Training the Hypermobile Dancer with Jennifer Milner

[00:37] Dr. Linda Bluestein: Welcome to Bendy Bodies. This is your host, Dr. Linda Bluestein, and I am so excited to bring you an interview today with my guest co-host, Jennifer Milner, ballet coach and certified Pilates trainer specializing in athletes, dancers, and post-injury recoveries. Jennifer mentored under the dance medicine pioneer Marika Molnar and worked for West Side Dance Physical Therapy, the official physical therapist for the New York City Ballet and the School of American Ballet. She has trained a wide variety of clients, including Oscar winners, Olympic medalists, and dancers from New York City Ballet, the Kirov Ballet, ABT, San Francisco Ballet, Royal Ballet, and more. Jennifer is an invited speaker at international conferences and has vast experience working with pre-professional and professional dancers from all over the country. Her ability to move between ballet studios and cross-training venues, addressing biomechanical imbalances and technique dysfunctions in a practical strength training way, has made her a sought-after guest speaker for dance schools and companies.
[01:40] Jennifer has been a great asset to the Bendy Bodies Podcast as a guest co-host for many dance-specific episodes, generously sharing the knowledge she has gained from her many years of training dancers all across the spectrum of hypermobility. Something she describes as a superpower and kryptonite all at once. In this episode, the tables are turned. Jennifer shares with us her unique approach to training hypermobile dancers, whose bodies she compares to a partially played Jenga game. She shares how she trains dancers to be in tune with their bodies and educates dance teachers on how to train hypermobile bodies in a healthy and efficient way. Other topics discussed include the importance of constructive rest, pacing, and the hazards of flexibility without stability.
[02:37] So today the tables are turned and I am so thrilled to be getting to interview my co-host Jennifer Milner. Jennifer, welcome to Bendy Bodies.

[02:50] Jennifer Milner: Thank you.

[02:52] Dr. Linda Bluestein: It's great to have you on today and to hear more about how you train hypermobile dancers. Super excited to hear about this. Can you start out by telling us a little bit about your background?

[03:05] Jennifer Milner: Sure. So I started out as a ballet dancer, kind of where we all are, and did ballet for a while, had a couple of injuries that I later realized were hypermobility-related that pulled me out of dance off and on as a teenager. It got to the point where I thought, if I have a chance to be in ABT, I would keep moving forward. If I had a chance to be in a smaller company, I just didn't want to push myself for that. So it was really a choice of — I was too lazy to do the work that would have had to be done to keep moving forward. So I had ballet apprenticeships, that kind of thing. And decided to do musical theater instead. Had always loved it as a kid and had always loved the singing aspect of it, which I wasn't super good at, but I loved musical theater dancing and all the Broadway musical movies that were out in the '50s and '60s.
[04:03] So I got into that and ended up having a really nice career as a musical theater dancer and learned how to sing, and could do that as well. And then had a reasonably injury-free career because the older I got, the smarter I got about how I trained and worked, and about keeping myself healthy and the maintenance aspect of it. And then I just ended up having an injury with my knee that my body could not come back from. So I transitioned from there into teaching Pilates, which I had always — well, not always. I had done it for about 2 or 3 years before I got injured. I had discovered it as a method of cross-training and maintenance and really enjoyed it. And so while I was injured, I thought, well, maybe I'll try this, see how it works, get my certification, and see what it looks like.
[04:57] So I got my certification and started teaching and just didn't look back. I was really fortunate to do my rehab for my last injury at West Side Dance Physical Therapy, which is the physical therapy clinic for New York City Ballet and School of American Ballet. And the owner there, Marika Molnar, who's the mother of dance medicine, watched me as a Pilates teacher and offered me a job working for West Side Dance. So I ended up working for them and working with New York City Ballet dancers and SAB, and dancers from all across the world — Royal Ballet, Kirov, American Ballet Theatre — and then Broadway dancers, international athletes, and Olympic athletes. That was just what started channeling my career in a specific direction. And I realized I loved taking what I knew as a dancer and being able to apply it as a teacher, as a trainer, from the other side of the table. So it just kind of went from there.

[05:59] Dr. Linda Bluestein: Wow, that's incredible. I love your description. The only thing is, having known you now for 2 and a half years, I think lazy is definitely a word I would never ever associate with you. We all, when we describe ourselves, tend to be a little — as dancers especially, right?

[06:17] Jennifer Milner: Right, that's true. That's true. Well, I should say, I think we all hit that point. After you've had an injury — I missed most of my year around age 15 to 16 with an injury, and that's a really crucial year to move forward as a dancer and to try to get into that professional level. I was at Pittsburgh Ballet Theatre as an apprentice, and they were very kind. I went back to them and I could tell they were encouraging, but I wasn't at the level that they had hoped I would be at. And for me, that was sort of the idea of, okay, I either need to double down or I need to find a way to keep dancing that I love. And I loved musical theater, so it was not a sacrifice at all to go into that. I just didn't have that drive to push myself so hard to get to where I needed to be as a ballet dancer. So I recognize that about myself. But you're right. It's not laziness.

[07:20] Dr. Linda Bluestein: It's definitely not laziness. It's making an educated choice and really looking at your options. And that's important, right? That's something that you obviously talk with dancers about all the time. And it's wonderful that you are able to guide them and really use your experiences in this way. And hypermobility specifically — you're known as the hypermobility guru — how did you specifically get so fascinated with hypermobility?

