Hypermobility Then and Now

[00:29] Dr. Linda Bluestein: Congratulations, Dr. Bluestein. Happy 200th episode. That's really a phenomenal feat. And I know I'm completely biased, but I would certainly say that this platform is a very much needed exercise in educating providers and patients in the community of Ehlers-Danlos Syndrome. Thank you so much for what you do. Congratulations, Linda. This 200th episode of Bendy Bodies is a huge achievement and a tremendous milestone for the Ehlers-Danlos and hypermobility community. You have not only created an extraordinary platform and a vital resource for the medical community, but you've also provided an invaluable gift and voice to those who have long sought representation. Your work, your dedication, and your impact are truly outstanding, and I'm so grateful to be part of it. Congratulations again. Congratulations, Dr. Bluestein and the entire team at Bendy Bodies.

[01:28] Jennifer Milner: What a milestone! Your podcast is so important. It is the number one podcast that I refer my hypermobile folks to. It's a free resource that leads people to discovery, to next steps, to experts in the field, and creates an incredible community all around the topic of hypermobility and beyond. I can't wait to see what you're going to do with your next 200 episodes. Thank you for being there for us.

[01:53] Dr. Moira McCormack: 200 episodes. Wow. Congratulations, Dr. Bluestein. The Bendy Bodies Podcast has absolutely changed the world for those of us with EDS and those of us who care about EDS. Thank you for everything that you do. Congratulations on the success of the podcast, and thank you for everything that I know you will continue to do for people like me with bendy bodies. It has been an honor to be on your show, and I look forward to seeing what's next.

[02:25] Jennifer Milner: Congratulations to Bendy Bodies on an incredible 200 episodes. What began as a podcast has become a powerful voice for the EDS and HSD community, bringing education, validation, connection, and hope to people around the world. So thank you for amplifying lived experience and reminding so many that they are never alone.

[03:01] Dr. Linda Bluestein: Welcome back to the Bendy Bodies Podcast. I'm your host, Dr. Linda Bluestein, the Hypermobility MD, a Mayo Clinic-trained physician specializing in Ehlers-Danlos syndromes, hypermobility spectrum disorders, and related conditions. And today is a very special episode because this is episode 200. When Bendy Bodies first began, I had the joy of starting this podcast with my original co-host, Jennifer Milner, a dance medicine specialist, who has been such an important part of this work from the very beginning. For this milestone episode, I could not think of a better way to celebrate than by bringing Jennifer back along with our very first guest, Dr. Moira McCormack. Moira brings a rare and powerful combination of lived experience, clinical expertise, and research. She was a professional dancer with the Royal Ballet, went on to become a chartered physiotherapist and dance health specialist, and was one of the early researchers helping bring attention to joint hypermobility in dancers, with published work on the topic dating back to 2004.
[03:55] Since we first interviewed her in 2020, Moira has also earned her PhD through University College London. Her doctoral research, supported by the Rudolf Nureyev Foundation, developed the first ballet-specific reliable musculoskeletal profiling tool designed for vocational school auditions. While her research focuses on dancers, the questions beyond it matter far beyond the dance world. How do we identify physical risk earlier? How do we distinguish flexibility from control? And how do we help people with highly mobile bodies build strength, stability, and resilience instead of simply being told they are just flexible?
[04:35] In this conversation, we come full circle. We'll reflect on where Bendy Bodies started, how the field of hypermobility has evolved over the past 20 years, and what Moira has seen change since her early publications in 2004. We'll also talk about what still needs to change, not just for dancers, but for anyone living in a body that is more bendy, more symptomatic, or more misunderstood than the traditional medical system knows how to handle.
[05:01] As always, this podcast is for education only and is not a substitute for personalized medical advice. Stay to the end for our hypermobility hack. Here we go.
[05:10] Well, I can't believe that we are here to celebrate episode 200 of the Bendy Bodies Podcast, and I could not think of any better way to celebrate than to bring back the person who helped me launch Bendy Bodies, Jennifer Milner, and the very first guest we ever had on the podcast, Dr. Moira McCormack. When we recorded episode 1, conversations about joint hypermobility, Ehlers-Danlos syndromes, and systemic issues in dancers were still so niche. And yet Dr. McCormack was already one of the very first people researching hypermobility and EDS in dancers alongside the late and deeply missed Professor Rodney Grahame. Fast forward 200 episodes and awareness has definitely exploded, but in many ways we are still scratching the surface. So today is part reunion, part reflection, part celebration, and part look toward the future. It is so great to see you both, and thank you so much for coming back on Bendy Bodies.

