Stabilizing the Hypermobile Body through Circus Arts with Emily Scherb, PT, DPT

[00:11] Jennifer Milner: Welcome to Bendy Bodies with the Hypermobility MD, your podcast to learn all about the benefits and complications of being bendy. This is your co-host Jennifer Milner here today with host Dr. Linda Bluestein. Before we introduce our special guest, a couple of quick reminders: please subscribe and leave a review. This really helps grow the audience. And please also email your questions or call the number in the show notes and leave a voicemail. We may answer it in the next episode.
[00:39] Today's special guest is Dr. Emily Scherb. Emily is a physical therapist specializing in circus and performing arts medicine. Through her almost 30 years of training and working in the circus arts, she has gained deep insight on how circus bodies work in the air and on the ground. Emily now teaches workshops for circus artists, instructors, and healthcare providers with the mission of improving health and safety in circus training and performance. Her best-selling book, Applied Anatomy of Aerial Arts, was published in 2018. Dr. Emily Scherb, welcome to our show.

[01:26] Emily Scherb, PT, DPT: Thank you so much. It's really lovely to be here with you.

[01:29] Jennifer Milner: Yay! I'm excited. Linda, are you excited for this one?

[01:29] Dr. Linda Bluestein: I'm so excited. I cannot wait. Yes, I'm super excited.

[01:32] Jennifer Milner: I feel like I'm at the circus.

[01:37] Emily Scherb, PT, DPT: Oh wow! Is it all the lights and sparkly costumes that I'm wearing right now?

[01:41] Jennifer Milner: You cannot see us, but we are all wearing sparkly costumes right now.

[01:45] Emily Scherb, PT, DPT: Oh, perfect.

[01:46] Jennifer Milner: So Emily, you started out as a circus artist and aerial dance performer. Can you tell us a little bit about that experience?

[01:56] Emily Scherb, PT, DPT: Absolutely. I started out even further back as a gymnast as a young kid, and I was exposed to circus as a hobby or a fun thing to do at a summer camp when I was still pretty young. It turned out that I really enjoyed performing a lot more than I enjoyed competing. There are similar demands on the body and kind of the culture of training, and I slowly shifted over to circus. By the time I finished high school, I was both doing a little teaching and doing a little performing, and ended up taking some gap years to go out and do some performing before going on to college, and then taking more time off before going back to grad school. So it's kind of a long and winding road that has always circled back around circus since I was pretty young.

[02:46] Jennifer Milner: Nice. Well, before we get to how you treat other people's bodies, what did you learn about your own body while you were performing and studying aerial arts?

[02:54] Emily Scherb, PT, DPT: Oh my goodness. I learned that bodies are complex and fallible, even if your 20-something-year-old self feels like it's all gonna be okay. Just like a lot of us who grew up as athletes and artists, dancers, gymnasts, performers in general, we're always looking to present our best selves. And especially when we're younger, we don't realize how those repetitive movement patterns might be influencing our long-term lives, or how any injuries that we assume will just go away may stay with us for a while or reoccur in different parts of our body in different patterns.
[03:37] Also, as a circus artist in particular, when I started, circus was still really small in this country, and so the knowledge about how to teach it was still evolving — and is still evolving, as all good pedagogy should. But it was really nascent, and we knew kind of what the body should look like and not necessarily how to get it there. Similar to dance, even after all these years, we're still talking about — well, in port de bras in ballet, how are the shoulders actually working to achieve that long line, and what is a healthy way for our shoulders and bodies to be working?
[04:14] But in circus, it was kind of accelerated a little bit faster because you've got end range motion and high demands on the body. And we're still trying to figure out how to actually teach that to another person, versus the family handing down and passing of knowledge that was more traditional prior to circus being available on a recreational level like it is now, or having schools that are training people to a professional level.

[04:40] Jennifer Milner: So in all of your experience, as you were going through it yourself, is that what made you think, "Hey, the things I'm learning about myself I want to use to help other people"? What pushed you into the PT area and wanting to specialize in circus arts?

[04:55] Emily Scherb, PT, DPT: As a person who's always been a mover, I always knew that I wanted to do something with the body. I wanted to do something with orthopedics. I wasn't sure if I was going to go and be an orthopedist — because that's kind of like, "Oh, doctor!" Like when you're 10, you're like, "I know what that is!" — or if I wanted to go chiropractic or physical therapy. But I always knew from the time I was pretty young that I was fascinated by the body and movement, and movement was kind of the highest priority for me as a kid. I knew I wanted to do something studying the body even before I found circus, and then with circus, it just kind of expanded my knowledge of movement.
[05:42] Through circus, I really learned how to teach as well, and that's probably what drew me to physical therapy in the most direct line — that love of teaching and that love of explaining how bodies work to another person. Instructing movement and observing movement was kind of how I got into PT. And when I got to PT school, I realized all the things that we were doing in circus that were questionable, and that made me go back into the circus realm. I mean, I always wanted to work with circus performers because I love my community and it's such a big part of my life, but it wasn't like, "I'm gonna go to PT school to be a circus PT." I went to PT school because I love movement and bodies, and then learning more about bodies brought me back to circus.