[07:54] Jennifer Milner: Well, I am hypermobile, and I'm somewhere on the hypermobility spectrum disorder spectrum, depending on how it's defined. Either I'm in the HSD category or the hypermobile Ehlers-Danlos syndrome category, somewhere around there. But I'm not one of those super flexible people, so I never thought of myself as, you know, crazy hypermobile girl. But I was the one that if you pull on my hands, my wrists subluxate, and my shoulders come out of the socket all the time, and my hips do weird things. I've just always had these weird issues that I know you see all the time — issues that by themselves seem kind of random, but then they start to stack up, and you're like, huh, well I do also have this, and I do also have that.
[08:38] So as I was going through my physical journey as a Pilates trainer, I was learning more about my body and what to do with it. And I was also working with dancers, trying to bring them back from a rehab perspective. I saw the ones who were classically defined as hypermobile just had different issues than I did, but I kind of went, oh, no big deal. And then I moved back from New York to Dallas and switched from professional dancers at the very high end of the spectrum to pre-professional dancers. When I moved back and started working with teen dancers, I saw so much more hypermobility and so much more towards that hypermobility spectrum disorder end of it. And I was like, where has this been all along? And I gradually realized it's because it kind of weeds itself out. So I see so many more in the pre-professional level.
[09:33] That got me really interested in how I can help these kids and how I can dig deeper. I had dancers come to me who said, I've been diagnosed with Ehlers-Danlos syndrome. And then another one 6 months later, and I'm like, wow, this is so much more prevalent — as you know — in the younger dancers, because it does tend to contribute to early career endings. And it made me angry on behalf of these dancers. And it made me angry enough to want to do something about it. So I love puzzles and I always have, and I love problem solving. I thought, let's figure this out. Let's dive into this. I can't solve it, I can't cure it — that's not within my scope, and I don't have the knowledge to do that. But what I can do is say, well, here's where you are. Let's take where you are and make it better.
[10:26] So that's been a passion of mine — to help these dancers who are 12, 14, 16 years old survive through this time period and try to have a career. And then to have the older dancer — older, you know, 20 or 24 — coming to me and saying, everything hurts and nobody can help me. And being able to help them. That's kind of where I came from, just seeing that need and wanting to help them the way I didn't have a chance until I was older.

[10:58] Dr. Linda Bluestein: Sure. And can you go into more detail about what you observe in your hypermobile dancers?

[11:07] Jennifer Milner: Sure. Well, one of the big things is spatial awareness. If dancers' parents say, you know, she's so clumsy, and kind of laugh that off, I'll put that down in my box as one possibility. Hypermobile dancers really don't always know where they are in space. And I'm speaking in huge generalities — one of the things about hypermobility, as you know, is that it's not one size fits all. But in general, they have a huge difficulty discerning where they are in space. They think their arm is straight, and it is not. It is beyond straight. And so they have to learn the difference between a straight line and end range of motion for them, and those things might feel really different.
[11:53] There was a study that came out, I don't know, 15 years ago — I can't even remember where I saw it — looking at hypermobile versus non-hypermobile people and how "smart" their joints were, basically. They would have a hypermobile person take their arm out to the side, move the arm from front to back, and just stop straight out to the side. Then they would have them do it with their eyes closed, and they compared them to non-hypermobile people. Non-hypermobile people would stop within about 10 degrees of straight out to the side. And hypermobile people, the joint range was like 40 degrees — as much as 40 degrees off from straight out to the side. And they were like, I think this is right, because they can't trust what their body feels. So spatial awareness is a big part of it.
[12:34] What I call the short attention span of the body is another thing. It's like the body has ADHD and can't really focus and pay attention. It's like you want to smack your hands and go, "Hey, hey, muscles, pay attention!" It may make it harder for them to understand choreography — or not understand, but to really own it and keep it in their bodies. It'll feel like we're going over the same ground every week. I have taught it to them and explained it to them and they've gotten it, and they go away and a week later their body's like, you never told me this. So it can be really slow going with them — that whole idea of being able to grasp a concept within your body and really hold on to it, especially the small muscles: the foot intrinsics, the local stabilizers, the really small stuff. That's really hard.
I also notice with hypermobile dancers that when I start working with them it's like their body is a Jenga game that is partially in progress already. Jenga is where you stack the different, perpendicular pieces to each other and start removing those pieces. I'll look at them and from some angles their body looks strong and ready and can do anything. But then you start looking at it from a slightly different angle and you're like, wow, there's a big hole here and a big hole here, and these things are missing. And if I try to remove this one piece — if they overuse their big back muscles, for example — everything's going to come crashing down. So that piece is there for a reason, because it's needed, because something else isn't working. I have to move really carefully and slowly with them to make sure I don't take everything apart without having a support system ready to come online for them. I see that much more in hypermobile dancers than in non-hypermobile dancers.
[14:30] And then I also see — again, just my own experience — a higher incidence of anxiety, OCD, and depression in hypermobile dancers. I see a higher incidence of perfectionism and also of attention deficit disorder diagnoses. Those patterns can also feed easily into self-harm, disordered eating, and eating disorders — things that can come along as ways to try to control that. So when I see those patterns, I know that it's time to refer out, and I have a really great referral system that I use because of that.
[15:20] A lot of extremely hypermobile dancers — we're talking the bigger end of the scale, not just a flexible thumb — can be living with a low level of pain all the time, and that level of pain is emotionally draining. And then on those days when it's gone, for whatever reason, all of a sudden you're like, wow, this is what people feel like on a regular basis — this is amazing! You don't realize it until it's gone. But living with that low level of pain can increase your anxiety, your worries, your sleep issues. So I see a much higher incidence of those in dancers with hypermobility as well.