[06:03] Jennifer Milner: Thank you for having us.

[06:08] Dr. Moira McCormack: It's so wonderful to have you here — just the three original Bendy Bodies discussers. Well, congratulations on 200 episodes, Linda. That's pretty amazing. Just to have been on your radar since the very beginning, watching this community grow has really been extraordinary. It's been amazing to see it start from where it was and grow to what it is now. Does it feel real to you?

[06:40] Dr. Linda Bluestein: Well, it's funny because it's so cool that we're all together. And obviously we just went through all of our tech stuff and I'm thinking about how simple it was when we did that first recording. I think we were on a phone call and one of us just hit record. So in some ways it's great that we're able to get these higher quality recordings and we're recording the video, so people can see us and if we're making hand gestures, as I often do, then they can follow along that way. But yeah, it's very exciting. It's been quite a journey and I really appreciate both of you being a part of it.

[07:11] Dr. Moira McCormack: Absolutely. And Moira, when you joined us for this conversation — we originally talked about this after IADMS Montreal, I think, which was 2019. And we thought, gosh, there's so much that needs to be talked about with dancers. Moira, did you ever think that this would become such a general population discussion and see it growing into what it is today with Bendy Bodies?

[07:37] Jennifer Milner: Oh, absolutely. The incidence of hypermobility is so high. We see so much of it. You walk into a studio and at least 50% of them are hypermobile. And we know so much more now. We don't get so panic-stricken. We've got plenty of strategies. We know that they make great dancers, and it's all much more positive than it was when we first started.

[08:08] Dr. Linda Bluestein: That's great. And Moira, for listeners who may or may not have listened to that first episode and may not know your extraordinary background, can you tell us a little bit about your career journey?

[08:19] Dr. Moira McCormack: Well, number one, I'm not hypermobile. A lot of people who get very interested in hypermobility are hypermobile themselves. I'm not at all. I was working at the Royal Ballet School at the time when I re-met Professor Grahame, and suggested to him that we look at our population again and look at the professional dancers and just see what's out there compared to what he first did many years before that at the Royal Ballet School. We found the incidence was high. We looked at the 11 to 16-year-olds and saw the incidence there was high. And then we went into the company and looked at the professional dancers, and it was interesting to find that as we went up the ranks, the incidence got less and less. We put that down to probably loss of the hypermobiles through injury.
[09:28] But now I think we are so much more aware of hypermobility and how to teach it — still very difficult. One of the main questions I get from teachers is how to rehearse it. And I think the healthcare teams — there's still a lot missing in how the healthcare teams deal with their professional dancers.
So I did all of that with Professor Grahame, and then I did go and work with the Royal Ballet Company for a very long time. After that, over COVID and all of that, I left and came to University College London and started my PhD. I started seeing dancers there and then decided I'm going to stay here and see the whole cross-section of dance — the West End dancers, the young adolescents, the very young 11-year-olds, even younger than that, and also the professional dancers. So I see a cross-section here, which is great.
[10:39] And I should be doing more research, but I'm actually enjoying treating. A lot of my treatments are very involved because it's all to do with control. And control takes a very long time to explain, to educate, and then to exercise and leave the dancer with strategies on how to manage it. So I do find treating takes a very long time with each patient. Physical therapists want in, out, half an hour — I can't do half an hour with a dancer. It has to be an hour plus to get everything done: the manual, the exercise, the technique. But I enjoy that. I find, because we're understanding more now, you can look at a physique and you can just see what's missing. You know what they need to release, you know what they need to tighten up and control. And then it's into technique. But that's the big issue, certainly with me.

[12:14] Jennifer Milner: It is for sure. And I love that you started just sort of seeing what you saw at Royal Ballet and then went into this huge undertaking, looking at everybody from every level. And now you've come back down to the one-on-ones with the treatments, taking everything you've seen and putting it in there. You mentioned being able to see it when you first started working. What patterns were you seeing that a lot of people were just missing? What were the first things that you started to pick out?