[06:25] Jennifer Milner: Interesting. So it was your love of it that got you into PT school, and then when you're in there, you're like, "Oh, maybe we should revisit how we're doing some of this and how I can help them move safely and be healthy." So as you were going through PT school and moving through that, what sort of training did you find for wanting to specialize in circus and performing arts?

[06:50] Emily Scherb, PT, DPT: Yeah, so I went to Washington University in St. Louis for my graduate training, and their program is very heavily centered on movement and movement systems. So it was actually a really great fit for someone coming from a movement background — that idea of looking at movement impairments and how the movement pattern may be imperfect and how that might relate to the actual injured tissue.
[07:15] It was a great mix of using my circus training eye and watching movement and being able to pick up on that in a normal person who's doing a step up on a stair or a forward bend or raising their arms up over their head. My brain was kind of used to slowing down movement and watching the pieces. So I think it was almost like I felt like, at least in the movement observation parts, I had a leg up on my classmates because I was so used to watching bodies. There were a few other people in my class also from a dance or performance background, and it was the same thing — we're so used to watching movement and kind of taking it in and feeling what that feels like in our bodies, that kinesthetic learning. I think it's a little bit easier for those of us who are used to that, versus just the academic side, to really see what our patients are doing and how they're moving.
[08:14] So the type of training that I got was actually very relatable for me. I know not all schools are going to be as focused that way — they're going to look more at tissue and structure and function, and this was much more movement to get that bigger picture. So for me, it was a great fit. I almost lucked into that, but it was a really great experience.

[08:38] Jennifer Milner: Well, and some of the best things to have happen — you look back and you're like, "Oh, that was kind of lucky," or very fortuitous, right?

[08:46] Emily Scherb, PT, DPT: I didn't really understand the differences in types of PTs and types of training that people could get. I just was like, "Oh, this one's good."

[08:52] Jennifer Milner: Right. Well, Linda and I are both more familiar with the world of dance medicine and helping dancers than with circus arts specifically. So it's interesting to me to have seen just in the past few IADMS meetings that circus arts are starting to come into their own as a distinct subset — or even a distinct, different field. What do you see as some of the differences between specializing in circus arts rather than performing arts?

[09:23] Emily Scherb, PT, DPT: Yeah, so I'll start with what's similar. What's similar between the disciplines is the artist's focus, their treatment of their body as a tool and an instrument — they're always going to go above and beyond. You need to tell them, "No, really, I want you to do this, but I don't want you to do this, and I want you to only do 5 of those. 30 is not better." And also with that, the fear and anxiety that comes from your body being your instrument and your tool that you perform with, especially in a professional artist. But even in many hobbyists, it becomes so much a part of the person's identity, especially when you're using your full body to do something, and your brain as well. That's where the similarities lie.
[10:17] The differences lie in that so much of circus is happening at end range of motion. And so much of circus is happening in an environment where we're still learning a lot about the body. It's grown very, very rapidly, versus dance, which has a much longer history. Circus, at least in its current form in the United States — around the world it's a little bit of a different culture — but circus in the U.S. has exponentially grown in the last 10–15 years. In about 2007, there were about 10 schools in the U.S. Now there's almost 800.

Jennifer Milner: Wow.

[10:55] Emily Scherb, PT, DPT: I'm hoping that lockdown and the pandemic does not take too many of them out. I know a few of them are really suffering and struggling right now. But there's really been a lot of schools cropping up with instructors of hugely different backgrounds and varieties. There's not as much teacher training — there's getting to be more and more over the last couple years — but with growth that rapid and that extreme, it's really hard to maintain consistent messaging from the teaching aspect and for the students. And with Instagram and YouTube and all the social media ways of learning, keeping a consistent message of how things should be done is harder.
[11:42] The other thing that's really different about circus is — in some ways similar to dance in that there's a wide variety of things — but if we think about circus, it can be an acrobat tumbling, kind of like a gymnast. It could be an aerialist in the air hanging from their hands, their knees, their feet, their ankles, depending on what apparatus they're on. It can be a juggler standing on the ground and moving their arms in a rhythmic pattern. It can sometimes even involve a musician. Circus can really encompass so much that even within circus you have to pick and choose what you're actually looking at.
[12:30] For me, what I tend to specialize in within circus are the more acrobatic elements — ground acrobats and aerialists — leaving some of the more vocal and dance elements a little further afield. But circus is just so big, and what can be defined as circus keeps changing as it moves into theaters, out of tents, or back to tents in a lot of cases.