[16:13] Dr. Linda Bluestein: That's fascinating, and I love your description about the Jenga game because I've never heard anyone describe hypermobility in that way, or working with a hypermobile body in that way. That's really a great visual, and a lot of us have played that game.

[16:37] Jennifer Milner: Well, hypermobile dancers are often so lovely to look at that we forget there's a lot going on in them, and we need to not just take that structural beauty for granted. We need to look at the issues that are going on inside.

[16:52] Dr. Linda Bluestein: Right. And there could be some compensations going on — maybe they're getting away with it now, but that doesn't mean that they're going to be able to continue to do things the same way. So really looking at their movement patterns, and working with somebody like yourself who is truly an expert in this, is really important.

[17:15] Jennifer Milner: Yeah, absolutely.

[17:17] Dr. Linda Bluestein: And what are your objectives in working with hypermobile dancers, and how do you achieve those objectives?

[17:27] Jennifer Milner: Well, first of all, I want to give them some awareness. I want them to start being able to feel where they are and where their joints are in space. That involves training them in closed chain and doing a variety of different exercises and approaches, but I really want to give them a sense of where they are in space. I also want to give them strength, and giving them strength is difficult. A lot of times with my classic hypermobile dancers, the teachers will say, no matter what we do, she just doesn't build muscle. There's a certain look to a certain type of hypermobile dancer — you can see those muscles just won't bulk up. And that's often because of a collagen issue, and trying to build their strength can be really difficult in a healthy way.
[18:16] So I need to teach them that it's not going to be picking up a 50-pound barbell. It's going to be picking up a 5-pound barbell and doing it correctly enough times that you feel it, but not so many times that you start to get tendinopathies from it. It's that fine line of learning how to build strength. And then working on their balance is a huge one. They just don't have that proprioceptive awareness that other dancers do, and that comes with their awareness of where they are in space. So training their balance is really, really important as well.
I'll use closed chain rather than open chain — a push-up is closed chain and a bicep curl is open chain, so I would rather do closed chain, which gives more information to more joints. I'll use props, so squeezing a ball or using a small yoga block or something that they can feel that tells their body where they are in space. I'll change their position relative to gravity — having them do pliés lying down so that they're going through the same pattern but in a different relationship to gravity, so different muscles are working, and their body can't make assumptions and fall back on old habits. So those are the main things that I try to do for hypermobile dancers.

[19:39] Dr. Linda Bluestein: That's fantastic. I love that idea about changing the relationship to gravity, because we do get into those patterns. I know you have quite a few hypermobile dancers, but you also have some non-hypermobile dancers as well. Could you go into a little bit more detail about how you train the hypermobile dancers differently than the non-hypermobile ones?

[20:00] Jennifer Milner: So every dancer is different, and I will tailor each workout to what the individual dancer needs at that moment. But looking at the big picture, in general, I'll move slower with a hypermobile dancer. They're experts at problem-solving just because they've had to be their whole lives — figuring out how to make their wonky bodies do what we're asking them to do. And most of the time, their problem-solving isn't necessarily healthy. It may be the shortcut or the best way for their body with the strength that they have, but it's not the healthiest way to do it. So I have to retrain some habits that are pretty ingrained.
[20:42] The work we do at the start can seem really boring and really tedious, especially to dancers who are hypermobile and who can't tell where they are in space. It just feels like they're getting no input whatsoever when we're doing really small work, and their body's like, I don't know, I can't tell, is this right, is this wrong? But I try to give them exercises they can do by themselves right away, because I want them to go home and have homework. I want them to do it daily to try to get it into that short-attention-span body. I want to give them small stuff they can take home and do. Usually dancers are frustrated enough with where they are that they will actually do it rather than say, "Yeah, yeah," and then never do it.
[21:26] I can tell who does it and who doesn't. But it takes a while for those basics to get in. So I ask them to hang in with me for just a month, and then we can start to move them forward. But it still takes a long time to push them harder, because as soon as I give them something a little bit harder than they can handle, they'll reach for it, they'll find their own shortcut, and they'll do it and be like, yes! And I'm like, no. So it's a really long process, and I really appreciate that my hypermobile dancers and their parents are in it for the long haul.
[22:00] I have one dancer that I've worked with since she was 11 and a half or 12, and she is now going to be 16 soon. It has taken us 4 years just to get to the point where she can stand on one leg and balance with her eyes closed for 30 seconds — which for me is a baseline for my pre-professional dancers. They should be able to stand on one leg and balance with their eyes closed for 30 seconds. At the same time, she's beautiful on stage and does these amazingly difficult things on stage, but she couldn't do something as basic as that. And she just got that this school year. When she did, I just about started crying — I think I actually did start crying — because it takes so long to get to that point. It feels to them very frustrating and very slow. We do fun stuff, we move, it's not that we don't move, but it can feel like they're not making progress. So it's really hard to get them to hang in there.
[23:01] And then I want to educate them about how to pace themselves — that it's not all about push, push, push, just get stronger. It's educating them what it feels like in class when they're starting to do too much, what it feels like across their school year, across their calendar year, when they're doing too much in their company, when they need to maybe sit out a class, when they need to sit out jumps, when they need to go to their director and say, hey, can I have a rehearsal day off because I can feel this starting? Training them what it feels like to hold back so that they have a longer career is really key.
[23:40] My best dancers will look at their schedule — we sit down and look at it a few times a year — and my best ones will sit down and say, you know what, I am tired. Sometime this next week I need to take a day off. They recognize that now, and they don't push themselves through it, and that makes me super happy. I have a dancer who trains with me twice a week, and she's hypermobile, and we have worked really hard to get her really flexible back under control. She's such a smart dancer now. She will say, I think I want to come in and work with you, but I want to do just release work, or I think I need to take a day off from dance tomorrow. And she's 16, but she's taking ownership of her career and recognizing what she needs to do to stay healthy. So that's something I really try to instill in my hypermobile dancers.

