The Risks of Hypermobility

by Julie Ferrell-Olson

Summary: Hypermobility is often coveted in the dance community, but can predispose dancers to training risks. This article briefly covers what hypermobility is, the risks involved, and what we can do to keep dancers with hypermobility safe.

Hypermobility, double-jointed, overextension. Whatever you call it, we’ve all seen it: the ballerina with legs that seem to bend backward, or the popper with both arms comfortably tucked behind their head. While it can be beautiful and exciting to watch a strong dancer with hypermobility, it’s worth taking a step back and looking at what causes such extremes and the risks that follow it. Hypermobility may be localized to a single joint (usually caused by repeated injury, such as multiple ankle sprains), or generalized throughout the body. This article will focus on general joint hypermobility.

Joint hypermobility is best defined as an excessive range of motion in the joints; it is not the same as flexibility, which deals more with elasticity and range of motion in the muscles. For example, a dancer’s knees may have a backward curve when they lock their legs (hypermobility), but they cannot touch their toes when sitting in pike (flexibility). General joint hypermobility is relatively prevalent in the dance world, with some studies citing 44% of dancers having general joint hypermobility compared to the 4-7% prevalence in the general population. Hypermobility is generally genetic, caused by loose connective tissue that can symptomize at other parts of the body, such as more elastic skin or difficulty maintaining orthostatic pressure (blood pressure) when standing up quickly.

In 2013, researchers compared a population of dancers to non-dancers on fitness and hypermobility. Overall, they found dancers with general joint hypermobility to be more at risk for injury from fatigue, psychological distress, and had lower physical fitness levels despite undergoing the same level of training as non-hypermobile dancers; similar results were found in non-dancers with hypermobility.

Other risks that are commonly seen with hypermobility also include but are not limited to:

• Slower recovery from training
• Lower bone density
• Reduced proprioception
• Strong positive correlation with anxiety disorders
• Increased musculoskeletal problems*

The severity of hypermobility is most easily assessed on a scale of 0-9, with 0 being not hypermobile and 9 being general hypermobility**. However, just because a dancer has some hypermobile joints does not mean that they will have any or all of the issues listed above. It is our job as educated instructors and dancers to realize there may be a correlation and keep hypermobile dancers dancing longer and stronger by:

Recognizing they need adequate rest time, and that supplemental training may be detrimental unless coupled with adequate recovery (QUALITY over QUANTITY)

• Giving them enough time to go through a full and proper warm up - coupled with using protective dancer shocks
• Realizing that if they get injured, they will need extra recovery time  - preferably spent by wearing a recovery compression sock for dancers
• Strengthening supportive muscles so they don’t “sit into” and rely on their hypermobility for balance or stretching

It is possible to have a long and successful career with hypermobility as long as we do everything we can to keep dancers away from training risks and injury.

 *There is no clear data without confounding variables to support this on dancers, but there is in the general population

 **Joint hypermobility is also a part of Ehlers Danlos Syndrome and Marfan Syndrome. Since such a high portion of dancers have hypermobility, there is a higher chance (compared to the general population) that they may have one of these syndromes. Please seek professional medical advice if you believe there are further complications beyond what is laid out above

Daily Dancer Takeaway: If you have hypermobility, be cognizant of what your body needs. Realize you might need extra time to rest or pick up choreography and that’s okay. If your symptoms are detrimental to your performance, seek advice from a medical professional.

 References:

Beighton, Peter H., Rodney Grahame, and Howard Bird. 2011. Hypermobility of Joints. Springer Science & Business Media.

Bulbena, Antoni, Jordi Gago, Guillem Pailhez, Lili Sperry, Miquel A. Fullana, and Oscar Vilarroya. 2011. “Joint Hypermobility Syndrome Is a Risk Factor Trait for Anxiety Disorders: A 15-Year Follow-up Cohort Study.” General Hospital Psychiatry 33 (4): 363–70. https://doi.org/10.1016/j.genhosppsych.2011.03.004.

Bulbena, Antonio, Albert Agulló, Guillem Pailhez, Rocio Martín-Santos, Miquel Porta, Joan Guitart, and Jordi Gago. 2004. “Is Joint Hypermobility Related to Anxiety in a Nonclinical Population Also?” Psychosomatics 45 (5): 432–37. https://doi.org/10.1176/appi.psy.45.5.432.

Day, H., Y. Koutedakis, and M. A. Wyon. 2011. “Hypermobility and Dance: A Review.” International Journal of Sports Medicine 32 (7): 485–89. https://doi.org/10.1055/s-0031-1273690.

Deighan, Martine A. 2005. “Flexibility in Dance.” Text. March 2005. https://www.ingentaconnect.com/content/jmrp/jdms/2005/00000009/00000001/art00003.

Hakim, Alan J., and Anshoo Sahota. 2006. “Joint Hypermobility and Skin Elasticity: The Hereditary Disorders of Connective Tissue.” Clinics in Dermatology 24 (6): 521–33. https://doi.org/10.1016/j.clindermatol.2006.07.013.

Hall, M. G., W. R. Ferrell, R. D. Sturrock, D. L. Hamblen, and R. H. Baxendale. 1995. “THE EFFECT OF THE HYPERMOBILITY SYNDROME ON KNEE JOINT PROPRIOCEPTION.” Rheumatology 34 (2): 121–25. https://doi.org/10.1093/rheumatology/34.2.121.

Kirk, J A, B M Ansell, and E G Bywaters. 1967. “The Hypermobility Syndrome. Musculoskeletal Complaints Associated with Generalized Joint Hypermobility.” Annals of the Rheumatic Diseases 26 (5): 419–25.

“McCormack - 2010 - Teaching the Hypermobile Dancer.Pdf.” n.d. Accessed January 15, 2020. https://cdn.ymaws.com/www.iadms.org/resource/resmgr/Public/Bull_2-1_pp5-8_McCormack.pdf.

McCormack, Moira. 2010. “Teaching the Hypermobile Dancer” 2 (1): 4.

McCormack, Moira, Janet Briggs, Alan Hakim, and Rodney Grahame. 2004. “Joint Laxity and the Benign Joint Hypermobility Syndrome in Student and Professional Ballet Dancers.” The Journal of Rheumatology 31 (1): 173–78.

Russek, Leslie N. 1999. “Hypermobility Syndrome.” Physical Therapy 79 (6): 591–99. https://doi.org/10.1093/ptj/79.6.591.

Scheper, Mark C., Janneke E. de Vries, Rien de Vos, Jeanine Verbunt, Frans Nollet, and Raoul H. H. Engelbert. 2013. “Generalized Joint Hypermobility in Professional Dancers: A Sign of Talent or Vulnerability?” Rheumatology 52 (4): 651–58. https://doi.org/10.1093/rheumatology/kes220.

Seçkin, Ümit, Birkan Sonel Tur, Özlem Yılmaz, İlker Yağcı, Hatice Bodur, and Tansu Arasıl. 2005. “The Prevalence of Joint Hypermobility among High School Students.” Rheumatology International 25 (4): 260–63. https://doi.org/10.1007/s00296-003-0434-9.