[12:44] Dr. Moira McCormack: Well, it's looking at a school full of students or a company full of professional dancers and asking, why is that injury incidence in that particular dancer again and again? And that's when I really started going, there's something very different about this physique. The injury risk is so high. And then that's where the interest grew. I learned through one particular dancer at the Royal Ballet Company whom I treated a great deal over many years. He's now retired. I really learned through him and his physique. He was a principal dancer working very hard — huge work ethic. And I realized that's what it takes when you are hypermobile. When you're that hypermobile, you have to work harder than anyone else. You don't really take holidays. It's the only way to hold it all together, keep going, increase that strength and that control, and prolong the career.
[14:00] So that was it — really through one dancer. And then I had another dancer who was just so unfortunate. She just kept getting injured again and again, and of course was unpopular with the management. She was the youngest to be taken into the company at 17, and I really felt very protective of her. So the two of those contrasting dancers — very similar physiques, but contrasting ability to stick with it, determination, and thinking everything through — were very different.

[14:46] Dr. Linda Bluestein: And when you talk about the hypermobile dancers having to work harder, I would also think that they require more rest in some ways. So what does that actually look like?

[15:06] Dr. Moira McCormack: Of course, one was a male and one was a female — different hormones, different muscle. The education piece was going, okay, we've got to look at all of this. You can work hard, but you'll have to find your recovery time, or else it's not going to work out. Fatigue takes over. With the female, she got fatigue far sooner than the male. Stamina was definitely not at his levels. So I still think about that and ask, what was so different? It's also personality. You've got to have a personality to fight for it. If you don't fight as a really hypermobile, probably verging on Ehlers-Danlos dancer, you really won't make it. You've got to think through things so intelligently and balance your day, your week, your month, your three months, your year of performing.
[16:15] And you can't do too much guesting. At the Royal Ballet, the dancers do all their set work that they're cast for, and then they go out guesting. The moment that happens, the exhaustion starts to set in, and that you've got to try and control. But of course, dancers need to make money — it's a short career, so they just want to work, work, work. And it just doesn't work out in the end. The injuries start to creep in. We've seen that with a few dancers there.

[17:00] Jennifer Milner: I appreciate what you said about one of the dancers you thought probably had EDS — Ehlers-Danlos syndrome — which of course leads to a whole other big group of issues as well. So it's one thing to try to get companies to understand a hypermobile dancer's needs: more rest, slower learning process, all of those things. But did you also find that people were resistant to the idea that the hypermobility could be more things — that it could involve pain, fatigue, instability, dysautonomia, GI symptoms, a multisystemic illness? Did you find that as well?

[17:38] Dr. Moira McCormack: Managements don't want to know. They just don't want to know about different physiques. We like you, we'll cast you, you do your work, and we don't want to know that you are injured or off. Although certainly in this country there is an understanding of risk-taking and vulnerability of dancers, and they're pretty patient with dancers who are injured and have the backup of the healthcare team — it still doesn't matter which way you look at it, it's still a black mark. And it mounts up. Those black marks mount up until someone's asking the healthcare team, how many performances has she actually done? And that's when you can see the warning signs.
[18:33] That's where we are there to protect. I look at the whole management of the company and the school that feeds into the company. You took this young child in, you trained them up, you got them into the professional position. Now you've got to be patient and go with them. That's where we as a healthcare team stand in and say, okay, we have to be patient here. We have to have recovery time. This was unfortunate. Yes, it does look as if she's missed a few performances, but we've got to go with it and we'll get her better again. It's a fine line that we tread in trying to protect dancers and keep them going.
[19:36] And they need our support. They really do. They need teachers' support and they need choreographers' support. Teachers are an awful lot better at recognizing problems and being careful with physiques, but choreographers aren't as careful. They just want to produce their creations, and the dancer is the instrument. And you might even suggest that the education of the choreographer is not there. They're often ex-dancers who progress into choreography and magically forget that they were dancers. When they start choreographing, it's amazing how much they forget and how much they drive those dancers.
[20:43] And then there are the non-dancers who are choreographers — very creative, wonderful artists. Do they really understand the stresses on the dancer and the different physiques? They don't. They'll walk into the studio where they're casting and they'll pick out the physiques they like. It'll often be the hypermobile ones, depending on the style of their choreography. It sometimes amazes me — you look at the cast sheet and go, oh, it's all the hypermobiles, and they're going to have to work very hard with this choreographer.