[24:33] Dr. Linda Bluestein: Wow. So you're really able to take this lack of body awareness — although it is funny, because I think emotionally a lot of people with hypermobility and hypermobility disorders have increased emotional sensitivity. We kind of are aware of what's going on in a room, you know.

[24:55] Jennifer Milner: Absolutely.

[24:56] Dr. Linda Bluestein: So it's a very fascinating thing. But yes — in terms of awareness of the body, you're really finding that with practice, they are able to make some very significant improvements.

[25:10] Jennifer Milner: Yes, for sure. And it's just training them to listen inward rather than be so focused listening outward. So many hypermobile people are really good at reading a room, and if they can turn that attention to reading themselves, then they'll be like, oh. Even my dancers — I have a dancer who is a competition dancer, and she's incredible and she is going to have a huge career, but she has consistent issues because she pushes herself too far. But now she's at the point — she's 15 — where she'll come to talk to me and she can barely move. And I'll say, what's going on? She'll go, I did too much. I did this, this, and this, and I knew it was happening, and I knew I shouldn't, but I just didn't want to hold back, and I did too much. So at least she recognizes that. She knows she's making a choice when she's going into it. And eventually she'll get to the point where she recognizes it and makes the choice before she does it. That's a huge part of it — that they can recognize that and make choices.

[26:09] Dr. Linda Bluestein: And you're helping them install the wisdom in their minds and in their bodies at a stage where it is life-changing for them to really get more out of their dancing and have a better quality of life. So it's amazing the work that you're doing with these — I started to say kids. Are you working mostly with pre-professionals at this point, or kind of a mix?

[26:11] Jennifer Milner: Yes, it's mostly pre-professionals. I'd say it's about 70% pre-professionals and then 30% professionals. Some of my proudest moments are my dancers who go off to be an apprentice at Miami City Ballet or a dancer with Pacific Northwest Ballet, and hearing them tell me stories about advocating for themselves. Like, someone in a position of authority will tell them maybe they should diet and they'll say no. No, I know my body and this is how I do it. Or someone will say, yes, you need to come to another rehearsal. And they say, okay, what can we cut from the rest of the week then? Because physically I can't do more. And that they have that courage to stand up for themselves — if that's my only legacy, that makes me super happy.

[27:25] Dr. Linda Bluestein: Oh, that's amazing. That's fantastic. And we know that dance teachers play a pivotal role in dancers' lives. What do you wish dance teachers knew about hypermobility?

