Fun fact: my nickname post-college was “flexy.” But it wasn’t until years later that I learned more about hypermobility and how it had, for so long, challenged my ability to build strength as a dancer. I eventually began working with an incredible pilates therapist (Adrienne Weidert, hats off to you!) who taught me how to optimize my performance potential in a way that supports, not exacerbates, my hypermobility. Alongside this came a deeper understanding of nutrition and the role it plays in hypermobility disorders— specifically in regard to a dancer’s risk for disordered eating.
Hypermobility is commonplace in the studio— the ability to move with agility and contort the body into shapes that otherwise feel like an impossibility for non-dancers. If you’ve ever been nicknamed “flexy,” “bendy,” or “double-jointed,” then this article might uncover a ton of insight for you.
Is hypermobility the same as flexbility?
Hypermobility, in its simplest form, involves an increase in the laxity (AKA looseness) of a dancer’s ligaments. Flexibility encompasses the degree to which muscles can contract and stretch. While both ligaments and muscles support the overall structure of the skeleton, they are two different bodily tissues with two different functions:
- Muscle is contractile tissue, allowing for the movement of our joints and ultimately, our bones.
- Ligaments are bands of connective tissue that connect bone to bone (hence the name: connective tissue). In fact, our ligaments are meant to protect our joints— keeping them from moving too much or too far out of range.
Hypermobility in dance- limitless or limited?
Inherited abnormalities in both the structure and function of collagen and connective tissue explain the common presentation of hypermobility, including loose joints and stretchy skin. For many dancers, hypermobility can feel like a plus in the studio. Aesthetic ideals often depict lines that boast hyperextension. There are several different subtypes of hypermobility, with some being less problematic than others. According to the Ehlers-Danlos Society “…hypermobility that does not cause pain…[asymptomatic joint hypermobility] does not need to be treated.” But when hypermobility presents alongside joint instability, problems arise.
Hypermobility spectrum disorder (HSD) refers to hypermobility experienced on a spectrum, from mild to severe joint involvement. Ehlers-Danlos syndromes (EDS) refer to a group of more distinguishable hypermobility disorders with hypermobile Ehlers-Danlos syndrome (hEDS) being one of the most common subtypes. Dancers with hEDS or HSD may also experience a compilation of multi-organ symptoms that impact performance potential.
10+ symptoms that may present alongside hypermobility disorders
- Joint pain
- Muscle stiffness
- Digestive disorders like constipation
- Thin, stretchy skin
- Joint instability/difficulty with coordination
- Increased risk of injury (ie. sprains)
- Dysautonomia (autonomic nervous system dysfunction), including:
- Postural tachycardia syndrome (PoTS) and its negative impact on quality of life
- Neurodivergence, including anxiety, depression, ADHD, and Autism Spectrum Disorder
Because of the broad range of symptoms experienced alongside hypermobility disorders, many clinicians are either not informed or easily dismissive— with the “it’s all in your head” response a common and incredibly frustrating experience for dancers seeking support. Dr. Linda Bluestein, best known as Hypermobility MD, is an integrative pain medicine physician specializing in hypermobility and hEDS. Dr. Bluestein has dedicated her career to supporting dancers who struggle with hEDS/HSD, debunking the myths, and clarifying the countless challenges dancers can face, such as misdiagnosis and the invalidation of symptoms. Dr. Bluestein offers an extensive library of resources for dancers looking to learn more about conditions like hEDS, most notably the Bendy Bodies podcast—a must-listen!
The Role of Nutrition in Managing Hypermobility Disorders and Ehlers-Danlos Syndrome
While an inheritable predisposition underlines these disorders, various factors might exacerbate them. Gastrointestinal symptoms, including bloating, IBS (irritable bowel syndrome), and motility disorders (such as constipation), have been associated with hEDS and HSD. Neurodivergence is another common thread— impacting a dancer’s ability to fuel adequately. To dive deeper into the various nutrition concerns and appropriate interventions for dancers with hEDS/HSD, I’ve collaborated with fellow dance dietitian and friend Kristin Koskinen.
Gut health and eating disorders
Many dancers experience challenges with functional digestive disorders, including symptoms like gas, constipation, and diarrhea, and in relation to hEDS/HSD, Koskinen agrees that “…some of the most common struggles among these dancers stems from their experiences with digestive discomfort.” Depending on the dancer’s symptoms, interventions might involve a deeper examination into food intolerances, the role of FODMAPs, and the dancer’s intake of foods rich in probiotics.
