In a large, softly lit room, a plastic skeleton gestures with welcoming hands and seems to watch as elderly patients shuffle about with their therapists. The room is hushed, the beeps of medical equipment and the squeaks of weight machines punctuating the quiet along with whispered encouragement from the physical therapists.

But then, a young woman lying on her back calls out “Help me!,” her leg swollen and purple beneath a medical tourniquet on her thigh, her eyes screwed shut in mock pain.

She’s joking — she’s fine.

Jessica McCann, 33, had her hip replaced on April 21 after discovering a large bone cyst on the femoral head. Less than a week later, she was walking without crutches. Five months later, she’s still in intense physical therapy at Fox Chapel Physical Therapy and working back into a regular routine.

“I’m gonna need some oil for this bionic hip,” she said, grinning from a mat on the floor.

McCann’s recovery is impressive for anyone, but it’s particularly important to her. She’s a professional ballet dancer, a soloist at Pittsburgh Ballet Theatre who regularly dances roles like the Sugarplum Fairy in “The Nutcracker” and Odette in “Swan Lake” as well as in the company’s more contemporary offerings. She’s been dancing since she was 4-years-old; it’s a lifelong passion.

Even though ballet is considered an “art form” and not a sport, it is an incredibly physical activity that requires hours and years of intense training and exercise. According to a 2023 study, “[Ballet] dancers and athletes have comparable muscle quality,” and the “gluteal muscles are larger in ballet dancers compared to athletes, suggesting high-level loading of these muscles.”

A 2008 study found that seven in 10 ballet dancers were in better overall shape than international swimmers.

Despite the elegance and artistry of the movements, dance is every bit as taxing as other athletic professions. And like with any sport, the flexibility and repetitive movements take their toll over the years, particularly on the ankles, knees and hips.

“I don’t know of any dancer who has never had an injury,” said Adam McKinney, Pittsburgh Ballet Theatre’s artistic director and a dancer who has had lateral menisci surgeries on both knees over the course of his career.

“At Pittsburgh Ballet Theatre, we are working to lessen the number of injuries that dancers have toward the goal of 100% injury-free company,” he said.

That’s a tall order. A 2016 retrospective study tracked injuries in a professional ballet dance company over a 10-year period and found that most dancers experience a new injury every year. Company turnover is typically around 34% year-to-year at many companies, the study indicated.

Many other studies indicate similarly high rates of injury across ballet companies, comparable with injuries on sports teams.

Even though many dance companies have begun retaining physical therapists and sport physicians, most dancers don’t perform professionally past their mid-to-late 30s due to the extreme physical toll the art form takes on their bodies.

At 31, McCann wasn’t ready to hang up her pointe shoes, despite the severity of her hip deterioration. After consulting with doctors, surgeons and physical therapists, she set herself a goal of returning to the stage for this year’s production of “The Nutcracker,” which launches on Dec. 8.

She’s ahead of schedule. McCann appeared for a brief performance at the end of October, a duet with her husband, fellow PBT principal Yoshiaki Nakano, as part of the ballet’s “Light in the Dark” performances at the Byham Theater. And she will indeed dance the “Nutcracker” this year, which opens Dec. 8 in the Benedum Center. (Tickets begin at $29 at pbt.org.)

McCann, a California native who joined Pittsburgh Ballet Theatre nine seasons ago, has had hip pain for years. She knew she would likely need to have her right hip replaced, but she was hoping to put off surgery until later in life.

Hypermobility, part of what led to her hip deterioration, is more common in the right hips of dancers than the left, according to a recent study.

Jessica McCann. (Anita Buzzy Prentis)

With Yoshiaki Nakano in 2021. (Duane Rieder)

By the end of 2022, McCann’s muscles would seize up after rehearsals, and walking to the car after performances became a struggle.

“I didn't realize how much pain I was holding in my body,” she said.

In December 2022, during the opening weekend of “The Nutcracker,” she hit her breaking point.

After imaging her hip, doctors told her that she had the hip of a 90-year-old and that she would not be able to continue to dance professionally without a replacement. The cartilage in her hip had eroded completely. She had bone spurs and calcium deposits. The cyst was ready to rupture, which could lead to permanent complications.

Still, “I absolutely didn't think about retiring for a second,” McCann said.

