For the bendy people: Managing hypermobility for circus (part one)

“Hmm… now that you mention it, I’ve just always been flexible,” she told me.

Unbeknownst to me—but I’m pretty sure it was knownst to some of you—the month of May was Ehlers-Danlos Awareness Month. By way of interesting coincidence, May turned out to be hypermobility month for me because it seemed like every circus athlete I found myself working with was (and still is) hypermobile and the same issues kept coming up again and again. This past weekend, I found myself talking to yet another obviously hypermobile individual—who, based on the way they described their ongoing experiences, may also have EDS—and after that, I felt like I just had to get my thoughts written down as a blog post.
Ehlers-Danlos Syndrome represents a spectrum of disorders that affect the body’s connective tissue, specifically it involves a defect in the body’s synthesis of collagen. EDS varies in severity from person to person depending on the unique nature of their case and it can affect the skin, joints, muscles, ligaments, blood vessels, visceral organs, eyes, etc. Of particular relevance to this post—and the inspiration for writing it—is the joint hypermobility that many with EDS experience.
Learn more at ehlers-danlos.com

For a condition that affects such a relatively small portion of the “general population”, I sure do seem to encounter hypermobile folks a lot. Now, within the circus community, I am unsurprised by this. Their natural bendiness predisposes them to being able to make the kinds of shapes and get into the kinds of positions that circus arts tend to call for, so it can be a bit self-selecting that way. But it seems that I keep running into hypermobile folks outside of a circus context as well.

For example, the other day at the gym I found myself watching a group exercise class. It was filled with the lunchtime group exercise regulars and they were having a blast. The theme of the class was teamwork and, as you might imagine, they were doing a number of different partner exercises. Since the group exercise studio is relatively small, it is not uncommon for some exercises to spill over and run out of the room… right past where I sit in between client sessions.

On this particular day, I looked up and saw people doing a sort of wheelbarrow race past me. They weren’t racing—their task was simply to take a certain number of ‘steps’.

Because observing movement quality is kind of my thing, I noticed a couple of things that I have to say made me wince a little (and in some cases, a lot).

One particular person caught my attention:

As I watched her wheelbarrow past me (is that a verb? How else does one describe what one is doing when one is playing the role of the wheelbarrow? Moving on…), I noticed that she seemed completely unable to maintain good scapular position and control.

What I mean is that her torso was sagging down between her shoulder blades—perhaps you’ve seen this before. The reason this is notable to me is that it demonstrates a lack of dynamic stability, which requires two things:

• scapular stability (strength) and,
• scapular control (motor control).

For any given athlete, I would suggest that performing activities like this without establishing a certain level of dynamic stability beforehand is a problematic strategy. (Read: this is a bad idea.)

What I mean by that is that doing exercises that demand more stability and control than you have means that you will be unable to maintain good joint position while putting stress on the joint.

Poor joint position during exercise –> extra stress on labrum, rotator cuff, shoulder capsule.

However, I also noticed that this particular everyday athlete’s elbows were hyperextended.

The bendy folks out there will know what I mean.

Doing exercises like a wheelbarrow walk or even holding a high plank with hyperextended elbows puts extra strain on the ligaments holding the joint together.

You see, having worked with this person before—she came to a mobility class I was teaching—I know that she is particularly hypermobile. (We went through the Beighton Hypermobility Scale and she scored quite high).

So what?

In just about any case, moving around in the wheelbarrow position without being able to demonstrate sufficient scapular stability means extra stress on the labrum and the ligamentous joint supports.

But in the case of the hypermobile athlete, it can also mean creating (additional) joint instability. Over time, that tends not to be helpful.

All of the hypermobile athletes I’ve worked with have something in common: if they knew they were hypermobile (and about half didn’t), they did not know how to manage their hypermobility within their circus experience.

So there are a few things I would like to share for the bendy circus artist-athletes  out there.

First and foremost: knowledge is power.

If you’re particularly bendy and you think you might be on the hypermobile side of things, here’s a quick self-test you can do:

[https://www.ehlers-danlos.org/about-eds/getting-a-diagnosis/beighton-score/]

Hypermobility and Ehlers-Danlos Syndromes

On one end of the spectrum, we have hypermobility that results from a defect in how the body produces collagen (as in Ehlers-Danlos Syndrome Hypermobility Type)…

Ehlers-Danlos syndromes are a group of connective tissue disorders that can be inherited and are varied both in how affect the body and in their genetic causes. They are generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility.

