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61. Understanding Hypermobility in Dancers with Dr. Linda Bluestein, MD
177 Plays1 month ago
In this enlightening episode, we’re joined by Dr. Linda Bluestein, MD — a former ballet dancer turned physician and founder of Hypermobility MD and Bendy Bodies. Dr. Bluestein is a leading expert in hypermobility disorders, especially among dancers, and she’s passionate about educating and empowering those living with conditions like hypermobile Ehlers-Danlos Syndrome (hEDS).
We dive into:
- What inspired Dr. Bluestein to specialize in hypermobility in dancers
- The difference between flexibility and hypermobility
- How to tell if you might have hypermobility or hypermobility spectrum disorder (HSD)
- The distinctions between HSD and Ehlers-Danlos Syndrome
- Common signs and symptoms dancers should watch for
- What steps to take if you suspect you're hypermobile
- Dr. Bluestein’s M.E.N.S.P.M.S. framework for managing hypermobility
- Why early care is key to a sustainable dance career
- Myths about hypermobility that need busting
- How dance teachers can support hypermobile dancers
- How to find medical professionals who understand dancers' needs
Whether you're a dancer, teacher, or parent, this episode is packed with practical insights, expert advice, and actionable steps for navigating hypermobility in the dance world.
Connect with Dr. Linda Bluestein:
SUBSTACK: https://hypermobilitymd.substack.com/
WEBSITE: https://www.hypermobilitymd.com/
INSTAGRAM: https://www.instagram.com/hypermobilitymd/
PODCAST: https://www.bendybodiespodcast.com/
Links and Resources:
IADMS: https://iadms.org/find-a-provider/
Doctors for Dancers: https://doctorsfordancers.com/
Aloha Nutrition Bars: 20% off using code: BRAINYBALLERINA
Get your copy of the Intentional Career Handbook
Let’s connect!
My WEBSITE: thebrainyballerina.com
INSTAGRAM: instagram.com/thebrainyballerina
Questions/comments? Email me at caitlin@thebrainyballerina.com
This episode was brought to you by the Pivot Ball Change Network.
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Transcript
Dancer Self-Comparison
00:00:01
Speaker
And what's tricky with dancers is they're all hypermobile. So many of them are hypermobile. So if they look around and they compare themselves to other dancers, they're just thinking about how they compare to other dancers.
00:00:12
Speaker
But really, we need to be thinking about how do we compare to quote unquote normal people.
Introducing Caitlin's Ballet Podcast
00:00:18
Speaker
I'm Caitlin, a former professional ballerina turned dance educator and career mentor. And this is the Brand New Ballerina podcast. I am here for the aspiring professional ballerina who wants to learn what it really takes to build a smart and sustainable career in the dance industry.
00:00:34
Speaker
I'm peeling back the curtain of professional dance world with open and honest conversations about the realities of becoming a professional dancer. Come along to gain the knowledge and inspiration you need to succeed in a dance career on your terms.
Dr. Blustein on Ballet and Hypermobility
00:00:52
Speaker
Hello and welcome to the Brainy Ballerina podcast. I'm your host, Caitlin Sloan, and I am joined today by Dr. Linda Blustein. Dr. Blustein is a former ballet dancer turned physician who specializes in hypermobility disorders with a passion for supporting dancers.
00:01:08
Speaker
As the founder of Hypermobility MD and Bendy Bodies, She provides expert care and coaching to those navigating conditions like hypermobile Ehlers-Danlos Syndrome. And before we dive into all of that, Linda, I would love to just hear a little bit more about your dance background and what led you to focus on hypermobility and dancers for your work.
00:01:29
Speaker
So I grew up like so many dancers wanting to be a professional ballet dancer. And I was, I mean, and i was obsessed and just loved it, loved it, loved it.
00:01:40
Speaker
I started getting injured though, quite a bit when I was a teenager and Looking back, like I probably should have realized something wasn't right. i was I was injured a lot more than most of my peers.
00:01:51
Speaker
And I even was interviewed when I was 16 for the local newspaper. And I even commented about the amount of injuries that ballet dancers have versus football players, that theirs are more dramatic, but that were injured just as much as they are.
00:02:04
Speaker
And it was funny because I was 16 at the time. We didn't have the internet, of course. So like I don't know i't know where I necessarily was like getting some of that some of my data from. But I was fascinated about injuries in dance from a very young age.
00:02:17
Speaker
So when I was in high school, i pretty quickly realized that I was not going to be able to have a professional career. So i would need to come up with my plan b So my plan B was to go into medicine.
00:02:27
Speaker
And i did want to specialize in dance medicine. But at that time, it seemed to me that most of the dance medicine specialists were orthopedic surgeons. And I knew that my upper body would not be able to, in my lower body, would not be able to tolerate like the pounding and all of the things that you physically have to do as an orthopedic surgeon. And I also knew that standing in the OR was going to be a problem.
00:02:50
Speaker
I was also terribly allergic to gloves every time because, you know, and as a medical student, you have to do all these different rotations. And every time I would go to take my gloves off, I would have hives and you know itching. And i had a lot of problems. They kept having to try different gloves out for me at that time.
00:03:06
Speaker
So I knew that you know that wasn't going to work out. So I actually became an anesthesiologist. And I worked as an anesthesiologist for over two decades. And i did really love that. But then I started having even more medical problems.
00:03:20
Speaker
And it's not like things were completely smooth all throughout there. I had all kinds of things happening.
Hypermobility and Career Impact
00:03:24
Speaker
um But then I really started to run into a lot more difficulty. And so I realized that I had a connective tissue disorder and I was formally diagnosed with hypermobile Ehlers-Danlos.