[27:37] Jennifer Milner: Well, first and foremost, the pain is real. I know it's hard with children and preteens and teenagers — there's the temptation to say, oh, you're just being a baby. It's hard to tell where that reality line is. With people with hypermobility, I've never seen them faking it, and I've never seen them overplaying it. I've always seen them underplaying it, because they're just so used to pain. So they're not being a diva, they're not being a prima donna. They really do need to sit down. They really can't dance anymore. That ankle really does hurt, and telling them to push through it is not going to be helpful. Working with them to figure out what they're doing wrong that makes their ankle hurt — that would be great. Getting them in to see someone who can help them with it — that would be awesome. But the pain is super real.
[28:26] And so is the fatigue. I have had dancers who were dancing with EDS and with POTS, and they didn't realize they had POTS for a couple of years. Before they had gotten diagnosed, they would just hit a point running Snow for Nutcracker where they just couldn't do it again. And I said, you have to tell your director I cannot do it again. You would see the blood pooling in their feet, and they would faint doing port de bras forward in ballet class. So I want those teachers to know: it's true. It's not just that they're deconditioned or that they don't have good aerobic strength. That might be part of it, but there may be another reason. There are really common comorbidities that go with hypermobility, and that fatigue is real, and it's going to hit them, and it's not going to be helpful to try to push them past it.
[29:24] Also, with dancers with hypermobility, you have to strengthen them before you can move them. Flexibility without stability is just a recipe for danger. And honestly, I don't find it that interesting to watch. I don't enjoy watching super hypermobility being thrown all around the stage if it's not coming from a position of strength. If I don't see grounding and strength in that standing leg and the support of their trunk, it's not interesting for me to see. So if you have someone who's super flexible and has the arched feet and the crazy back and the crazy legs and hips, that's great — but don't stick them out front and make them do a bird of paradise or a scorpion at the end of every number. Teach them how to hold themselves, give them that strength in a smaller range of motion, and they can gradually increase that range of motion. I'm not advocating that they don't use their flexibility, but they have to have that strength before they can use it.
[30:23] And speaking of flexibility, hypermobility doesn't always look like a Gumby doll. Like I said, with myself — I'm hypermobile, but I didn't have a crazy back. I had decent extension, but it wasn't super awesome. I have a dancer who is hypermobile and somewhere on the HSD spectrum, but she has a terrible arabesque because she has so much tightness through her trunk from other parts of her body being super loose. Her shoulders pop out of the socket all the time, her ankles subluxate, her wrists subluxate — all over her body — but she doesn't have a crazy high arabesque or backbend, so teachers aren't going, oh, she's not hypermobile. So it doesn't always look like what you think it looks like. So when a dancer says someone told them they have this, set aside your preconceived notions and dive in with them and say, well, who told you this? What are the criteria? How can I help? That's a great place to start from.
And you're going to have to be the one to hold them back. If you have someone who is hypermobile and super flexible, you as a dance teacher have to be the one to not put those crazy moves in the choreography, to not let guest choreographers do that, and to not let the dancer themselves do too much of it. They'll run into the studio between classes and try to film themselves doing all this crazy stuff. Don't reward that — which sounds terrible, because when it looks cool on social media, of course you want to repost it and get more likes. But teaching them their limits, and "just because you can doesn't mean you should," is going to be so helpful for them to have a long career and not get injured. I've had dancers have their shoulders dislocated because a guest choreographer swings them by their arms and pulls them completely out of the socket. Knowing how to advocate for that dancer so that she can grow up advocating for herself — that is so important.
[32:25] And then if you suspect that they're somewhere on that hypermobility disorder spectrum, have the resources to help them get help. Find people who specialize in your area, or online — now that everybody's online — and be able to pass that on to them. Point them towards a website and say, you might want to read up on this, see if there's anything helpful. You might want to get checked out. Having a diagnosis isn't going to change how you are as a dancer. You can't get cured from it. But it will give you a baseline, and it will help you keep an eye on where you are and compare it to where you are in the future, and make sure everything is staying healthy and strong, just because it's such a complicated issue. I'm not saying you have to get a diagnosis, but having some sort of support out there — if it's somebody who can cross-train with them, if it's a doctor like you, Linda, who can work with them — it's great to have that information to give to the dancer so they can get the help that they need.

[33:29] Dr. Linda Bluestein: Absolutely. And speaking of healthcare professionals, what do you wish that healthcare professionals knew about hypermobile dancers?

[33:40] Jennifer Milner: So much. Being hypermobile is like both a superpower and kryptonite. It's the coolest thing about you and it is also the hardest thing about you, the thing that makes you the most vulnerable. And it can show up in really weird areas. My dentist tells me that my superpower is how quickly I metabolize anesthesia. He said he'd never seen it. When I traveled on tour, he would literally write me a letter in case I had to have emergency surgery that would say, she's not a junkie. She metabolizes anesthesia really fast — I promise she's not just looking for extra drugs.
[34:21] So know that there's going to be weird stuff that goes along with it. It's okay not to know. It's okay for a doctor to have a dancer bring up, I think I might have this, and for you to say, I don't know that much about it, but let me look into it. It's great for the doctor to say, yes, I will dig into it more. It's real. And my favorite doctors are the ones that say, I don't know, let me find out, let me dig into it, rather than try to fake their way through it.
[35:08] Connective tissue disorders can affect the entire body, so it's not just hypermobility and making sure their joints are stable. It can also be heart issues, vision issues, so many neurological aspects — there's so much to it. Using it to look at the whole body is extremely helpful and is the best preventative I know of for whatever issues might come up. Just because a dancer can dance 30 hours a week, that doesn't mean she might not have cardiac issues. Just because she can get through those things, you can't say, oh, she's thin, she's healthy, she must not have a low thyroid. Or she's thin and healthy, so she must have a strong heart and be great for cardio. Don't let those assumptions put you off from running tests that you might need to run.
[36:00] Dancers will just go until you tell them to stop or until they pass out. They don't complain the way a lot of people will. They won't say, oh my gosh, I'm so tired. They'll just keep going until you tell them they can stop. So you won't get that feedback as an accurate guide.
[36:22] And then when they're injured, they will absolutely take longer to recover than most people, especially with soft tissue. I've had doctors, I've had nurses, accuse me of intentionally — like with my shoulder surgery — intentionally trying to make the scar heal worse. To make it look bad. Because they'd say, there's no way your scar would heal like that on its own. Because that's what I have, that's my issue. So they're going to take longer to heal, they're going to take longer to heal from connective tissue issues like tendinopathies. Not sticking to that 4 to 6 weeks and you're back, but sticking to what you actually see — that is so helpful.
[36:58] And through all of this, they might need mental health support as well. Because it's so overwhelming, and it's such a big burden, and you really can't always tell what's going on — and you may be more inclined towards anxiety and OCD — looking at their mental health support is great too. So that's what I hope doctors would take away from it.

