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February 17, 2017

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Part 2 of 3: Ballet - does it have to hurt?

January 18, 2017

If you missed Part 1: Alignment and Core Strength, you can access it here: yvballet.com.au/blog

 

The premise of our initial discussion was that with correct and careful training, classical ballet does not have to lead to pain or injury, even at the elite level.  In this day and age there is so much information available about safe dance practice, that there should be no excuse for lack of knowledge or understanding when it comes to early training and body safety.

 

This article aims to shed light on a subject that is not so widely written about or commonly understood, and that is: Hypermobility.

 

 

Part 2: Hypermobility and Safe Dance Practice

 

 

What is Hypermobility?

 

In its simplest sense, hypermobility (hyper=more than normal) refers to the amount of laxity (looseness) in the ligaments that support your joints.

 

Hypermobility is not the same as flexibility.  Hypermobility refers specifically to joints and ligaments, whereas flexibility is about the total range of movement in your body, including muscles, fascia and nervous system (a discussion for another day).

 

For a dancer or gymnast, a small degree of hypermobility is an asset, as it allows joints such as knees or hips to extend just enough beyond their normal range to give a beautiful line.  However in larger doses hypermobility can cause chronic joint pain and regular joint dislocation, or in extreme cases, digestive distress and autonomic dysfunction.

Figure 1, Ref 1: https://abioblog.wordpress.com/2015/08/30/joints-bones-and-exercise-a-jumble-of-hypermobility-syndrome/

 

 

 

 

Hypermobility and Training

 

Just because you can stretch your leg over your head, doesn’t mean you should.

 

If a joint, such as the hip, is repeatedly and regularly pushed past its normal range of motion there is a risk of damage to the surrounding tissues.  In young dancers in particular where bones are not fully developed there is a risk of damage to the shape of the hip socket.  Other risks include stress fractures or early onset arthritis due to the wear and tear on the cartilage.

 

Rather than stretching, early training needs to focus on building strength and stability in the muscles around the joint.  The image below demonstrates hypermobility in the knee joint.  In this instance, we would encourage the dancer to:

  • practice standing without locking the knee back into full range;

  • increase their sense of proprioception without using a mirror (eg, standing in correct alignment with eyes closed);

  • use tape over the back of the knee to increase sensory feedback;

  • use a balance board whilst maintaining the knee joint in correct alignment;

  • strengthen the surrounding muscle groups with specific body conditioning exercises.

In this manner, the dancer learns how to control their range of movement and choose where to place their body in space.

 

 

Figure 2, Ref 2: http://www.musicianshealthcollective.com/blog/2016/1/18/the-darker-side-of-hypermobility

 

 

     

    The Hypermobile Future

     

    “If they were hypermobile at the age of 14, we found they were twice as likely to have pain in the knee, shoulder, ankle or foot at 18.” (Professor Palmer via Janet Wright, Chartered Society of Physiotherapy) (3)

     

    “Every day in my role as a Physiotherapist I see people suffering from old injuries sustained by over stretching, repeated extensions and excessively mobile and unstable joints from early training. Unfortunately the slow and hard rehab that so many people have to go through to just be able to live a normal, pain free life is not so dramatically entertaining so doesn't get the coverage that dramatic photos and videos of performances involving extreme flexibility do.” (Lisa Howell) (4)

     

    “Some young dancers think that they can get an edge by copying the extreme dance moves they see on social media. But the end result is that health professionals are seeing dancers as young as 12 with serious back and hip injuries.” (Leigh Sales via Australian Broadcasting Corporation) (5)

     

     

    The dance industry seems to be growing by the minute, thanks to social media, social entertainment and the internet.  There are many great schools and great teachers out there, however if you are a parent of a child under 14 years of age, I urge you to become involved and be informed.

     

    A long dance career is not begun by performing a ‘back scorpion’ at age 10 or using chairs to achieve over-splits at 12.

     

    Please ask questions of your child and your child's teacher.

     

    Ensure you have a good understanding of the schools’ teaching philosophy, method and approach.

     

    Take time to learn about the stretches your child is doing in classes and monitor their stretching at home, particularly if your child is hypermobile.

     

    If it doesn’t look right, it probably isn’t.

     

     

     

     

     

     

     

     

    References

    1. M. (2015, August 30). Joints, Bones and Exercise; A Jumble of Hypermobility Syndrome. https://abioblog.wordpress.com/2015/08/30/joints-bones-and-exercise-a-jumble-of-hypermobility-syndrome/

    2. Musician's Health Collective. (2016, January 18). The Darker Side of Hypermobility. http://www.musicianshealthcollective.com/blog/2016/1/18/the-darker-side-of-hypermobility

    3. Wright, J. (2014, June 4). Stretching a Point - Hypermobility, Joints and Physiotherapy Research. http://www.csp.org.uk/frontline/article/stretching-point-hypermobility-joints-physiotherapy-research

    4. Howell, L. Is Over Stretching Bad? https://www.theballetblog.com/portfolio/is-over-stretching-bad/

    5. Australian Broadcasting Corporation. Whyte, S. (2015, October 12) http://www.abc.net.au/7.30/content/2015/s4330305.htm

     

    Further Reading

    • http://www.dynakids.org/Documents/hypermobility.pdf

    • http://www.newhealthguide.org/Function-Of-Ligaments.html

    • http://www.foundations-for-excellence.org/file_storage/infosheet74_1.pdf

    • http://www.perfectbalanceclinic.com/blog/injury-and-treatment-advice/hypermobile-vs-flexible-which-one-are-you/

    • http://www.4dancers.org/2014/07/the-hypermobile-dancer/

    • https://c.ymcdn.com/sites/www.iadms.org/resource/resmgr/Public/Bull_2-1_pp5-8_McCormack.pdf

     

     

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