00:03:36
Speaker
And I thought to myself, now, wait a minute, dancers are, a lot of them are super hypermobile, right? And of course, if you excel at it, you probably are on the spectrum somewhere of joint hypermobility.
00:03:50
Speaker
because you cannot become an elite ballet dancer. And of course, this is true for many other forms of dance, unless you have the ability to create the beautiful aesthetic lines and do the you know the things that that we need to be able to do.
00:04:03
Speaker
So I thought, this is a way to combine my love of dance and my love of science at a period that otherwise my career was was ending. I mean, I couldn't work in the operating room anymore, which was devastating to me because it was like, okay, first i had to give up dance Now I have to give up becoming an anesthesiologist, not becoming, I worked as one for quite a long time, but it was just, it becomes part of your identity, right? So the giving up dance part,
00:04:28
Speaker
in that respect, like I sobbed and sobbed and sobbed. It was so devastating. I was able to get back to dance and I did dance actually all through my anesthesia residency and even in the beginning of my anesthesia career. And then I stopped when I was in my early thirties, I had my first child and I tried to go back to class and I was like, okay, I'm working full time. have this little baby at home and I felt like this is just going to take up so much of my time. Whereas before You know, it was such a huge priority. So it's great to be able to kind of get back in the in the theater and im in the studio and be able to help dancers. And and I work with a lot of dancers. so
00:05:05
Speaker
Amazing.
Understanding Hypermobility vs. Flexibility
00:05:06
Speaker
Can you define hypermobility for us? How is it different from simply being flexible? Right. So joint hypermobility has to do with the range of motion of a joint or a group of joints.
00:05:19
Speaker
So for example, like if we're looking at the fifth finger, we've defined it as greater than 90 degrees. Now my fifth finger, cause I'm almost 60, my fifth finger doesn't bend back very far. And especially cause I know like don't hurt myself.
00:05:31
Speaker
But for some people, like i've I've literally asked dancers to show me their fifth finger and they literally can touch the back of their hand. like That's clearly, you're you're subluxing or dislocating. You're right dislocating your fingers in order to be able to do that.
00:05:44
Speaker
So every joint has a different normal range of motion, and it varies with your sex and with your age and also by by race as well. So we look at you know what's normal for that range of motion for that joint, and do you exceed that or not?
00:06:01
Speaker
And what's tricky with dancers is, They're all hypermobile. are So many of them are hypermobile. So if they look around and they compare themselves to other dancers, they're just thinking about how they compare to other dancers.
00:06:13
Speaker
But really, we need to be thinking about how do we compare to quote unquote normal people. So joint hypermobility refers to the range of motion of a joint. And flexibility, if you think of it in the you know real definition, has to do with the ability of the muscles to lengthen and access that range of motion that you have.
00:06:32
Speaker
So it is quite confusing because for the sake of being succinct on social media, sometimes I do use them a little bit interchangeably, but they're not interchangeable. It is very possible for somebody to have joint hypermobility, but be inflexible.
00:06:47
Speaker
So if they have hypermobile joints, but their muscles are hanging on for dear life, they're going to be inflexible. What's the difference between hypermobility syndrome and Ehlers-Danlos? Sure. So joint hypermobility, again, having a joint or a group of joints that have greater than expected range of motion has four different subtypes. So there's the peripheral type, which is the hands and feet.
00:07:08
Speaker
There's the localized type, which is like you just have a couple of joints. Or there's the generalized type where it affects multiple joints in the body or historical where you were hypermobile in the past, but you're not anymore.
00:07:19
Speaker
If a person has one of those types of hypermobility and has symptoms associated with it, The umbrella we talk about is symptomatic joint hypermobility. If you have generalized joint hypermobility and you have symptoms that are likely attributable to that, you are more likely to have either ah connective tissue disorder like hypermobile Ehlers-Danlos, which is a clinical diagnosis. We don't know the gene that causes that yet or the genes, I should say.
00:07:48
Speaker
or you have hypermobility spectrum disorder, most likely. Those are the most common things. Now, it could be due to, you know, a whole host of things. There's many, many things that can cause joint hypermobility, even the generalized type.
00:08:00
Speaker
But those two things are some of the common things. And Ehlers-Danlos is a connective tissue disorder category of which there are 14 different subtypes of Ehlers-Danlos syndromes.
00:08:13
Speaker
And the hypermobile type accounts for probably 80% to 90% of cases or maybe even more. So it's by far the most common. But it's also tricky because it's a clinical diagnosis.
00:08:24
Speaker
And the others have a known genetic marker. So I've had patients where I've suspected that they have classical Ehlers-Danlos, but the genetic testing comes back negative for the known causative genes for that type.
00:08:37
Speaker
So then they, you know, depending on what the rest of their exam looks like, if they have the skin changes like stretchy skin, abnormal scarring in their skin, et cetera, and weak tissues, then I might diagnose them with hypermobile EDS.
00:08:49
Speaker
So what are some of the common signs or symptoms that our dancers are looking for if they suspect that they are hypermobile?
Symptoms in Hypermobile Dancers
00:08:56
Speaker
So I like to divide it into the musculoskeletal and non-musculoskeletal.
00:09:01
Speaker
A lot of people think of only the musculoskeletal type of symptoms. So the musculoskeletal things involve the joint instability. So joint hypermobility and joint instability are two different things.
00:09:12
Speaker
The hypermobility has to do with range of motion. The joint instability has has to do with the ability of the joint to stay in proper alignment. So a lot of us like sublux our shoulders all the time and we have no idea that we're doing it because of course we only know what our own body feels like.
00:09:28
Speaker
So joint instability, whether it's a subluxation or a dislocation. So a subluxation is a partial dislocation. It just kind of slides in and out and it goes back into place usually pretty easily.