[12:55] Jennifer Milner: Or into a big huge swimming pool, right?

[12:58] Emily Scherb, PT, DPT: Into a huge swimming pool — now they have to be divers and swimmers as well. Or you've got artists that are used to maybe doing theater work or nightclub work, and then they're all of a sudden in a tent show because those are getting a revival in the U.S. And now they have to help set up the tent and deal with all the physical labor involved in that. So there's a huge range in what's demanded on a circus body. It very much depends on the artist and their discipline, and even within that discipline, their apparatus and their environment.

[13:01] Jennifer Milner: Yeah. As you've worked with this whole spectrum of circus artists — this is such a stupid question, but I'll ask anyway — have you encountered a lot of people with hypermobility?

[13:46] Emily Scherb, PT, DPT: It's not a stupid question at all, because we sometimes think of people with hypermobility as fragile and not able to do things. But realistically, just like in dance, hypermobility is incredibly common in circus because I think a lot of people look at it as an extreme movement thing and they're like, "Oh, my body can do that." So yes, a ton of people with hypermobility — and those who have normal mobility or even kind of leaning on the edge of hypermobility — look at hypermobility as the norm they're trying to achieve. So there's the messaging and the cognitive aspect of what is mobility in this population. Kind of like dancers — it's considered normal to have your leg extension be more than 90 degrees, but our normal ranges of motion for an average person off the street is that 90 degrees is plenty. Our perceptions of what's normal are very different.

[14:41] Jennifer Milner: It's very different, I'm sure. Well, we've spoken a number of times on the show about that whole spectrum of hypermobility disorders, and it's still kind of a moving target trying to get it codified and pinned down — the definitions seem to change every month. But in general, what do you see? Do you see more people with asymptomatic joint hypermobility? Do you see systemic hypermobility? Do you see connective tissue disorders? Where do most people with hypermobility fall in the circus world?

[15:14] Emily Scherb, PT, DPT: Most of my patients and clients are more in the asymptomatic hypermobility spectrum — and a lot of them don't realize how hypermobile they are, again because of the normalization of that in the circus community, even at the recreational level, or especially in youth performers or youth recreational artists. So most of them are falling in that category. Some have a little more of the connective tissue issues, but that's honestly more rare.
[15:54] I think still because circus is newer and because so many people are getting into it as adults, a lot of the schools that are opening up are almost exclusively adult or exclusively aerial. Because of that, you don't see the kids who have grown up in it and kind of found themselves there. So I think there's still a little bit of a fear of accessing circus if you are hypermobile — which, personally, I have had great results using circus as a tool to work with people with hypermobility.
[16:31] Because as long as you're training well, training strong, and training with good form, you're learning to control your range of motion through its full range. Contortionists don't just sit on their heads — they have to lift their bodies up and over to get their butts onto their heads if they're doing it right. And so they're learning to control all that spinal articulation all the way through the range of motion instead of just kind of collapsing there. Again, with good coaching — and not learning from YouTube — but with good coaching, you're learning as a contortionist, as someone who's demonstrating hypermobility, to really articulate and control the motion.
This gives these artists a better availability of their proprioception, it seems to me — granted, that is not scientifically documented, this is clinical experience. But I feel like teaching these bodies, who have started to learn movement like dancers, to understand how the body actually works and where the movement should be coming from, they're able to get better awareness and learn to have better control in mid-range as well.

[17:42] Jennifer Milner: Well, what I notice a lot in the dance world — and I think what you've seen as well, Linda — is that there's more connective tissue disorders and systemic hypermobility in the younger population, in the pre-professionals. It has a tendency to self-select: as they move up professionally, it's too hard for them not to be injured, too hard for them to keep going. But then when I see them retire — because I work with pre-professionals and professionals — when I see them stop dancing, it gets worse and it hurts even more. So I love that you're saying don't be afraid of working with someone who's trained in it, to help you strengthen what you have and to help you stay there. I love that.