[37:23] Dr. Linda Bluestein: Yeah, those are all really great things. I think so often in medicine we look for patterns. And if we don't necessarily know right away what something is, we can tend to — directly or indirectly — say, well, you know, you're crazy. So many dancers end up thinking that they're crazy. But the better thing to do is to say, I don't know what's going on with you — let me do a little bit of research. Or, like you were saying, if they can come in with some information and say, hey, could this potentially apply to me? So, in terms of the past 5, 10, or more years, have you seen any particular trends in dancers?

[38:15] Jennifer Milner: Yes. On the good side of the trends, I think that hypermobility disorders and issues like EDS and Marfan syndrome are becoming much more mainstream — much more talked about. 10 years ago, people in a large company might not have even known what EDS was. People would have said, oh cool, pretty ballet feet, pretty ballet legs, and just left it at that. So I think it's become much more discussed. And in the past 5, 10, 15 years, cross-training has become much more mainstream, and so the younger dancers are getting the help they need to hopefully move up into a professional career. I think that's good.
On the not-so-great side, the tendency to have dancers do things at a younger and younger age and pushing them to do bigger and bigger tricks and fancier and harder choreography — I don't think I could have done what a lot of my 14-year-olds are doing, even when I was 20 or 25 and at the peak of my dance career. And that's not even the hypermobile ones — that's just regular dancers. Dance has advanced so much as an art form and has become so much more athletic. So add to that the pressure of social media, and all of a sudden we're doing all the tricks and all the fancy extensions and all those things, and it's not helping them achieve a longer career. I've had 13 and 14-year-olds quit because they're burned out — literally burned out. They say, I don't want to dance anymore. It's too much. I've worked too hard. My body hurts every day when I wake up and walk down the stairs. I had a 10-year-old tell me that.

Dr. Linda Bluestein: Wow.

[40:09] Jennifer Milner: And to see them at 14 burned out — I could understand it when you're 20 or 25, but to hit that point when you're not even old enough to go to a school dance, it's sad. So that's the bad side of what I've seen in the past few years.

[40:33] Dr. Linda Bluestein: Sure. And I'm sure social media has a significant role in that, as you were mentioning earlier about teachers sometimes wanting to put their particularly hypermobile dancers in the front — drawing more people into the school thinking, well, come here and you're going to become more flexible, because that's what most of us as dancers are wanting.

[41:05] Jennifer Milner: Yeah, it's true.

[41:06] Dr. Linda Bluestein: So what have your dancers been experiencing in their medical care regarding their hypermobility?

[41:15] Jennifer Milner: On the good side, the best case scenario — there have been some of my dancers who have found doctors who are really open to learning about this. As a non-medical practitioner, as a fitness professional who does not practice, treat, diagnose, or any of that, I will carry the current criteria for hypermobile EDS with me in my packet of information. And if I see a dancer that I think may fit somewhere in there, I'll say, hey, take a look at this. Read through it. Talk amongst yourselves. Make an appointment with your doctor and talk to them about it, and see if this might be something worth researching more.
[41:56] I've had dancers who have done that, and they've had some wonderful doctors who have said, I don't know, but let's find out. And then the doctor has really gotten down to business and looked into it. I have one dancer who is completely symptom-free but was diagnosed with hypermobile EDS based on me encouraging her to go and the doctor being willing to look at it. And he promptly sent her to an ophthalmologist and a cardiologist, even though she had no issues, because he said, I want to check these things — I just want to make sure we've got a baseline. And then he said, now we put that in our pocket. We don't have to worry about it again until something comes up. I love those doctors because they don't panic. They don't issue a ton of unnecessary tests, but they say, okay, let's learn about it. Let's find out what we need to find out, and we can go from there.
[42:43] And then I have great doctors like you, Linda — people who can work with patients, and who weren't around 5, 10, 15 years ago. People like you are just now emerging over the past 5 years or so. So it's been really helpful to have someone to refer out to who specializes in it. Some of my dancers now have somebody who is taking charge and creating that umbrella — saying, I'm going to send you here for this and here for that. We're going to keep an eye on it. Let's check in every 6 months. Let's talk about your vitamins, your eyes, all of it. So I've had some really wonderful experiences with that.
[43:25] The other side is dancers who have doctors that don't really understand it, or aren't willing to listen when the dancers give feedback and say, that hurts, or my body feels different when you do that than you'd expect it to feel. They've been pushed into surgery when surgery is not — for me — always the first option for hypermobile dancers, because it's so complicated how they recover and the issues they'll have long term because of it. And that surgery may not fix their issue.
[43:57] Some of the dancers have gone to a doctor who's been like, oh, you've got X, Y, and Z, so the answer is A, B, and C. And they have not had those issues fixed. They've had doctors who say you're exaggerating, that pain can't be real. There's no way you hurt all the time. And just dismiss it. Or say, oh, you're just being dramatic with the fainting. I had a dancer come to me when she was 15 and a half or 16, and she had such an obvious case of EDS and POTS, and it took her about a year to find doctors who would listen to her and give her a diagnosis. Up until then, she was having so many injuries and she couldn't stand through dance class, and the dance teacher was pushing her to do her rehearsals and run-throughs, and she was like, I'm fainting. And the teacher was like, you need to go do more cardio, just jog more. And she hit the point where she couldn't dance, and she had to retire from dancing at age 17. Now she's just trying to manage her health. But if she had had that intervention sooner, she would have had a different story to tell about those precious years. So I see kind of the whole spectrum with doctors, but I am cautiously optimistic that it's becoming more mainstream and that more people are talking about it, and dancers can find the help that they need.