00:09:40
Speaker
A dislocation is when the bones are completely out of alignment with each other. And especially the first time that it happens, you probably need a healthcare professional to pop it back into place for you. But there's kind of a common misconception that you always need that.
00:09:54
Speaker
But if your shoulder has been dislocating and comes in and out really easily, you're going to be able to get it back in yourself probably. You're not going to need a healthcare care professional to do that. So that's not like a good marker for whether it's a subluxation or a dislocation.
00:10:08
Speaker
So joint instability is the first one. You also get a lot of soft tissue injuries. So you get sprains, strains, tendinopathies, bursitis, because the joints are moving in a range that's greater than what was intended.
00:10:23
Speaker
So you get like, for example, if you have hyperextended knees or back knee, it's beautiful, right? To have a little bit of a hyperextended knee, but the structures on the back of the knee are being stretched more than they should.
00:10:36
Speaker
And the structures on the front of the knee are being compressed more than they should when you go into hyperextension. And especially if you're standing on that leg, if you're weight bearing on that leg. So we see a lot of joint problems. We see a lot of joint pain.
00:10:50
Speaker
um We also see a lot of muscle pain and tightness because sometimes those muscles are trying so hard to keep that proper alignment. So we see a lot of things happening in the in the joints.
00:11:01
Speaker
And in dancers specifically, you know, we we need better data on this, but we feel very confident that there's a higher incidence of labral tears in the hip. Your hips and your shoulders have like a suction cup type tissue almost that lines the joint that helps it stay where it's supposed to stay.
00:11:17
Speaker
And as we get older, it's not uncommon to get a tear in the labrum and our hip related to arthritis. But dancers, because they use their hips in such an extreme range of motion, they can get tears in the labrum and their hip even if they're you know not arthritic.
00:11:33
Speaker
but then that can actually lead to arthritis. So ah we can see different things happening at different parts of the body. So that's the musculoskeletal side. On the non-musculoskeletal side, we see things like fatigue, brain fog.
00:11:47
Speaker
We see GI symptoms and the GI symptoms can be anywhere along the GI tract. So it can be difficulty swallowing. It can be heartburn. We can see small intestinal bacterial overgrowth, which is where we get ah bacteria growing in the small intestine.
00:12:02
Speaker
We can see bloating, food intolerances, constipation, diarrhea, difficulty getting stool out. We can see pelvic floor problems. We can see pain with intercourse. Painful periods are very, very common.
00:12:14
Speaker
And if you think about it, connective tissue is everywhere in the body, right? Everywhere. So I went to an ENT doctor once and I was having difficulties with my throat and they literally said to me, well, that's not related to your EDS.
00:12:27
Speaker
And I'm thinking to myself, well, how sure are we about this? There's connective tissue everywhere in your body, including in your larynx, which is the airway part of your of your throat. So I knew that I disagreed with that person, but I i also knew it wasn't worth fight, right? so And then we also see a lot of co-occurrence with a couple of other syndromes, dysautonomia, which is dysfunction of the autonomic nervous system. One particular type of that is called POTS, postural orthostatic tachycardia syndrome.
00:12:56
Speaker
And then we also see a lot of mast cell activation syndrome, which is where the mast cell is part of your immune system, becomes hypersensitive. Okay, so I'm listening to all these symptoms and I'm thinking you to myself, you're describing me to a T. So if there's a dancer like me out there, what do we do? Who do we go see? What are the next steps to kind of approach all of this ah spectrum?
00:13:19
Speaker
Dancers listening to this, I want you to know that you do not need to have all of these symptoms. You might have some symptoms on some days. You might have other symptoms on other days. And you might not ever have some of these symptoms. You might be like, you know what? I don't have problems with fatigue.
00:13:34
Speaker
Could I still have this? And the answer is definitely yes. And the other really important point is you don't have to be the bendiest dancer in the room. in order to have a connective tissue disorder.
00:13:45
Speaker
So backing up just slightly, connective tissue disorders is when there's something faulty in how the connective tissue is made. And we don't know, actually, if mast cell activation syndrome might actually underlie some of the cases of connective tissue disorders.
00:14:00
Speaker
Because when those mast cells are activated, they release chemicals that do a number of things. They cause inflammation, they cause cause allergic phenomena, and they also degrade connective tissue.
00:14:12
Speaker
So it's possible that some people, myself included, because I had terrible lifelong... you know, allergies, eczema, asthma, like all these things. So it's very possible that I don't have a genetic connective tissue disorder, that mine is all mast cell related. But at this point in time, because it's clinical diagnosis, we don't know. So sorry for that diversion, but I just want to point that out.
00:14:34
Speaker
So getting good help is hard. I have to say it's very hard. Most doctors do not understand these conditions and they really don't understand that. the incredible suffering that they can cause.
00:14:46
Speaker
And I feel like dancers are even at a bigger disadvantage because if you go to a doctor and you say, I have this problem and this problem, this problem, but you're still dancing, they kind of look at you like, well, but you're still dancing, so you must be fine.
00:14:59
Speaker
And I feel like that's a huge problem in our society. So I work with a lot of dancers virtually and help them get better resources, get connected to better care, even if they can't come see me in person.
00:15:11
Speaker
So I have, like, i see people in person as patients, but I also see them virtually for, like, consults and more like coaching. There are other people who are really knowledgeable about these conditions, and sometimes they could be even in your backyard. So it's possible that you could go to your PCP, and that's your primary care provider, I should say, and they might actually know enough but to be able to help you, to be able to point you to the referrals that you need.
00:15:35
Speaker
They might know how to you know listen to you, and they might be willing to prescribe some of the medications that can be helpful and treat you in a holistic way, because that's really what dancers need that have hypermobile joints and have symptoms.