[17:44] Emily Scherb, PT, DPT: Yeah, and with some of the physicians in my community who have gotten to know me — because circus in Seattle, Washington, where I am, is actually getting pretty large, we have a couple of really large schools here in the area and they do work with people of all ages — when I've had physicians come up to me and ask, "I have this kid who came into my office, they're hypermobile, they're doing aerial — should I tell them not to do it?" Or parents asking the same thing. And I'm like, no, please tell them to continue training. Make sure they work with so-and-so or so-and-so. Please tell them to continue training. It's going to really give them better strength and a better starting place.

[19:04] Jennifer Milner: Right. And I love that you mentioned proprioception, because that's such an important part for people with hypermobility — to continue trying to train their proprioception. That seems like such a great way to help them work with where their bone is in the socket, where their joint is in space, and how they can continue training themselves that way in a healthy manner, as you said.

[19:31] Emily Scherb, PT, DPT: One of my patients — she wasn't that early in my career, kind of mid-way between when I started and now — she came into my office as a new patient. She's an aerialist and she said, "Okay, I can do one pull-up, but I can't do two, and I can't figure out why I can't do the second one." She came in and showed me a pull-up — it wasn't the best, but it wasn't the worst. But as she lowered, she actually subluxed both her shoulders. So she was no longer stabilizing in the socket, and that's why she couldn't do the second pull-up. And it didn't hurt her at all. She had no idea, and her coach at the time didn't really understand what was happening because it's not necessarily something you're familiar with seeing.
[20:19] As soon as she learned what that was — and I had to verbally tell her, "That's not the end of your range. The end of your range is here. You need to control that. You can control that with the rotation of your arm and by lowering this way" — within 10 minutes, she could distinguish the difference and stop going there and stop putting her shoulders and her joints in that position. She had the strength; she just didn't have the awareness of where she was. Helping her identify that made all the difference.
[20:49] But yeah, the proprioception of being an aerialist in space — knowing even without reference to the ground where your foot is, where your hand is, where up or down is — I think that also helps with that brain training too.

[21:02] Dr. Linda Bluestein: Absolutely. And I think that when they're younger, if they can work with somebody like you, that probably really helps to prevent injury rather than just getting them after they've been injured. I'm curious — as someone who is often on the front line of medical intervention for these circus artists, you might be the first medical professional in their life who has seen signs that they have some kind of hypermobility disorder, hypermobile Ehlers-Danlos syndrome, or some other condition. Although as you're mentioning, sometimes another medical professional will have been involved in the process. How do you handle that if you see somebody you're working with where this has not been raised by anyone else on their team?

[21:47] Emily Scherb, PT, DPT: So I haven't had it with a kid yet — I've had it with adults, which is interesting, where they don't quite realize what's going on. With kids, I think it's still about raising awareness in the kids, the parents, and the instructors of what pain is normal and what pain is not normal in circus. Because there's kind of a phrase in circus — "circus hurts" — and there's the education of: circus hurts because there's pressure on different parts of your body and it might bruise you as you're getting used to things, and then there's circus hurts as in my joints hurt or something is wrong. Educating and working on that distinction is important.
[22:35] Part of what I do — and I'm kind of tangentially addressing your question — is go in and work with educators. I'm really trying to increase the knowledge in circus educators about what to look for in bodies, including hypermobility, so that they're aware that this kid might need a little more cueing to know where their body is in space, to take things a little bit slower. In my community, I have a couple of physicians I work with and might refer out to them depending on what's going on with the body.
[23:08] But it's a lot of education and giving permission to slow down the learning process, because hypermobile people tend to have lower proprioception — and I know we keep coming back to proprioception — the learning process just takes longer. And sometimes it's saying to them, "Hey, it is okay if people in your class are doing XYZ and you're doing ABC," and explaining to them why and how. I like to frame it as: your body will allow you to do these really cool things, and you just need to learn how to control it and use it. Their strength and their control is going to take a little longer to catch up.

[23:53] Dr. Linda Bluestein: That's a great explanation. People don't like to feel like they're falling behind or not doing what they feel they might be capable of doing. And speaking of what they might be able to do — if you're hypermobile, your joint end range is going to be different than someone else's joint end range. Whereas in some other areas of life we might tell someone who's hypermobile not to work in their end range, in circus the artists actually have to do just that. So how do you help artists stay strong and healthy while pushing their bodies in the way that they need to for circus?