Injuries like sprained ankles and knee dislocations are common for dancers, but there are few recorded cases of dancers undergoing a full hip replacement and returning to the stage. In most cases, the dancers move on to teaching. McCann said she found this terrifying and isolating — she’s been documenting her own surgery extensively on social media and in a podcast to help other dancers and dance students who may face similar surgeries.

She entered physical therapy in December to prepare for surgery and secured a surgery date in April at the Hospital for Special Services in New York City, with Dr. Edwin Su, who has worked with dancers previously in New York and performed the same surgery on dancers in the New York-based Alvin Ailey American Dance Theater.

Today, there are a number of options for hip replacement materials ranging from titanium to ceramic to plastic — only a “dual mobility hip” replacement would allow for the kind of range of motion a dancer requires.

The surgery was a complete success. McCann stayed one night in the hospital before her husband drove her back to Pittsburgh the next day, stopping regularly to let her hobble about on crutches beside the turnpike to help acclimate her body to the new hip.

McCann’s physical therapist, Chris Woods, made a house call the very next day, and within a couple more days she was walking without crutches.

“Ballet just seems to have more injuries than other kinds of dance,” said the no-nonsense Woods, a therapist at Fox Chapel Physical Therapy.

Therapy sessions in Fox Chapel began a couple of weeks later and involved a range of techniques to help build strength and flexibility, including several methods that Woods said are common in pro-athletic facilities.

At a session in September, she began by asking McCann to flex and bend her back and legs and describe any tightness, to march in place and put the hips through various angles and rotations. Later, she attached a blood flow restriction cuff to McCann’s leg, causing the leg to swell and turn purple while McCann exercised.

“Thank you, department of defense,” Woods quipped, explaining that the cuff would help break up scar tissue and fibrosis. Later, she inserted electrode needles into McCann’s muscles, causing them to begin twitching and jumping.

“It doesn’t hurt at all!,” the dancer noted brightly, explaining that the electricity was another means of limiting scar tissue and reducing pain and stiffness and restoring strength more quickly.

McCann attended PT for several hours several times a week, with worker’s compensation covering 100% of the cost of her treatments.

“I am over the moon about the way she is taking responsibility for her health,” said McKinney, who has been keeping in contact with Woods over the course of the recovery.

“Jessica is a hard worker, and I want to ensure she is taking the time that she needs to recover fully,” he added.

There are efforts to move the needle around the country, to reduce the rate of injury by increasing transparency in dialogues around health. Such efforts include self-assessments and regular company check-ins, as the pressures of such a competitive field can encourage some dancers to hide the extent of their pain for fear of missing an opportunity. (Hundreds of dancers audition for each opening at professional ballet companies, as the Post-Gazette reported earlier this year.)

The national service organization Dance/USA, for example, has a Task Force on Dancer Health, which issued a statement in response to a request for comment noting that “Our current mission is to potentially improve injury risk reduction by helping companies and dancers implement cross-training, which has been shown to be beneficial to injury reduction in other sports.”

The Task Force also noted that most dance related injuries are due to overuse rather than trauma and that it advises professional companies to track their injuries.

In Pittsburgh, McKinney noted that the PBT has begun to track injuries in recent years.

“There are certainly moments in my own career where I shouldn’t have gone onstage,” McKinney said. “I think I would have needed someone in whom I could confide in that it wouldn’t hinder my growth as an artist or my ranking. That I knew that I would always have a place in the company. That’s very important to us, here.”

At an October rehearsal, McCann floated around the room, dancing the duet “Lacrimosa” choreographed by Annabelle Lopez Ochoa as the ballet’s rehearsal director Steven Annegarn looked on and offered occasional feedback.

“That’s a bit early. You might wait a hair longer before reaching full extension,” he called at one point, as Nakano lifted McCann from the floor in a smooth, powerful gesture.

The piece is technical and physical, with McCann and Nakano spinning and leaping in close proximity. There’s a sinuousness to the movements, strength apparent in the carries and holds.

To the untrained eye, there’s no way to tell that McCann is dancing with a new hip.

“I can’t do everything yet, but it’s coming back day by day,” she said.

Was it all worth it?

“What we do can be hard — so hard on body and mind, but I absolutely love it,” she said. “We’re here to give our souls and our bodies to the art.”

Jeremy Reynolds: jreynolds@post-gazette.com. His work at the Post-Gazette is supported in part by a grant from the San Francisco Conservatory of Music, Getty Foundation and Rubin Institute.