00:15:50
Speaker
They need somebody to look at them as a whole person and address every facet of that. Not just say, stop dancing and all your problems are gonna go away, right? And so Caitlin, is that what you were told?
00:16:02
Speaker
Well, I don't think that I ever really understood that I was hypermobile. Because of what you're saying, I was never a super flexible dancer. And so it didn't quite ever occur to me that I could be hypermobile because I could never be like a Cirque du Soleil kind of. right Right.
00:16:23
Speaker
knees especially is that is something that i've had to really deal with but i've been training that kind of thing but i again i didn't really understand it and no one really talked to me about it and also like you said and the dance world it's kind of applauded it's like wow you have really beautiful hi and so it was like thing but then when you're saying all of these different symptoms and i'm starting to learn more about it i'm going those are all things that i have and i'm treating each of these individually Right.
00:16:47
Speaker
Not understanding that there is an underlying cause that I could maybe be treating to target the problem where everything is starting from instead of saying, let me just put a bandaid on all these symptoms.
00:16:59
Speaker
So I'm curious, what are some of the things for hypermobile dancehall that you need to be doing?
Managing Hypermobility: MEN's PMMS Approach
00:17:04
Speaker
Like what are the medications or any kind of lifestyle things that are helpful? Right. When I first started my practice, I viewed these conditions as like primarily based in the connective tissue.
00:17:15
Speaker
And I thought some of my patients are going to have mast cell activation syndrome, but maybe not that many. But as it turns out, once I realized that mast cell activation actually contributes to pain and it actually contributes to the sensitization of the nervous system i really changed up my approach and i started treating everyone as if they were somewhere on that mast cell spectrum because we all have mast cells we need them for life so we have them and if they are you know at all unstable they're going to contribute to pain they're going to contribute to weaker tissues
00:17:50
Speaker
And it's an excellent target because there's a lot of things that we can do to address that. but There's more that we can do to stabilize mast cells than there is for anything else related to these problems, in my opinion.
00:18:03
Speaker
So, because we want to treat the root cause, like you said. So what I do is I have a comprehensive treatment approach that I use, and I have an acronym that I use for that. And it's called MEN's PMMS.
00:18:16
Speaker
And those letters stand for movement, education, nutrition, sleep, psychosocial modalities, medications, and supplements. So the movement piece is, you know, for dancers, it's not, it's not dancing more. It's maybe, maybe actually the load of your dance is actually too high.
00:18:34
Speaker
And maybe so you're dancing less, but you're working with a strength and conditioning coach. a Pilates instructor, a physical therapist, a gyro instructor, somebody like that who can help you really work on your body in a way that you're using the correct muscles to execute the correct movements and you're stabilizing your joints and you're making sure that Yes, and in dance, we're going into extreme ranges of motion, but we can do it in the safest possible way.
00:19:01
Speaker
And I also urge people to think about what are my goals? I mean, if I'm this incredible elite you know ballet dancer and that's my dream is to be professional, but um I'm already like a pre-pro and I'm very...
00:19:15
Speaker
I'm doing very well and in the YAGP and in Prita-Lazan and things like I'm doing well and that's my dream. Okay. Then you need to be going into those extreme ranges of motion because that the judges want to see that the audience wants to see that. Right.
00:19:28
Speaker
But if you're a more casual dancer and you're like, you know, I just want to dance for fun, then don't do that. Yeah. You know, because it does cause wear and tear on the body.
00:19:39
Speaker
And so we need to be thinking about, yeah, am I going to be in Cirque du Soleil? And so therefore I need to be doing know those kinds of things in a very methodical, thoughtful way. Or am I going to be doing some other form of dance? I had an adult ballet dancer who was going to go up on point, like in her thirties, and she already had foot pain.
00:19:56
Speaker
And I was like, so you're in your thirties. So at that point, like you're not going to be a professional ballet dancer unless there's some you know Maybe there's some like offshoot adult ballet companies that she could have joined, but I asked her what her goals were and her goals were not to do that.
00:20:09
Speaker
And I said, then why are you going on point? Why are you doing that to your feet? And she was like, yeah, now that you mention it, good point. So she didn't. And I think that was a smart choice. So so movement, the E stands for education.
00:20:21
Speaker
I feel it's very, very important for people to understand how pain processing works in the body. I feel like dancers in particular, early on, ignore their pain. We're used to being in pain. So whether it's pain from pointe shoes or from you know just having really, really hard rehearsal and class days, and so we have muscle soreness the next day, plus or minus like a nagging overuse type injury, we're used to being in pain.
00:20:49
Speaker
But there's a big difference between the pain related to an injury and pain that is you know later on when it might be related to sensitization of the nervous system, like when we're not dancing anymore, but we still have all this pain.
00:21:03
Speaker
So i feel like in general, dancers don't pay enough attention to pain and signals that their body is giving them early on. But then later on, after we've been in pain for years and years and years, now we have like kind of an imprint in our nervous system. And so we have to deal with that.
00:21:19
Speaker
So it's really important for dancers to understand how pain processing works So that we make sure that we're taking good care of our bodies. The N stands for nutrition. Everything that we eat either increases or decreases inflammation in our bodies.
00:21:31
Speaker
So we want to make sure that we are dosing our food in a way such that we're giving our body the nutrients that it needs. Because of course, dancers often... are depriving their bodies of nutrients.
00:21:42
Speaker
And our bodies need the energy and they need the micronutrients and the macronutrients to build our tissues. As Lisa Howell says, the body is in a constant state of reformation.
00:21:53
Speaker
So it's really, really important that we're giving our body the proper building blocks in order to recover from all of these you know little micro injuries that we're getting when we're dancing every day, because we are You know, that's how we get stronger is we push our muscles so hard and then they have to rebuild themselves.