[24:38] Emily Scherb, PT, DPT: One of the things I work on with people is telling them when to push into that end range and when not to. So, for example — kind of like a dancer standing in first position. We have a dance medicine or performing arts medicine group that works together here in Seattle, and we see performing artists at a free clinic, which is a wonderful resource. We usually have at least another PT and maybe an MD, and we all see an artist together.
[25:11] This is one of those times we were seeing a ballet dancer, and her first position — her knees were together and her feet were turned out. If I told you only that, you would say, okay, sounds pretty good, she's turning out well from her hips. But her knees were so hyperextended that her feet were almost like in second with her knees together. And she's like, "Well, my knees are together, so it's fine."
[25:34] We can make that same analogy with handstands. In a handstand, an artist can lock their elbows out, hyperextend their elbows, and kind of hang on the joint — or they can learn where neutral is, staying in a straight arm, which is going to be a lot more muscular effort, but they need that strength. You don't want to be load-bearing on the joint when they're usually weight-bearing. When we want to exploit that end range, it's just like in dance when you're doing a leap and you want that gorgeous line with a little bit of knee hyperextension — you've got that beauty — but you don't want to do it in first position where you're landing and load-bearing.
[26:14] The same holds true in circus. When your arms are overhead in a handstand, same thing with standing on one leg — is the knee locked back? It's very similar in that way. When you're in the air and you want a beautiful split position, maybe that's when you go into more of your hypermobility. But even then I want you to be able to actively get there and control on the way back. So encouraging that active control, making sure they know where normal range is — in a healthy performer way, not a sedentary adult way — and when they're choosing to go past it. Again, increasing that awareness and proprioception, and increasing their active strength and mobility as well.

[28:01] Jennifer Milner: I hope all of my dancers are listening and just heard that, because that is one of the things I talk about so much of the time. First position — your heels are together and we're going to figure out how to make that happen. I talk so much about the difference between closed chain and open chain "straight," right? How your développé leg can be hyperextended and fabulous, and your standing leg is going to be not locked. And same thing with the arms. I feel like I should just staple it to my forehead. So thank you for saying that — somebody else has said it.

[28:31] Emily Scherb, PT, DPT: Oh, it's so important. But having that strength in that straight-leg, not-locked position gives you better balance, gives you better control, will give you the ability to move in and out of that position with more power and strength and grace. And you'll have a longer career. So it's a win-win-win. It just stinks while you're learning it.

[28:50] Jennifer Milner: While you're learning it, yeah — preach it, girl.

[28:56] Dr. Linda Bluestein: And while we're on that subject of long careers — we want to catch people before they're injured, or at least while we can still have some really meaningful interventions. If you're fortunate enough to be able to do that, what do you prioritize as a way of keeping them from getting injured?

[29:16] Emily Scherb, PT, DPT: So again, for me, I am currently just one person. I try to be everywhere at once. That's going to change. And there are other people who are doing great work everywhere else in the world, so thankfully it's not just me. But I really am prioritizing education for instructors. I'm also trying to teach workshops for students on how the body is supposed to work — kind of like we teach anatomy in dance. How is this supposed to work? Where is my motion supposed to be coming from? Why is it that my upper back doesn't move the same way as my lower back? And how much of that is my shoulders, versus just my upper back?
[30:05] The shoulder is one of the most important joints in circus. We stand on our hands, we hang from our hands, we hold other people above our heads, we pick people up, we juggle — and the shoulder in the community is such an under-understood joint. There's such a lack of knowledge on how it works and how it moves. There's kind of the weightlifting adage of "squeeze your shoulder blades together when you do everything," which really doesn't work when your arms are overhead. I don't think it works all that well when your arms are by your side either.
[30:38] But just starting with an education of: how is this joint supposed to work and what is it supposed to look like? Because if we can change the technique and the language around technique, and the way we talk about learning the basics of movement, we can encourage an entire generation of performing artists to have more longevity in their careers.
And then there's that adage of "circus hurts" — in young bodies, giving them the self-efficacy and autonomy to ask for help, knowing when something is wrong with their body, and knowing that it's okay and not weakness. It means that you're going to be doing this longer and better. Hopefully changing the conversation about what an injury is and the opportunities that an injury might present — that it's not just a bad thing, not something you need to hide because you're a performer, and not career-ending if you seek good advice and good care.
[31:35] So hopefully catching them before by doing education and reaching out as much as I can with others who are spreading the word. There is so much more of that going on now, and it's really interesting to see how things are moving online and how those things are being amplified. I'm sure some things are also being amplified that I wouldn't love — I'm sure there's somebody out there showing a video of hyperextended knees — but I'm seeing a lot more conversations about how the body should work making the rounds, and that's encouraging.

[32:18] Dr. Linda Bluestein: That's great. Absolutely. And how do you rehab a hypermobile artist differently from someone who's not hypermobile, if at all?