[21:30] Dr. Linda Bluestein: And when you were talking earlier about the two dancers that you were really working with a lot in your earlier years — one male and one female — I'm also thinking about the massive influence of hormones. The male would have had a much higher testosterone level than the female, so they're going to have more muscle mass and a greater ability to build muscle and some anti-inflammatory benefits from that. And also females, if they have cycling hormones throughout the month, they're going to have varying levels of estrogen and progesterone, and that also activates mast cells and can cause them to be more lax at certain times of the month compared to others. Are those things that you saw as well, or how did that play out?

[22:22] Dr. Moira McCormack: That's a hard one to really answer unless you follow a dancer through several months and really examine with the dancer the fluctuations — in how they perceive their flexibility or hypermobility — unless you work very hard with the dancer to try and track some sort of common theme. It's quite hard to work out whether they really have become more lax and then get injured. I didn't find that explicitly, but I guess if I'd really worked with her, we might have come to some sort of conclusion.
[23:17] It is still an interesting area. But with dancers, their commitments and their choreography changes all the time. So you'd be doing Swan Lake for maybe six weeks, but in between that, you'd be doing a contemporary piece. And then the whole thing would change and you're onto something else. The demands on the dancer change from month to month. It's quite difficult to work out what it is that has injured the dancer — made them at risk. Was it the choreography, or how are they feeling that month, or was it a hormone shift? That still needs quite a bit of looking at, doesn't it?

[24:04] Jennifer Milner: It does. I agree. And I think I could go down a three-hour rabbit hole with you about ballet and how to handle choreographers and teachers and all that. But I also don't want to lose sight of the importance of the work that you have done in the bigger picture of hypermobility disorders as well. I know you worked closely with the late Professor Rodney Grahame, who was truly ahead of his time. What was groundbreaking about the work that you were doing together?

[24:42] Dr. Moira McCormack: We just did that first investigation into the 11 to 40-year-olds. I didn't manage to do very much more with Rodney after that. But he held these gatherings — he used to call it his Hypermobility Club. We would meet every six weeks and he'd cover different subjects with doctors and podiatrists and physios, and we would just enjoy different professions coming in and talking about their research, talking about what they were most driven by. That was always refreshing — to just get that input and be aware of what other people around were dealing with.
[25:41] My supervisor for my PhD worked very closely with Rodney as well — Jane Simmons. She was really the lead on the SPIDER, which is a great diagnostic tool. So that's Jane Simmons — always a fantastic woman to exchange ideas with and learn from. And of course she's hypermobile herself, and that's what drove her into all of this research. But the SPIDER — do you use that, Linda? Do you use the SPIDER?

[26:31] Dr. Linda Bluestein: I do, I do. I think it's a great tool. And it's so fascinating — for people who are not familiar with the SPIDER, basically for each individual person it looks like a spider web, where you can see: does this person have more of a musculoskeletal picture? Do they have more of a neurologic picture? Is it more anxiety or mental health? Is it more GI? It's funny because in my practice I have patients that are so similar in so many ways, but they're so vastly different from each other. Somebody will have a really predominant gastrointestinal picture; somebody else something very different.
One thing that's interesting — what you pointed out early on about that female dancer: fatigue. Fatigue is such a huge problem for so many of these dancers and for so many people who have hypermobility. I just recently came across an article published last year about oxidative phosphorylation, and how people with hypermobile EDS may have altered oxidative phosphorylation. And we're also learning more about the immune system and different levels of proteins and so many other factors that may be involved. So it's a fascinating space, and I do love that SPIDER tool. I think it's a very useful thing.

[27:53] Jennifer Milner: Linda, as Moira was talking about the Hypermobility Club — meeting every six weeks with all the doctors and different people coming in to just talk about what they were looking at and thinking about — it kind of reminded me of the Bendy Bodies Podcast and how you make such good use of your really smart friends and the people you admire and the work that you see that you think, oh, let's talk about that, let's bring that in. I love seeing that as a continuation or a manifestation of sort of the next step of it.
[28:31] Moira, do you have a scientific or personal anecdote that you want to share with us about Professor Grahame? Anything that you want to share about him?

