Hypermobility is defined as the ability of a joint to move beyond the expected range of motion for that particular joint. Hypermobile joints tend to be inherited and can become an injury risk for young dancers when not fully understood.
Our bones are held together by ligaments crossing our joints. Ligaments are passive structures that do not move. Muscles and tendons also cross the joints and can be activated to stabilise the joints. Therefore, the stronger your muscles are, the greater the stability of the joint beneath, there is less "wear and tear" and the joint remains healthier for longer. Injuries occur to hypermobile dancers when joints are extended beyond their "normal" range of motion because the muscles lack the strength to control the excessive range. To reduce the risk of injuries, dancers must learn how to take care of their ligaments by not overstretching them and also learn how to support their hypermobile joints by strengthening their muscles.
It is important to note that hypermobility and flexibility are two very different concepts. Flexibility is how well a muscle can stretch over a joint. It does not take into account how well the ligaments and joint capsule move. It is possible for someone to have tight ligaments and flexible muscles, just the same as for someone who is hypermobile to have stretchy ligaments and tight muscles. For example, I have a young patient at the moment who is classified as hypermobile and yet, she cannot touch her toes. Her ligaments and joints move well, however she is restricted by her tight hamstring muscles. Flexibility changes quite rapidly and dancers may feel "tight" one day and "loose" the next. Hypermobility is generally quite stable and is unlikely to change unless forced (which can be dangerous)!
Being hypermobile as a dancer obviously has its aesthetic advantages; effortless flexibility and the ability to achieve beautiful lines in positions others would struggle with. However, without recognising your hypermobility and without proper training, consequences may be disastrous.
How do I know if I'm hypermobile?
Clinically we measure hypermobility on the Beighton Scale. The maximum score is 9 and a score of 4 or more out of 9 generally indicates hypermobility. What's your score?
What to do if you are hypermobile:
It is important to know how to manage your hypermobility to ensure you remain injury-free and able to dance without issue for many years to come.
Hypermobile dancers require exceptional strength, stability and proprioception. Proprioception is the body's ability to know where it is in space. Research has shown that proprioception is not always as good in hypermobile dancers and often requires specific training. Static and dynamic stabilisation exercises can help with spatial awareness and your Dance Physiotherapist will be able to guide you through these.
To ensure your joints do not wear out quickly it is important to know not to "sit" in your joints. Often this happens when the dancer is being "lazy". Instead of using their muscles to support them, they rely on their ligaments to hold them up which can do some serious damage long term. This is what is happening in the first picture. No muscles are being activated and there is a lot of strain placed on the ligaments of the knee. The second picture shows the same dancer. This time she is activating her quadriceps, gluteals, adductors and hamstrings. This ensures that the muscles are supporting the joints. This not only provides her with correct weight placement and stability, but also reduces the load on the ligaments.
As well as an individually prescribed exercise program, taping can often help those who are hypermobile by increasing sensory feedback, allowing the dancer to self-correct their position.
Safe dance practice and injury prevention is becoming an increasingly significant issue. Applying specific strength and proprioception training to those who are hypermobile is an important undertaking to minimise potential injury. This allows dancers to have a lengthy career whilst allowing them to perform better than ever before.
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