While many dancers stretch for hours, a lucky few have virtually unlimited flexibility. Stretchy is prized in the dance world, so this can seem like a big advantage. But is more always better?
“As dance progresses, dancers are increasingly asked to work their end range of joint movements with very high arabesques or développes,” says Nancy Kadel, orthopedic surgeon and co-chair of the Dance/USA Task Force on Dancer Health. But she warns: "If someone has hypermobility, there is more play in the joint, which can increase the risk of injury."
Being hypermobile can help you create beautiful lines and shapes, but it doesn't can have serious consequences if not handled properly.
When more flexibility is not necessarily better
There are different types of flexibility, says Heather Southwick, director of physical therapy at Boston Ballet. “Some dancers are flexible, but that doesn't mean they're hypermobile,” she explains. “There is a difference between muscle flexibility and what happens in the joint.” When someone has hypermobility, the ligaments that hold the bones in a joint together are loose, allowing for increased movement beyond the normal range of motion. This can lead to wear and tear or even displacement of the joint. So although the ligaments are more mobile, they are also more fragile.
Sometimes it is a sign of benign joint hypermobility, an inherited condition in which joint stiffness is accompanied by pain, fatigue, a tendency to bruise easily and even digestive problems or hernias. Rarely, it indicates a condition such as Ehlers-Danlos syndrome, in which extreme flexibility can be accompanied by problems with the eyes, skin, blood vessels and heart.
Of course, excessive flexibility doesn't always cause symptoms, but regardless, dancers must balance their innate flexibility with strength and control.
Kadel, kneeling, recommends strength exercises to combat hypermobility. Photo by Aaron Burnell, courtesy of Kadel.
Be aware of the dangers
The disadvantages of extreme flexibility can include fatigue, pain, sprains and chronic injuries. Some dancers experience the condition only in certain places. But even an unstable joint, such as a knee, can be a weak link in a chain reaction that throws other links out of sync.
Annette Karim, director of dance medicine at Evergreen Physical Therapy Specialists, says she sees many dancers with hip problems. Examples include labral tears – when the ring of cartilage lining the hip socket separates from the joint – and impingement, where the bones of the hip joint rub against each other, causing pain and joint inflammation. Dancers may hear a clicking sound or feel pain in the hip when developing forward or to the side, but should consult a dance physiotherapist before jumping to conclusions.
An overly mobile spine is also vulnerable to injury. “The L-4 can slip in front of the L-5 during back cambrés, battements or arabesques,” says Karim, which in extreme cases can cause a vertebral fracture. In the long term, osteoarthritis of the spine can develop, leading to chronic back pain and stiffness as we age.
Southwick collaborates with Boston Ballet dancer Alec Roberts. Photo by Lauren Pajer, courtesy of Boston Ballet.
Managing the condition
You can't reduce hypermobility, but you can control it. “Dancers really need to work on stabilizing and protecting the joints,” says Kadel. As with all dancers, stability begins with a strong center. Pilates is a great option for building core strength.
Southwick provides dancers with strengthening exercises that engage and engage the core and deep muscles. “All athletes and dancers tend to use their global muscles, and it's hard to find the deep muscles,” she says. For example, if you're not strong enough to do a stretch, the larger muscles like the quads take over.
Isometric exercises, where the muscle contracts without changing length (such as pushing against a wall), are also important for building strength, says Karim. “A dancer can still go to extremes, but they have to be strong,” she says. “You have to be stable throughout the entire series.”
Dance teachers should be aware that strength exercises taught during class may not be sufficient. Dancers may need to do additional strengthening on their own or with a physical therapist. And while stretching is still important, hypermobile dancers should be careful to stretch only the muscle itself, and not the joints or ligaments.
It is worth seeing a physiotherapist who works with hypermobile dancers. Physiotherapists often use an initial test of flexibility and may refer the dancer to a doctor if in doubt.
Hypermobile dancers need to come to terms with their bodies, says Southwick. “The key is to make sure students know how to control it.” She especially warns against splits. Kadel likes to remind dancers to balance flexibility with stability and control: “With great mobility comes great responsibility.”