[28:41] Dr. Moira McCormack: Well, I went to his funeral, and it was a small gathering of all the people he'd worked with, his really close friends, his family. And it was so heartwarming. People talked about him with such huge warmth and admiration. It was very emotional — the whole thing was quite short but very intense. And everyone was saying goodbye to a really very valuable and fascinating man. I just felt that that said it all — how much we really loved him and admired him and respected him for all the work he'd put in all those years.
[29:52] And the determination — that's what got me. He said he fought for his patients. He fought for recognition of hypermobility and Ehlers-Danlos. These patients used to come to him from all over the world, not knowing what was wrong. They knew they were sick, but they didn't have a diagnosis. And he started to really be able to give them a diagnosis they could hold on to and then work with. And I thought, that is the sign of a good doctor, a good clinician. You have to fight for your patients.
[30:44] And I feel that's what I do a lot in ballet. I'm trying to tell people, no, she's not getting injured all the time. She just needs better teaching, slower teaching, more considerate teaching. It's not her fault. It may actually be your fault. So whether working with dancers in a professional company, at a school, or with several schools as I do now, you have to fight for your patients, protect them, and show the way.

[31:28] Jennifer Milner: You do. And I do believe, just going back to Professor Grahame, I think our community owes him a big debt of gratitude. As you said, the genuine energy and the love that came out at his funeral is indicative of how much influence he had over so many people. So much of what we do within our own lanes is fighting for our clients, fighting for our patients, and fighting for them to be heard. I love seeing it move forward in the way that you work with your patients, Moira, and in the way that Bendy Bodies is working to tie all those different pieces of the web together for people to see and understand.
[32:12] I'm still trying to wrap my head around the fact that this is the 200th episode and you are our very first person to have talked with us. Looking back on the first episode — if you remember what we talked about — was there anything that we talked about at the time that you thought was very fringe or extreme, and now you're like, oh, that's so mainstream, everybody knows that, everybody talks about that?

[32:34] Dr. Moira McCormack: I think just about everything we talked about in that first episode is now just normal. We know ways to deal with that.
[32:45] But you know, sometimes you do have the patient that you almost don't know what to do with. I had a 13 or 14-year-old who doesn't want to do sport at school. It's the worst thing she can imagine because it's too vigorous. The athletics is too hard for her. Dance is what she wants to do — that's her go-to exercise and what she really enjoys. But we've got knee pain, we've got hip pain, we've got ankle pain, we've got back pain, and it sort of goes round and round in circles. There's no use giving her floor exercises to do. She's not going to do them. She's 13.
[33:35] So we arranged with her mother to go to a gym and have a trainer there — someone she likes, someone she can connect with — who will just take her through a couple of times a week, a regime of loading exercise so that she can feel things. And then connect with the teacher and just say, have patience. Some days she won't be jumping, and other days she'll be fine and she will be jumping. And that's about the best I could do. She's growing. Everything's against them at that age. They're growing fast, they adore their dancing. So you've got to keep them dancing. You can't say don't dance. She's very flexible, but she's not going to dance to any great level — she just wants to dance. So you have to keep them exercising and enjoying it. And I resorted to loading to help her. And the control comes from a very understanding teacher who's just going to go with her and keep her going with everyone else.
[35:04] You do get those cases, and of course the mother comes too, and you search in the family and you find, yes, it is inherited. There were people in the background who had bad musculoskeletal problems. So every individual that comes in is going to be different and will need different suggestions, whatever is available to them. But here in London, a lot is available to a young one. What do you do when you get those really difficult ones — looks fairly impossible because they are in pain, the history is full of all of that, the mother is looking for a solution, a teacher has sent her looking for a solution? It's not going to be easy, but you just have to keep her coasting along quite happily without too many extreme incidents.

[36:28] Jennifer Milner: Yeah, you're right.

[36:30] Dr. Linda Bluestein: How do you handle that, Jen?