[45:22] Dr. Linda Bluestein: Definitely. And that will be better for more people to have more awareness, so people don't have to travel as far. At the same time, like you said, we are able to do more via telemedicine now, so that's a nice benefit that we have been acquiring over time. In terms of longevity for dancers, that's an extremely important thing. What do you think are the most important things for dancers to maintain as much longevity as possible in their career?

[45:54] Jennifer Milner: I think the biggest thing is to keep your eye on the big picture. My dancers that do the best are the ones who don't say, I have to do this Nutcracker. Or, I have to do this YAGP. They realize, I want to dance 5 years from now and not just next month. And so I may need to sit out for 2 months in order to guarantee that I'm still dancing when I'm 30. Having that eye on the big picture is so important.
[46:19] And going along with that is pacing yourself — like we talked about earlier — being able to read your body and turn that superpower for reading the external inward and say, I may need to ease back a little bit. I may need to change my diet a little bit. I'm feeling tired doing the same things I used to do without feeling tired. So I may need to get some blood work done. I may need to consult a nutritionist. How can I make sure that I'm ready for Nutcracker? What can I do in September to get ready for what I know I'm going to have to do in December? Knowing how to pace yourself is important.
Continue to cross-train regularly. This isn't just a plug for working with me — find someone — but cross-training is especially important for hypermobile people because continuing to challenge your body is the big key. I am constantly trying to invent new exercises just as a way to make their body go, oh, okay, let's try that. It's the same basic thing — I just want them to do a tendu correctly — but I can't get them to do it the same way every time, so we try this and we try that. Cross-training is something other than dance that will surprise your body and challenge it in a different way.
[47:31] Continue to have privates as long as you can. I know there's a financial aspect to that, but — Moira McCormick talked to us about how the Royal Ballet has technique coaches who do one-on-one work with their dancers to fix small things. That's one of the things I have to do with my dancers: go into the ballet studio and fix their tendus or fix their pliés. Not that their dance teachers aren't good, but these are such small adjustments that the teacher isn't catching them with 20 other students or 30 other company members. So taking ballet privates is going to continue to keep you healthy, along with cross-training privates — not just doing the cross-training videos all the time, but having someone physically look at you and say, hey, you're doing that wrong. You're cheating. Let's fix that Jenga board and go back and do it correctly. Or, I noticed that you're doing this — let's not do these exercises and let's focus on this instead. Having a person give you that feedback is going to help you avoid overuse injuries and not miss holes in your body that you're going to have to work on later once you get injured.
[48:43] And then finally, make sure you have a support system. Have your friends to talk to. Have a doctor on speed dial who understands you and understands the issues and can refer out to the right people — specialists who also understand these issues. And don't be afraid to talk about it. Don't be afraid to get a counselor or a nutritionist or whatever you need, because there's a whole team that wants to be your pit crew and wants to keep you on the road and running as many laps as you can.

[49:15] Dr. Linda Bluestein: Awesome. And I know I've done some of your exercises, and I love the creativity, because it makes all the difference in the world to really feel the things that you're trying to get people to feel. Completely changing up the way you're doing the motion really makes a big difference.

[49:35] Jennifer Milner: Yeah, it does. And so keeping your body challenged is important.

[49:39] Dr. Linda Bluestein: Mm-hmm, definitely. And speaking of challenging your body, are there hypermobile dancers that you have ever told — especially young ones — that they probably shouldn't dance?

[49:46] Jennifer Milner: You know, I never have and I never will, because that's not a decision that I feel I can make. At the very most, I think it's a decision that the parents can make if it's a younger dancer. But I am certainly never going to tell a kid, don't dance. If there's somebody who's very hypermobile and we're really struggling and going uphill, I will have regular conversations with their parents and say, I am seeing progression. If the teacher gives you feedback and asks, when is she going to be ready to do Dew Drop? When can she compete? — I can just say, we are moving slowly. Her team is seeing improvement, and if the teacher wants to talk to me, I'm happy to talk to them. But as long as I'm seeing improvement, as long as I'm not seeing them stay 100% flat, I think there's hope and there is a possibility for them to have that career.
[50:53] Now, most of my dancers who are diagnosed — actually all of my dancers who are diagnosed with EDS and who are above the age of 16 have gone on to drop out and not have careers in the professional ballet world. I have known some dancers in the professional world who have EDS, but I didn't know them as pre-professionals. So as I see them in the pre-professional world, a lot of times they'll hit that senior year — like the dancer I mentioned who had the POTS and the EDS and all that — and it's just so much work. Even dancers who aren't on that extreme end of the spectrum — I'll have dancers say to me their junior year, I just don't know if it's worth going through this much pain. My back is always hurting, I'm constantly doing so much work just to tread water, I'm constantly going to PT and seeing you and taking my ballet privates. They may hit that wall and say, it's not worth it. And that's totally fine. It is totally fine to walk away at any point. It is also fine if you've got that fire in your heart to keep going, as long as you can move forward in a healthy way and feel like you have a healthy support team underneath you. So I will always support them until they're the ones who decide it's too hard.