00:22:11
Speaker
But if you're not giving your body what it needs, it can't rebuild itself well enough.
00:22:16
Speaker
Let's quickly pause this episode so I can share with you one of my favorite snacks that I have been loving lately. As a busy dancer, educator, and mom, I am always looking for a snack that I can throw into my dance bag that will be quick, convenient, and provide lasting energy.
00:22:35
Speaker
That's why I was so excited to find Aloha Protein Bars. Aloha bars give me everything I need. With 14 grams of plant-based protein and 10 grams of fiber, I can count on this snack to keep me going.
00:22:50
Speaker
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00:23:03
Speaker
And the best news is you can get 20% off your first order with code BRAINYBALLERINA. Head to the show notes and click the link to try Aloha Protein Bars for yourself today. The S stands for sleep.
00:23:16
Speaker
So a lot of dancers are not sleeping adequately, and sometimes it's related to sleep apnea. So it's possible, even if you're a young, thin dancer, it's possible to have sleep apnea where your airway closes during sleep.
00:23:29
Speaker
And so you don't get good quality sleep because you're waking up constantly to breathe again. But you don't know that you're doing this. Maybe your partner... tells you that you snore and that you sometimes hold your breath, but most of the time people don't know that they're doing it.
00:23:41
Speaker
Usually we think of people with sleep apnea as being, you know, big guys, right? And like, you know, being overweight and stuff. um And that, those are risk factors. But if you have a connective tissue disorder, your airway can collapse more easily. So we are at higher risk.
00:23:55
Speaker
So getting good quality sleep is critically important. And a lot of people with these conditions have multiple different challenges to their sleep. Another one is dysautonomia. So if their heart rate is spiking in their sleep, that's also going to disrupt their sleep.
00:24:09
Speaker
The P for psychosocial means surrounding yourself with a supportive network and also having counseling and things like that in order to address the the challenges that come along with having these conditions. And one of the things that I forgot to mention when we talked about how do these present is neurodivergence.
00:24:27
Speaker
We know that joint hypermobility and things like ADHD, autism, Tourette's, dyscalculia, dysgraphia, Like these are much more common to occur together.
00:24:38
Speaker
So that's a very, very common thing that people encounter as well. So counseling can really help you in your relationships and help you if you have autism or you have ADHD, that can be very helpful.
00:24:49
Speaker
The next M stands for modalities. So it might be using virtual reality glasses, acupuncture, acupressure, ultrasound, like a whole bunch of different things. Vagus nerve stimulators.
00:25:00
Speaker
These things can help with pain and other symptoms. And then the next thing, M medications. My favorite medication is low-dose naltrexone. Naltrexone is an opioid antagonist, but in low dose, it actually helps the body make more opioids and helps you become more sensitive to your own opioids.
00:25:19
Speaker
It's not a controlled substance. It's not an opioid. It's an opioid blocker. I started taking this probably eight years ago, and I think it is probably the single most important thing in my improving my quality of life so dramatically over where I was about a decade ago.
00:25:35
Speaker
So it can be very, very helpful. Some people might be listening to this and think, oh, but I tried that and I had some adverse reaction. Sometimes adverse reactions are to the excipients or the quote unquote inactive ingredients and medications.
00:25:47
Speaker
So I urge people that, look well, let's try it again. Let me prescribe it in a different way. Let's do the dosing differently. i have some people who take it twice a day. Some people take it once a day. It's It all varies, and I work with the individual person to find the right dose and the right dosing strategy for them.
00:26:04
Speaker
Also, another medication that can be really, really helpful, or or class of medications, I should say, is antihistamines. Not to take all the time, and of course, dancers don't want to be sedated from antihistamines, and antihistamines can cause weight gain, which can be a limiting side effect relating to antihistamines, but those can sometimes be really helpful, especially used on an as needed basis. So the other day I had a terrible episode of abdominal pain and like a food intolerance type reaction. I took my ketotaphan, which is a compounded antihistamine.
00:26:33
Speaker
Within 15 minutes it was gone. And I had tried like, you know, all kinds of other like over the counter type things. None of that had helped. So those are medications. supplements. There are lots and lots of supplements that can be very helpful.
00:26:46
Speaker
Dancers tend to be, or a lot of dancers I should say, are low in vitamin D. So vitamin D is a hormone. It's not a vitamin. Very important for sleep, pain, mood,
00:26:57
Speaker
And a lot of doctors don't realize that if you're not totally insufficient or deficient, that doesn't mean that you're sufficient. So I like to see people in like the higher end of the normal range.
00:27:09
Speaker
And so I often prescribe vitamin D with vitamin K2 because that helps the vitamin D go into the bones and not calcify the tissues. So vitamin D is really important.
00:27:19
Speaker
Magnesium can be very helpful, vitamin C. I have a lot of this information in my Substack newsletters. And also I published a couple of papers about this as well. That was amazing. and That was very helpful. I'm taking mental notes about all the things that I need to think about. Yeah.
00:27:35
Speaker
As I said before, hypermobility is kind of admired in the dance world. People are like, wow, you're so on mobile. That's amazing. like I wish I had your legs. I wish i had your feet, all those things. But it really does affect you.
00:27:46
Speaker
And so I think most dancers aren't thinking about the fact that what you're able to do now as a young dancer is going to affect you long term. Can you kind of paint a picture or make a case for why dancers need to be taking care of this as a young dancer so they can have long-term good health effects?
00:28:04
Speaker
Yeah, I love that question so much because the challenge is we do not know yet what the ramifications are of dancers doing the kinds of things that they are doing now.