But these interventions are only encouraged alongside the support of a registered dietitian nutritionist. About 44% of digestive disorder patients engage in restrictive eating habits, so there’s no question that dancers with hEDS are at higher risk for disordered eating. According to Koskinen, “…they’ve [dancers] often restricted their diets to ten or fewer safe foods.” Working with a dietitian to prioritize a supportive relationship with food, in addition to learning how to identify tolerable foods without relying on elimination diets is key. Here are a few additional resources to consider in this work:
Inflammation and pain
Hypermobility disorders like Ehlers Danlos syndrome are associated with chronic inflammation and pain. Reducing life stressors is important, and can be further supported alongside the work of a mental health therapist.
There are mealtime additions that can also be considered to support efforts to alleviate inflammation, but it’s encouraged that these suggestions be prioritized within the context of an inclusive approach— rather than an exclusive approach to food. Recommendations to avoid any foods, including those that are processed and made with processed ingredients like refined sugars, can lead to a polarized mindset and ultimately, unsupportive “clean” eating goals. As mentioned earlier, food anxiety is a very common experience among dancers and a life stressor that we can work to combat. Here’s an article about anti-inflammatory diets and how dancers can utilize this information in a non-obsessive way. Generally, a few mealtime additions to consider:
- Add foods rich in omega 3 fatty acids, like flax, fatty fish (salmon, tuna), avocado, and olive oil.
- Prioritize balance at meals and snacks— a mix of carbs, protein, and fat— to support blood sugar control.
- Incorporate foods rich in fibrous complex carbohydrates like whole grains, beans, nuts and seeds.
- Access a broader spectrum of anti-inflammatory nutrients like antioxidants with colorful produce— leafy greens, applies, tomato’s, berries, and citrus fruits are examples.
And alongside this work comes the benefit of working with an informed fitness trainer— Jennifer Milner is a certified Pilates instructor and informed trainer who specializes in working with hypermobile dancers.
Food anxiety and disordered eating
Confusion around whether or not certain foods, food groups, and/or ingredients impact symptoms relating to hEDS is often speculated. As a result, many dancers might experience a higher degree of food anxiety and self-doubt at mealtimes.
One of the most common myths about intuitive eating is that for those with chronic health conditions, eating in a way that eradicates rigid food rules is unattainable. But as I discuss in this article, for those with chronic illness, intuitive eating enhances interoceptive sensitivity to your biological cues (hunger and fullness) and helps to remove obstacles (like food and body beliefs) that block your ability to make choices in support of your disease management. As a registered dietitian and certified counselor of intuitive eating, when working with a dancer with hEDS or HSD, I utilize the tool of gentle nutrition to support symptom management and flexible meal plan adjustments.
Several reasons, including restrictive eating patterns, chronic fatigue, impaired digestion, and malabsorption, can lead to a variety of deficiencies in dancers with hEDS and HSD. As Koskinen explains, “…as a dietitian, I can order and evaluate lab tests alongside a dancer’s primary care provider to better assess their needs and then implement plans to make sure they are meeting their nutrition goals without immediately turning to supplements.”
I echo Koskinen’s testament: swapping supplementation with a food-first approach. For dancers with hEDS and HDS, we stress the focus be on injury prevention, including foods rich in protein, vitamin C, copper, zinc, and iron— nutrients that also play a role in collagen health.
There are several co-existing conditions commonly presenting alongside hypermobility disorders like hEDS that can further impact a dancer’s nutrition status and ultimately, performance potential. Conditions that, according to Koskinen, “fall under the umbrella of Neurodivergence— anxiety, depression, ADHD, autism spectrum disorders, and perfectionism— where food aversions to certain food flavors or textures can make meeting their nutrition needs more complicated.”
Postural tachycardia syndrome (PoTS) is also a presentation alongside hEDS/HDS. PoTS involves a malfunction of the autonomic nervous system that causes an irregularly fast heartbeat when standing. Episodes of dizziness and fainting might also occur. For dancers with PoTS who experience occasional dizziness, Koskinen stresses a focus on electrolytes, “including foods rich in sodium and chloride can be a game-changer… you can get them easily by adding more salt to your food or adding sports drinks to your dance bag to sip before, during, or after class to replenish losses from sweat.”
Last, dancers should be wary of suggestions for food sensitivity and the need for elimination diets. Instead, medical evaluation (such as with an allergist) of suspected food intolerances and allergies is encouraged especially if mast cell activation syndrome (MCAS) is suspected.
Hypermobile dancers: key takeaways
Given the confusion and lack of knowledge surrounding hypermobility and associated disorders, dancers would benefit from learning more about injury prevention and symptom management. Relying on trusted clinicians is essential— building a team of knowledgeable practitioners, including a medical doctor, physical therapist, dietitian, and mental health provider is encouraged.