[52:11] Dr. Linda Bluestein: Yeah, I love that. It's their decision — that's fantastic. And what do you hear dancers saying that they wish they could tell their younger selves?

[52:29] Jennifer Milner: Keep an eye on the big picture is by far the biggest one. I wish I hadn't stressed so much about this Nutcracker casting. I wish I hadn't stressed so much about that summer intensive audition. I wish I hadn't forced myself to do this. I hear so much of that. There will always be another thing. This is not it. And even during this time with the quarantine going on — people are afraid, I'm never going to get a contract, I'm never going to get cast. And I'm like, everybody else feels the same way, everybody is in that boat. Unless all art on the earth ceases completely, it's not going to happen. And we know art's never going to cease because it's part of us. So keep your eye on the big picture — that's what all my dancers will say back to me.
[53:22] And then stay healthy. Definitely, 100%, stay healthy. All of my older dancers have said, I wish I had told my younger self not to fuel myself with Cool Ranch Doritos. It's fine to eat them, but do you want your entire body to be made out of them, right? Dancers will obsess and they'll eat the same 10 foods. So encouraging them to fuel in a healthy way — in a healthy spectrum of foods — get help from a nutritionist if you need it, fuel yourself well, train smart, and lean on your support system. Those three things to stay healthy. Healthy fueling, smart training, and lean on your support system. That's what they all say they wish they had done.

[54:21] Dr. Linda Bluestein: And speaking of quarantine, how are your dancers handling this very challenging and interesting time?

[54:31] Jennifer Milner: It's hard. All of my dancers are having a hard time with it emotionally because of all this uncertainty. There's that sense of, I'm never going to dance again, I'm never going to perform again, should I even try to stay in shape, what's the point? So running that gamut of emotions. Some of my dancers are seeking out counselors to talk to, which I think is excellent — just to help them process this and to acknowledge that this is a really difficult time. I keep telling my dancers, this is something that hasn't happened in our lifetime. To think that you should just be able to suck it up and keep moving is crazy. So it's really okay to try to process this and to say, I don't know what's going to happen over the summer. I don't know what's going to happen over the fall. I don't know if I'm going to get an opportunity to audition for a company. I don't know if my contract's going to be offered again because my company may not be around. Living with that uncertainty is really key.
[55:31] And the ones who are getting through this the best are learning to control what they can — control their environment as best they can, give themselves a healthy space to dance in and do their dance classes and stay in shape, fuel themselves well, stay mentally healthy with a support group, with friends, whatever they need. And then let go of the things they can't control and just say, I don't know what's going to happen. I know what I can do right now, and that's what I'm going to do. They're training virtually online, they're continuing their privates with me, they're continuing with their schools. And my smart hypermobile dancers will stop doing some of the center work if they don't have a perfect floor for it, because they know it bothers their back or their knees or whatever. So they're continuing to be smart about that. They know that the quarantine will absolutely shape them, but it's not going to define them. And I think that's what we need to remember. The quarantine is going to shape us as a society, but it doesn't have to define you as a person, and it doesn't have to define you as a dancer.

[56:30] Dr. Linda Bluestein: Right, I love that. That's a fabulous way to think of it. And is there anything else that we didn't talk about that you would like to let us know? And also, can you let people know where they can find you and learn more about the amazing work that you're doing?

[56:50] Jennifer Milner: I feel like we talked about a lot, so there's always something else I can talk about because I love talking about this. You can find me at Jennifer with two N's — Jennifer.Milner, M as in Mary, I-L-N-E-R — on Instagram. And on Facebook it's Jennifer Milner Bodies in Motion. You can find my website at either jennifer-milner.com or Bodies in Motion — they both point to me. I'm happy to answer questions and happy to talk with people. I do live streams on my Instagram page and do virtual privates right now. I love answering questions and helping people connect with the people that they need to work with, if I'm not the right one to help you.

[57:37] Dr. Linda Bluestein: Fabulous. Well, thank you so much. It was so great to get this wonderful information into the hands of dance teachers, dancers, and dance parents. They will learn so much from your incredible knowledge base and the breadth of experience that you have working with so many different dancers. Really appreciate you taking the time to chat with me today.

[58:02] Jennifer Milner: Thank you. It was fun to chat with you.

[58:04] Dr. Linda Bluestein: Flipping the tables.

[58:05] Jennifer Milner: I love it. That's right. That's right.

[58:08] Dr. Linda Bluestein: Well, thank you, and we'll catch you next time on Bendy Bodies with the Hypermobility MD. Jennifer Milner today. Thank you.

[58:20] Jennifer Milner: Bye-bye.

[58:20] Dr. Linda Bluestein: Bye. Thank you for listening to the Bendy Bodies Podcast. Please visit our website, www.bendybodiesbodcast.com for more information and to access the show notes. If you are enjoying this podcast, please remember to subscribe and leave a review. For a limited time, you could win an autographed copy of the popular textbook Disjointed: Navigating the Diagnosis and Management of Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders just by giving us a shout out on Instagram or Facebook and tagging @bendybodies podcast. The thoughts and opinions expressed on this podcast are solely those of the co-hosts and their guests. They do not necessarily represent the views and opinions of any organization. The thoughts and opinions do not constitute medical advice and should not be used in any legal capacity whatsoever. We'll catch you next time on the Bendy Bodies Podcast.