00:28:17
Speaker
They are doing things that we never did before. 20 years ago, 30 years ago. I mean, the things that people are doing, which I have to confess, I love to watch, right? And I love going to Cirque du Soleil. i've got I've gone many times and i and I love to watch it, but I worry about these dancers and athletes' bodies and what's going to happen because we don't know yet. So you know back in the 19...
00:28:41
Speaker
30s and 40s, you know, if you think about the height of the dancer's leg, it wasn't even at 45, right? And then, you know, we probably get to like the 70s and it was seven it was like, you know, maybe 90 degrees, but not much higher.
00:28:54
Speaker
And then we get to like the 2000s and yes, it was higher. was probably, you know, like maybe, you know, it was well past 90, right? But now we're looking at all these 180, you know, people are doing all these needles and scorpions and, you know, especially if you're doing competitive dance, but even ballet dancers are doing things that are just insane. and And I would say that if you did an x-ray on some of these dancers, their hip is probably fully dislocated when they're doing these things.
00:29:23
Speaker
And they probably have hip dysplasia, which is where the hip socket is very, very shallow. And that allows you to have this incredible range of motion. But if you have hip dysplasia, you are at increased risk of having hip replacement surgery at a much younger age.
00:29:39
Speaker
So I really worry about these about these dancers and especially when they are doing things over and over and over again, right? What you do really frequently matters a lot more than what you do once in a while.
00:29:51
Speaker
And so I understand that if you're preparing for a competition or whatever, you're going to need to do the same variation over and over. But unlike when I grew up and we were like in class all the time, and then every once all we'd have a performance and we'd be rehearsing those pieces.
00:30:06
Speaker
Now I feel like because of a performance like YAGP, which I love by the way, but they're doing they're they're doing their regional competition. Then they're doing, you know, semifinals, finals, if they if they make it that far.
00:30:17
Speaker
So they're practicing that that same variation over and over and over again, like so many times. And so those certain parts of the body are getting that, you know, overuse and load over and over and over again. And we just don't know yet how that impacts the body because when dancers are young, they can do a lot of things that they're not going to be able to do when they're older.
00:30:37
Speaker
So I don't want to see a dancer peak when they're 16. That's my biggest fear. My biggest fear is that they're either going to peak when they're 16 or they're going to be retired when they're 18. I actually worked with a dancer who,
00:30:49
Speaker
She was the bendiest. She was like always right in the front. And her her mom was a dance teacher. And she was the scorpion, the needle. She actually won awards that were called, you know, the bendiest dancer award and stuff like that.
00:31:02
Speaker
And when I saw her, she was 16. She was completely retired from dance and she had back pain every single day. And it was heartbreaking to me.
00:31:13
Speaker
And when I met with her, she cried. She was like crying, sobbing. And I was crying for her because she's like, I don't know if I'm ever going to get out of this back pain.
00:31:24
Speaker
And I was like, okay, we need to, you know, kind of figure out what's going on. But this was like such a sad story because here, this young lady is only 16 and she has this terrible back pain because a lot of other problems that can occur are things that don't necessarily have an easy fix.
00:31:39
Speaker
So for example, if you're dislocating your patellas or your kneecaps, because you have this fabulously stretchy connective tissue, which is wonderful in one way, but it's not wonderful when you're dislocating your patella.
00:31:51
Speaker
The surgery to fix that dislocated patella is not a simple surgery, and it's not simple to recover from that. If you get PARS fractures in your back, in the PARS interarticularis, and your back becomes kind of unstable, which is another really common thing that happens in dancers and gymnasts and contortionists, um because they're doing so much extension movement and they fracture these parts of their spine.
00:32:14
Speaker
And if that happens, you know, there's not a great fix for that. Maybe you're going to need spinal fusion surgery in order to fix that. So right now I know I'm sounding like a total Debbie Downer, but I feel like right now we need more people advocating for the dancer side and let's make sure that the dancer stays healthy so that they can have a really long health span in dance and longevity of their career and also be able to move after they've stopped dancing.
Long-term Health in Dance Practices
00:32:45
Speaker
Like I hate to see a dancer in their 30s using a cane or a wheelchair or something because of what they did when they were dancing.
00:32:53
Speaker
So, you know, we don't know. We need more data for sure, but I really worry about the extreme, extreme ranges of motion that we are currently seeing, especially in things like competitions. And young, young dancers are able to do these things because they have not reached skeletal maturity And if they haven't had their period yet, then also their body's going to be able to do things that are going to change once they start getting menstrual cycles. So it's it's a complex situation.
00:33:23
Speaker
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00:33:39
Speaker
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00:33:54
Speaker
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00:34:08
Speaker
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00:34:25
Speaker
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00:34:34
Speaker
Are there any common myths that you would like to debunk about hypermobility in dancers that we haven't already talked about? Definitely. So I guess one we already talked about, that is it's not necessarily the bendiest dancer in the room. And you're right. I was so jealous of this one dancer.
00:34:48
Speaker
I went to UC Irvine because they have a conservatory style dance program there. It was amazing. And there was one dancer in all my classes who was just gorgeous. And I was so envious of her extension and everything.
00:35:00
Speaker
But as soon as I started learning about these conditions, I looked back and I realized, oh my gosh, this is why she couldn't, she could get her leg up but like to 180, but she couldn't hold it up there. And so, although obviously a lot of dancers now, they can do that. But so it's not necessarily the bendiest dancer in the room. That's the first thing.
00:35:17
Speaker
The second thing is just because you're hypermobile does not automatically mean that you have a connective tissue disorder, but it's possible that you have something going on in your connective tissue. If it's more related to your hips, then it's very possible that you have a very shallow hip socket.
00:35:32
Speaker
And that's why you are able to do such crazy things with your legs. If you have a really, really deep hip socket, then you're actually going to have really limited range of motion of your hips and your legs.
