques to employ the full power of the diaphragm to support movement and stamina and exercises for the feet.

Dancers are not the only performers who benefit from Buffer’s services and insights. For actors in non-musicals, Buffer will suggest adjustments to how people sit to balance the stress on their backs. Buffer says that one of the most challenging shows from a physical therapy standpoint was A.R.T.’s 2022 production “Life of Pi.” It had life-sized puppets and a raked stage, one that is slanted for greater visibility but presents a physical challenge for actors. Actors Equity, the union representing actors, requires that performers working on such a stage receive a rake orientation, another service Buffer provides. Emma Watt, associate producer at the A.R.T, said that for performers, the functioning of their bodies is critical to their work. “It’s a cliché to say that their bodies are their instruments,” Watt says, “but it’s true.” 

Before each performance of “Life of Pi,” Buffer held a puppetry call to mock through the movements. “I would remind people to lift with their shoulders, try to grip it like this instead of this.” The puppetry in “Life of Pi” required many repetitive movements to replicate animal behaviors. Watt described the close collaboration between Buffer and Jill Johnson, the movement advisor for that production. Buffer and Johnson worked together to create warm-up routines and an icing protocol to protect the health of the performers. 

In their most recent contract negotiation, Actors Equity stipulated that any actor or company member in any Equity production has the right to request physical therapy at any point in the production. Buffer hopes more companies will see PT training and injury prevention as part of a show’s infrastructure, just like costuming, lighting, staging, and dramaturgy. She also encourages musicians and the crew for the back of the house — the people who build sets, string lights, and manage the stage during the performance — to avail themselves of physical therapy.

Buffer’s work with local performers extends beyond her services to A.R.T. “The mission behind my health collective is to bring what has been available to a very few elite institutions to regular performing artists,” Buffer explained. Because dancers are often underpaid and overworked, they don’t always have access to the health care support they need. Lane appreciates Buffer’s efforts to provide lower-cost services through programs like her Resilience and Recovery classes, which offer small-group physical therapy sessions. Buffer, she said, “is trying to bridge the gap, meet artists where they are at whatever stage they are at, to make sure services are accessible and affordable.”

Read more Two roads, one driven by survival, the other by friendship