[32:31] Emily Scherb, PT, DPT: It's not that different. Sometimes depending on the artist or the individual, it's maybe a little slower or a little more controlled. I might work with them more in mid-range before we get to end range so they know they're developing their strength through that full range, depending on their injury and what's going on.
[32:52] But it's not going to be that different, because for my less mobile people, often their goal is getting more of that mobility, which involves getting active control at end range. And with my hypermobile people, they've got the mobility but they need the active control. So I'm working on active control through a full range of motion with both populations. It's just a question of where do I start them, how much load am I putting them under, and how much range we're working through. Not hugely different, but probably just with a little more understanding and a little more education, even beyond the knowledge I'm generally trying to impart on people.

[33:34] Dr. Linda Bluestein: Sure. And we have a really wide range of listeners, so some are going to absolutely know what you mean by active versus passive range and control, but would you mind briefly explaining what that is for those who don't?

[33:48] Emily Scherb, PT, DPT: Yeah, so I'll give you an example of a common circus stretch. Passive range of motion is when you're just kind of pushing into that range and possibly holding it, or using resistance or the ground or the wall or the floor to push your body. In circus, a very common stretch — because everyone wants what we call open shoulders, meaning your arms as far back over your head as possible — is to put your hands on the wall and walk your feet back and stick your butt out and try to touch your chest also to the wall. So hands up overhead against the wall, chest trying to get on the wall, butt trying to get out. Hopefully that makes sense — you're really pushing your shoulders open, kind of arching back like a puppy pose, or what they often call a moose stretch. That would be a very passive stretch for the shoulders because you're using your body weight and the resistance of the wall to push into a relatively mobile joint.
[34:44] To make that more active — meaning you're using your muscles throughout the full range of motion — what I could have someone do is tie a resistance band around the wrist so they're pressing outward against it, activating their rotator cuff, so they're actively controlling the range of motion as they then also push into the wall to go down into that end range. So they're using their muscles to get into the end range as opposed to using their body weight, or worst case scenario, somebody else pushing on their body to get there. The more control you have of your muscles as you approach those end ranges, the more access you're going to have to actually use them in your performing arts or daily life.

[35:37] Dr. Linda Bluestein: I feel like that's such an important concept, because the difference between just sinking down into something — or somebody pushing you there — is so different from you actively getting there.

[35:50] Emily Scherb, PT, DPT: Yeah. What I look for is for people's active control to be able to actually move through almost all of the range of motion that they could push their own body into. I want those two to line up as closely as possible.

[36:05] Dr. Linda Bluestein: That makes sense. And what other members of an artist's team do you think are non-negotiable? Would it be a nutritionist, a strength and conditioning coach — who else do you really like to have?

[36:21] Emily Scherb, PT, DPT: This is such a great question, because circus in the U.S. is still in its relatively early stages of developing, and with funding especially. There are very few circus companies that have any sort of support at all for their artists. Luckily, some companies might have some funding put aside — I luckily get to work with two companies here in Seattle and help them with their bodies. But the funding and the importance just isn't there, so I don't usually get the opportunity to work with other practitioners.
[37:03] In some larger companies, like historically with Cirque du Soleil, they will have an athletic trainer or a physical therapist on the team. They often also have some psychological help available to the artists, and I believe in their training programs they have other facilities as well. But it hasn't been normalized that bodies need care — which is frustrating, because the artists know it does. It just hasn't been financially viable even for artist-led companies to provide those resources. And artists in this country are unfortunately just not paid well.
[37:48] For professional artists, I really think a sports psychologist would be a lovely partner or teammate, because it's so important to acknowledge all the things that our bodies do for us and all the things we have tied up emotionally with our bodies. Some of what I see — thankfully not too often — is artists who have dealt with their injury for so long that they are used to their shoulder hurting them. That's part of how they identify themselves. How do you let go of that? How do you even get treatment, because what if someone tells you your shoulder is never going to be okay, even though it hasn't been okay for four years?
[38:34] So if I'm talking about who would be the best people to work with, I think a sports psychologist to help deal with the cognitive aspects of the stress these performers are under would be wonderful. I'd love a nutritionist too — the physical demands on these bodies are immense, and they need to understand nutrition. Just like in dance and other performing arts, there are so many issues: the artist who trains all the time and thinks they can eat whatever they want, or the one who's so restrictive with their diet that they don't have good options, or the vegan who doesn't know how to get enough protein.
[39:18] When I was at the IADMS conference in Montreal, a group of us circus researchers and circus-interested minds got together and we were talking about the students at the National Circus School there. Apparently when they come back from break, they've trained so hard their fall semester, they go home for winter break, binge on all the snacks, and come back and their injury rates go up. But you know, they're also teenagers — they're 18 to 20, and we all do that, right?
So yes, a nutritionist would be great, but a sports psychologist would be really wonderful.