00:35:43
Speaker
And so I always also say dance with the body that you have because some people say, oh, but everyone, if they try hard enough. No, that's not true. i was working with a dancer the other day who has her feet are naturally rotated on her tibia, which is the lower bone, they're naturally rotated out at least 90 degrees to each other, at least. And she was like, everyone always always loved what how great my turnout was.
00:36:09
Speaker
But a lot of it is probably was probably what's coming from her lower leg. So we have these variations in our body that in dance can make such a huge difference. that I think sometimes we forget dance with the body that we have.
00:36:22
Speaker
Getting back to myths and connective tissue disorders, I think the biggest one, the one that drives me the most insane is why bother with a diagnosis because there's nothing that you can do. This drives me absolutely nuts.
00:36:36
Speaker
There's so much that we can do. I found on my own so many things that helped improve my quality of life. A decade ago, i was in terrible shape. little over a decade ago now, I guess, but I was in terrible shape.
00:36:48
Speaker
And now I'm like 15 years older and I'm physically way better off than I was despite 15 years of aging. There's so much that we can do. I had a dancer patient that I worked with who after 30 days said, I am 90% better.
00:37:05
Speaker
wow So it's so important for dancers to be proactive. There's no such thing as thinking about this too soon. We don't want to over-medicalize. We don't need to go crazy and order a bunch of tests. And, you know, we always need to do the care appropriate to that person.
00:37:22
Speaker
I was working with dancer the other day, a very young dancer who's still dancing and doing all the things, but mom just wanted to be super proactive. Great. We're not going to go start that person on low-dose naltrexone.
00:37:34
Speaker
You know, the care is always... adapted to the person that's in front of you and make sure to meet their needs. Are there any changes you'd like to see in the dance world regarding awareness and the support for hypermobility? I mean, and as a former dancer and now dance teacher, career mentor, like kind of what are some of the things that dancers should be aware of, but also us as teachers when we're looking at our students, how can we help them?
00:38:00
Speaker
So teachers can definitely be maybe one of, if not the first person to recognize that a dancer might be hypermobile. And oftentimes dancers will come up to their teachers and tell them, I have this pain. I mean, I'm sure you know this.
00:38:14
Speaker
I have this pain. I have that pain. you know And so they they often go to their dance teacher first. Then maybe they'll go to a dance physical therapist. Doctor is like a lot lower down on their list, which is fine, which is totally fine.
00:38:26
Speaker
But it's really important that dance teachers be aware of these things and that just because a student can do something doesn't mean that they should. So that's the first thing.
00:38:38
Speaker
The second thing is what Winona McCormick taught me on my very first episode of my own podcast, Bendy Bodies. She was the lead physiotherapist for the Royal Ballet and had danced for the Royal Ballet.
00:38:48
Speaker
And she was one of the earliest researchers on hypermobility in dance specifically. And she says that if she has a dancer who appears to have a tremendous amount of talent, she actually puts them up on point later.
00:39:03
Speaker
Yeah. because she knows they're going to be on point longer and she wants to really make sure that they're bones are there growth plates are closed and that their feet are really strong and their ankles are really strong and so i think that if you have a dancer who you feel like this dancer really has a shot at having a career really think about the load on the body. And again, the the ability that they can do certain things.
00:39:30
Speaker
It's like, okay, let's make sure that maybe they are able to still do those things for later on. But think about when do you want their career to peak? You don't want their career to peak at 12 or 13, right? Nobody wants that.
00:39:41
Speaker
So you want to just be thinking about what's a smart way to train? How can I incorporate these other ways of strengthening the body and stabilizing the joints. Like I mentioned earlier, so like I love gyrotonics, gyrokinesis. I love Pilates and work with strength and conditioning coaches and things like that.
00:40:00
Speaker
Dance teachers should be aware of what resources they have in their area so that they can refer their dancers to these places that they know understand the dancer mentality because um we know dancers just want to dance, right?
00:40:16
Speaker
And so i think sometimes we need to understand too as dance teachers, choreographers. um i taught dance for actually for a long time. And dancers won't always be transparent with you, right? About what what's hurting or or whatever.
00:40:30
Speaker
I've given talks before to a group of dancers and I hear them talking about their pain or their injuries or whatever. And then a couple times, like I'll stay and I'll watch part of class and I see that they hop right into class and I'll see that, you know, they want to dance. So they're jumping around the room and I'm like, oh my God, you just were talking about your injury.
00:40:46
Speaker
It's really important to educate dancers about their bodies and how our bodies are, they're strong and they're not all the same time.
00:40:57
Speaker
Like oftentimes we're stronger than we think we are, but we also don't want to treat our body as if parts are disposable because they're not. You know, replacing a hip when you're young is a huge deal and a huge problem because a replacement, you know, 10 or 20 years later is definitely not as good as that first replacement that you get.
00:41:17
Speaker
So you really don't want to be doing that. You don't want to be doing ankle replacement surgery and, you know, these other things. So you want to really talk to your dancers and make sure that they understand that it's okay to listen to their bodies, that you want them to listen to their bodies.
00:41:32
Speaker
that if they need to sit out or modify or whatever, that that's okay. How do you recommend finding a doctor who understands dancers in
Support and Resources for Dancers
00:41:42
Speaker
this way? Because I feel like, like you said, I would avoid going to the doctor because often they would just say to me, well, just sit out for four to six weeks and then you can dance again. And I was never told by a doctor, let's incorporate some strength training. Or even when I went to PT as a young dancer for a sprained ankle, and as soon as I could walk properly again, i was dismissed.
00:42:02
Speaker
And I was like, but i have to do so much more as a dancer. Like, that's the baseline. I need to be able to go on points. They didn't keep working with me that long because they didn't know what that took. So how do we find these doctors, these unicorns who can help us in this way?