If your Beighton score is above 5, it doesn’t necessarily mean that you have EDS, but it does suggest you are hypermobile.

I would like to responsibly point out that while your Beighton score is not a diagnosis—because I’m not a doctor and I won’t play one on the internet (or in real life, for that matter)—if you do score above 5, it may be really smart to have a look at the following link and decide for yourself whether it’s time to see your doctor for testing and/or a diagnosis: https://ehlers-danlos.com/what-is-eds/

Hypermobility by itself represents a greater-than-normal degree of laxity in your joints—specifically in the ligaments that would normally give your joints some built-in stability.

The concern here is that with the extra potential for ‘movement’ within a joint comes extra potential for things like joint dislocations and ankle sprains. In your shoulders or hips, extra movement of the ball within the socket can mean extra wear and tear on the labrum, which, over time, leads to osteoarthritis.

And that’s no fun. (Trust me, I know).

So you’re hypermobile. Now what?

I have three key pieces of advice:

1. Get really freaking strong.
2. Develop mastery-level proprioception.
3. Give some serious thought to giving up passive/static stretching.

Please bear in mind: this is by no means intended to be exhaustive nor is it intended to be one-size fits all. Your mileage may vary because your body may vary.

It is going to take more than one post to cover each of these. So let’s dive in:

1. Get really freaking strong.

I’m gonna drop some science.

Healthy joints—like, say, the shoulder or the hip—need a balance of mobility and stability. (How much of each varies from joint-to-joint). Joint stability is a product of ‘passive’ and ‘active’ components.

Another way to phrase it is that we have static stability and dynamic stability.

The passive component of joint stability is provided by the ligamentous structures that surround a joint and hold it together. As noted earlier, being hypermobile means having an above average amount of joint laxity. “Joint laxity” means that these ligamentous structures are not as stiff (resistant to stretch) as they are in the general population.

So…at baseline, hypermobile athletes have less passive (or static) joint stability. This means that hypermobile athletes need to make up for this lack of passive stability with active (or dynamic) stability—which is a function of muscular strength and control.

Wait.

Here’s a quote from renowned strength coach and shoulder performance expert, Eric Cressey:

“The more joint laxity you have…the more joint hypermobility you have, the more strength and motor control you need to have to go with it to keep you healthy and performing at a high level.”

And here’s another quote from renowned physical therapist and shoulder rehab expert, Mike Reinold:

“There’s two ways you stabilize: static and dynamic stability… Static [stability] is your anatomy, right, your joint, your capsule, your ligaments. Dynamic [stability] is your muscles. If you’re a hypermobile athlete… you have inherently poor static stability. It’s no biggie. It is what it is. It probably makes you a good athlete…but you have poor static stability. So you have to have pristine dynamic stability. You have to have even better dynamic stability than normal.”

So, just in case I haven’t been clear, I’ll reiterate:

If you are a hypermobile circus athlete, the key to keeping your joints healthy, happy and performing well, you need to develop some pretty badass dynamic joint stability.

And make no mistake: a very stable joint, dynamically-speaking, is a strong joint.

How to build strong, stable joints

It is well beyond the scope of this post to provide a comprehensive and exhaustive guide to strengthening your body for circus. However, what I can do is provide some guidelines.

In general, we want all of your joints to be strong and stable. If we were to prioritize, I would suggest the following:

• Core
• Shoulders
• Hips

There. That was easy, wasn’t it? You just have to make your core, shoulders and hips really, really strong.

And balanced.

Oh yeah, a part of making your joints strong and stable includes making sure they’re balanced in all planes of motion.

For your shoulders, we could simplify by saying your shoulders need to be balanced horizontally (in terms of pushing and pulling forces) and vertically (also in terms of pushing and pulling).

For example, say one horizontal pulling exercise in your training plan is a TRX Row.

You would want to balance that with a horizontal pushing exercise, like the good old-fashioned Push-up.

The same principle should apply to your vertical pulls and pushes, and your hip- vs. knee-dominant leg exercises.

There’s one more thing:

Hypermobile circus artist-athletes (and really, anyone)—particularly those with hEDS—will need to take their time with strength training.

Be patient and accept that you will progress at your own rate…and that might be slower than non-bendy folks.

Better to go slow now and to build a solid foundation than to rush ahead and risk hurting yourself.

This feeds nicely into my second and third thoughts (which I’ll cover next week in part 2 and 3).