[40:02] Dr. Linda Bluestein: I love that. Me too.
[40:07] You've written a book, Applied Anatomy of Aerial Arts. Who is this book geared towards, and what made you want to write it?

[40:15] Emily Scherb, PT, DPT: Yeah, so the book came out of conversations that had happened over the last about 8 or 9 years. I started teaching anatomy and biomechanics at a national circus conference — the American Circus Educators Conference. Back then it was still part of AICO, the American Youth Circus Organization, which are both different organizations that have since split off. But American Circus Educators is a group of circus instructors, educators, and school owners that get together every other year to share knowledge. They asked me about 8 years ago to do a talk on anatomy and biomechanics. From developing that, other people were asking me to come give similar talks, and I kept getting the same questions, coming back to the basics and fundamentals of movement, the movement vocabulary.
[41:13] Just like in dance you've got your positions — at least in aerial, there are some basics that are relatively universal across apparatus. You're going to hang from your hands. You're probably going to hook a leg and hang from a leg. You are going to turn upside down. And though we kind of know what these things should look like, we didn't have a shared vocabulary to talk about how the body is actually moving through space.
The book's primary audience was instructors, and maybe a recreational body nerd, and maybe a PT or medical professional on the healthcare side who didn't know anything about circus. Coalescing around the instructor level to get an idea of how to talk about the body with other people, from a nerdy anatomy perspective, but hopefully getting to translate it back to the general population.
Because there are so many universal themes in aerial that keep coming back, I thought it was really important to talk about what muscles are actually working when we're hanging, what muscles in what order should be firing to put the least amount of stress on our joints and ideally allow us to perform better. Because if we're in good alignment, we can have more power, we can develop more movement from that position of control.
[42:36] It came out of the conversations from teaching, and that slow development over the years. Then I was lucky enough to find a publisher who would pick it up — and that took a bit of work, because people don't realize that circus has become a recreational thing for hobbyists, that it's not just the professionals. It's the Microsoft employee doing it after work here in Seattle, or whomever.

[43:30] Dr. Linda Bluestein: And I would like you to repeat one piece of that that I feel was so important. You said a phrase about how when you are working properly, that actually also helps you to perform better.

[43:44] Emily Scherb, PT, DPT: Absolutely. If you're using the right muscles, that gives you good stabilization — it gives you a good anchor point to start movement from. I'm going to use hanging as an example because it's the most fundamental movement of aerial. If you're not hanging, you're not off the ground.
[44:01] So you're hanging from your hands. Your shoulder girdle is in a good position, which in this case means your shoulder blades are rotated upwards, your arms are overhead, and you're stable — you're then able to move your body around that. If you're hanging more off your joints, your shoulders are pulled down on your back — which is kind of like in dance if you're in fifth position and you've really sunk into your shoulders — you don't have the ease of movement to get into the next position. But if you're in a stable, open, controlled position, you can almost do anything from there.

[44:43] Jennifer Milner: So you're saying that stability encourages healthy mobility?

[44:49] Emily Scherb, PT, DPT: I am.

[44:52] Jennifer Milner: Are people listening here? You have to do the hard work and find that small range of motion before you can get bigger. Putting in that work in that small range of motion — and not going straight to the end range — will help you be in the end range stronger and bigger.

[45:11] Emily Scherb, PT, DPT: Absolutely, yes. Learning to find the smaller muscles, the stabilizers, allows you to save the powerful big muscles to be powerful and big, rather than using them as stabilizers where they're already half-firing and then you want them to do something else. That's really hard. Instead, the body can use the small muscles to stabilize and those big muscles to create the power and the energy to create bigger movement.

[45:36] Dr. Linda Bluestein: Beautiful. Because we can create a movement that would look on the outside like it's using the same muscles — but if I did a movement and Jen did a movement, she could be using the correct muscles and I might be using the wrong muscles, and to a less perfectly trained eye than your own, it might look like it's the same. Is that right?

[46:00] Emily Scherb, PT, DPT: Absolutely. It can be very similar looking with only a small few details that make a huge difference — the difference between someone who's going to have pain or difficulty with the next skill they're trying to learn, and someone who's not. So maybe in hanging, this artist doesn't have any pain or problems, but all of a sudden they're learning the next skill, they're trying to turn upside down — which is what we call inverting — and all of a sudden they're having pain or they just can't do it and they can't figure out why. And sometimes it comes back to: are you hanging correctly?

[46:35] Dr. Linda Bluestein: Fabulous. And where do you hope circus arts research goes next?