00:42:17
Speaker
So I think a good place to start is to look for a dance medicine-specific doctor. And you can go to the iadams.org website. And that's iadms.org.
00:42:30
Speaker
um So you can look there. You can also look on Doctors for Dancers. An important thing to know, though, with any of these websites, um because the Ehlers-Danlos Society also has healthcare professional directory on their website, but none of these are really vetted.
00:42:43
Speaker
So it's it's a matter of, you know, I want to join the organization. I want to ah want to be a part of this. It's not like they go to your clinic and see how you're treating your dancers and making sure that You are doing things the way that they think is is correct. I mean, not that they necessarily would know, like because each of us probably have such a narrow niche. you know But so that's a place to just find somebody to start with.
00:43:05
Speaker
Ask around. Definitely ask your fellow dancers, because they they definitely might know. And I would look in Facebook groups. I would look in dance-related Facebook groups or and Instagram.
00:43:16
Speaker
ed if it's If you have hypermobility and you're dealing with something related to that, look in EDS support groups for your area. And if there isn't an EDS Facebook group local to you, maybe start one because that's a great resource for people. All the time in those groups, they'll talk about different doctors, different physical therapists and things like that because you're right.
00:43:35
Speaker
The physical therapist, the more they understand about joint hypermobility, the more about hypermobility. the better. And the more they understand about dancers, the better. And one other thing I want to mention about that is when it comes to your doctor, i would say this is true for your physical therapist also, they don't necessarily have to be an expert in these conditions.
00:43:53
Speaker
If they are empathetic, open-minded, and wanting to learn, in some ways, sometimes that can actually be better than going to somebody who is a specialist, but might be kind of burnt out or doesn't it have the time to get you back in for your follow-up and and things like that. So I think that, you know, there's certain qualities that you can look for as well.
00:44:15
Speaker
Okay. Yeah, I think this has been so helpful. I'm sure there's many dancers listening who are just going ding, ding, ding, all these things I never realized were connected, you know, maybe are all part of a larger issue. So I really appreciate all of this wisdom you've shared. If anybody listening wants to learn more more about you and your work, where can we find you?
00:44:38
Speaker
Sure. So I have a podcast called Bendy Bodies. And the website for that is bendybodiespodcast.com, or you can just go to bendybodies.org. So definitely check that out because there's over 150 hours worth of backlog content at this point. And I do release episodes every week.
00:44:56
Speaker
And on the website, you can directly submit a voicemail, a question, and i love to get questions. And if you submit your email address, then we subscribe you to our Substack newsletter,
00:45:07
Speaker
Don't worry, you will not be inundated with emails. Of course, you can unsubscribe at any time. Of course, would never sell your email address, but it's a great way to stay on top of of things there. I also offer one-on-one medical care if you can travel to Wisconsin or Colorado. So it's funny that you're sitting in Wisconsin. I'm sitting in Colorado right now.
00:45:24
Speaker
It's very ironic. Medical licenses are state dependent and I have a medical license in Wisconsin. I have a medical license in Colorado. So if someone can come see me in person for the first visit,
00:45:35
Speaker
Then I can treat them as a patient. I can write for lab orders, imaging, prescribed medications, like the whole nine yards, like a regular you know doctor's appointment would. If somebody can't come see me in Colorado or Wisconsin for the first appointment, but they still want to work with me, they want to have a one-on-one session, I offer something that I call EduCoaching.
00:45:55
Speaker
So I do this on the BendyBodies Jane platform. That's just the name of the app that I'm using. And so I do a detailed you know intake of all of your symptoms that you're dealing with and kind of a chronology and all of that.
00:46:09
Speaker
And then I offer resources and um guidance and tips. And instead of saying you should take low-dose naltrexone, for example, instead I will say people with symptoms like yours often benefit from low-dose naltrexone.
00:46:24
Speaker
So it's like a one-on-one lecture. and So I'm not using my medical license, but I'm still a doctor. So I can't prescribe you medications. I can't prescribe, you know, or write for orders and things like that, like lab orders, but it's customized completely to you.
00:46:39
Speaker
And some of those things you can do on your own. Some of them you can't like order labs or order naltrexone. However, I write it in a way such that it makes it super easy for another doctor on your team to literally look at my note and go, Oh,
00:46:53
Speaker
oh, well, I can write it like that. Oh, this seems relatively safe, but they just didn't know what to do. So usually people report back that they found that really, really helpful. And sessions range from 20 minutes to almost two hours.
00:47:08
Speaker
And trust me, we never run out of things to talk about. so and So kind of wherever you are in your journey and whatever whatever it is that you need, we totally customize it to that to that dancer or or non-dancer and give them information so that they can have their body as healthy as possible for as long as possible.
00:47:28
Speaker
Amazing. Thank you so much for all of this. It's been wonderful. And I really appreciate your time today. Thank you so much for having me. I love dance so much. I love dancers so much. They work so incredibly hard. And we know that sports medicine has so much more to offer you know other types of athletes, whether you're a baseball player, or basketball player, football, you know at an elite level.
00:47:49
Speaker
But in dance medicine, I mean, we've come a long way but we we have more we need to do. So it's so important that we support our dancers and just do everything that we possibly can for them so that they can feel seen and heard and well cared for.
00:48:06
Speaker
Thank you for tuning into the Brainy Ballerina podcast. If you found this episode insightful, entertaining, or maybe a bit of both, I would so appreciate you taking a moment to leave a rating and hit subscribe.
00:48:19
Speaker
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00:48:32
Speaker
I'll be back with a new episode next week. In the meantime, be sure to follow along on Instagram at The Brainy Ballerina for your daily dose of dance career guidance.