[46:42] Emily Scherb, PT, DPT: Oh, there's so much on the horizon. I'm so excited. Circus arts is absolutely hitting its stride — not its peak, hopefully — hitting its stride. We now have researchers and people looking at stuff, and I know there's a lot of research that should be coming out in the next couple of years.
I would really love to see, first of all, good epidemiological study — really understanding where our injuries are coming from, which hopefully we will be seeing. And personally, I love the recreational population because that's the biggest group of people that we get to work with. I find it's always easier for researchers to go to a professional company and say, "I want to study your artists." So most of the limited research we have in circus right now is from the Cirque du Soleil data they have amassed over the years of performers, which is wonderful. But it's professional artists who are already trained, who are in a performance schedule, and may have years of history or not.
I'm very curious about the recreational population — and our recreational population isn't just necessarily someone who's popping in and taking a class. Many of the artists I'm working with here in Seattle have been training for years, and this is part of their life. Looking at that population is important, because that's where we as healthcare providers are really interacting the most. That's where I'd like the research to go.

[48:23] Dr. Linda Bluestein: Great. And how can aerial artists find someone who can understand and work with their unique needs?

[48:30] Emily Scherb, PT, DPT: Word of mouth is how a lot of artists are learning everything these days, and it's been true in the community — there's a shared knowledge that's handed down between performers, whether it's the old Russian coach saying "rub a raw onion on it and that will help with your bruise or your injury." That was one I've heard before. But there is a lot of shared knowledge in the community. So asking around at your studio — if you're a circus artist, go into your studio, ask around, ask your instructors who they have seen. Usually that shared knowledge gets passed around, and when someone's good and willing to listen, that's helpful.
[49:10] I also have at least a limited list of people who have expressed to me that they want to work with circus artists on my website under resources. So thecircusdoc.com — click on the resources button and there'll be a list of at least a few circus PTs who are practicing and have expressed interest. It's by far not an inclusive list, but it's a starting point. Asking your community is always the first step, and if all else fails, shoot me an email — I'm usually happy to help you try to find someone in your local area.

[49:47] Dr. Linda Bluestein: Fabulous. And we covered a lot of great, interesting topics. Was there anything else we didn't talk about that you would like to add? And can you also go through your contact information one more time so people know where they can find you and learn more about what you're doing?

[50:05] Emily Scherb, PT, DPT: Absolutely. Well, I think the thing that would be really fun to add is that circus is a great thing to start and try as an adult. For most of us, because it wasn't so prevalent more than 10 or 15 years ago, we don't have that judgment of going in and everyone else in the class having taken ballet since they were a kid. Almost everyone's going to be starting at the beginner level when you go into an entry-level class, and it can be a lot of fun and a great way to stay fit, stay active, and work through your full range of motion. I love circus for adults. I love circus for everybody.
[50:35] I guess another thing to add is that there are great opportunities to get involved in circus no matter what your body or your condition. We have worked with people on circus for Parkinson's, circus with people with cerebral palsy, circus for people with all sorts of different ways of entering into movement. Because circus is so broad, it's very adaptable, and finding a community through movement is super fun.
[51:06] And then to answer your question about how to find me — I am on social media. I am @thecircusdoc on pretty much everything: Twitter, Instagram, Facebook, all the places. I haven't been on TikTok yet.

[51:28] Jennifer Milner: Is your website The Circus Doc or just Circus Doc?

[51:32] Emily Scherb, PT, DPT: My website is thecircusdoc.com. And there you can find resources about circus bodies, information about my book, and online courses are also there. Once we all start up in the world again and are teaching in person, live in-person courses will also be listed there. But if you're interested in online courses or learning more about what I do, thecircusdoc.com — poke around.

[51:56] Dr. Linda Bluestein: Fabulous. Well, Dr. Scherb, it has been so wonderful chatting with you today. We are so grateful for you coming on the Bendy Bodies Podcast and sharing your knowledge with us.

[52:08] Emily Scherb, PT, DPT: Absolutely, it was such a joy to talk to you both today.

[52:13] Dr. Linda Bluestein: Great. And thank you so much, Jen. It was great to chat with you as always.

[52:17] Jennifer Milner: Of course, as always, loved it.

[52:19] Dr. Linda Bluestein: If you have enjoyed this program, please like, share, subscribe, and leave a review. This podcast is for informational purposes only and is not a substitute for medical advice. Please see your own medical team prior to making any changes to your healthcare. Bendy Bodies original music is by Andrew Savino and sound editing is by Rhett Gill. Thank you so much for tuning in, and we will see you next time on Bendy Bodies with the Hypermobility MD.