[36:33] Jennifer Milner: I was hoping it was rhetorical. I do get a fair amount of that as well. And I was thinking about how when we had our first conversation, the idea of heavy weightlifting for hypermobile people was pretty fringe. It's much more commonplace now to be able to talk about strength training for any dancer. Back then people were like, oh no, we don't want too heavy a load. But especially for hypermobile dancers, the ones that I work with — their joints feel better with more than a resistance band, with more information feeding back into them. So I have had success putting them in strength training.
[37:14] My secret weapon is my daughter, who is a certified strength trainer and a former dancer. She's way cooler than I am. They love to work with her, and she's all about really getting stronger. So that's one secret weapon. The other one that I've been going to a lot more recently — when they have a lot of aches and pains — is trying to find ways to distract the nervous system. Just yesterday I had a dancer who has a really high response to pain. She feels it a lot. She has two ankle sprains in the same ankle that are relatively fresh still. When she's distracted from the pain, she gets a lot more pain-free range of motion — but when she's reminded of it, she feels it. So I stick googly eyes, little stickers that look like googly eyes, onto her anterior tibialis, up towards the origin. It's distracting enough on her skin that her anterior tibialis starts to relax and she has a bigger range of motion and she's like, what? I've found that trying to distract the nervous system and distract the senses is helpful when they have those aches and pains. I know it sounds completely weird, but it really works.

[38:37] Dr. Moira McCormack: At what age is this child?

[38:40] Jennifer Milner: She is 14. My younger ones, I do a lot more sensory work with because my younger ones — if they're hypermobile — often have some neurodivergency as well. So my younger ones will do a lot of rolling on the floor, rolling the ball over the body, touching and that sort of thing. But yeah, through that whole age range, sensory really helps.

[39:00] Dr. Moira McCormack: Well, you are lucky to have a daughter who is an ex-dancer and a strength trainer. Because I wish she was over here. We have plenty of good Pilates trainers, but it's hard to find someone who's going to understand a dancer immediately — someone who's going to understand a young dancer, a child. That is difficult to find. It's even difficult to find at the ballet schools where they're employed. Sometimes those young men — I think sometimes they can't find a job in sport and so they go, I'll try dance. But you've really got to understand the body in front of you. As a strength trainer, you've almost got to be able to diagnose. You've got to look at that physique, understand it, assess it very carefully, look for where the weaknesses are, and then design a program for that particular physique. I find that quite difficult to find. Instead, it's a recipe — this is what we do for this, this is what we do for that. And no dancer does well with just a recipe. It is an individual and an individual physique you're dealing with. So I'd love to find a female strength trainer who understands dance technique and understands young bodies.

[40:46] Jennifer Milner: Well, I'll send my daughter out to you sometime.

[40:48] Dr. Moira McCormack: Thank you.

[40:49] Dr. Linda Bluestein: Please.

[40:50] Jennifer Milner: Can she come and visit?

Dr. Moira McCormack: She would love it.

[40:52] Jennifer Milner: It's great having someone like that because she also loves the idea that she has a voice in the dance world, so she can help them mentally and emotionally as well with how they do strength training.

[41:05] Dr. Linda Bluestein: Before we take a quick break, I wanted to say that I love what both of you are saying and doing. When I'm working with a dancer or a non-dancer, I use my MEND-PMMS framework, which I know Jen has heard ad nauseam, so she probably knows what all of those letters stand for without my even going through it. But the movement piece — the first M stands for movement because that is so critically important. I totally agree about building muscle and doing strength training. That's been pivotal for me over this past year. And then I also work with patients on supplements, medications, looking at their nutrition, and exactly what you said, Jen, about the nervous system, because sometimes they have central sensitization — their nervous system is so dysregulated — and that becomes part of the problem. So yes, Moira, absolutely — it's the personalization. And as you said at the very beginning, it takes more than an hour. My visits are long because it takes a lot of time to really figure out exactly where this person is at and exactly how you can meet them where they're at and get them to a better place. Each person has different needs.

[42:11] Dr. Moira McCormack: Yes. And the psychology as well. They need that positivity, that pushing in the right direction with a huge amount of support. I think with every clinician, when that person is standing in front of you, it's psychology. When they go to the strength trainer, whoever it is, that person has got to understand who you are, what you need, and carry you through with interest and creativity and variety. And I think that's probably what your daughter has, Jennifer — she's got that creativity, so she can design anything for anyone because she really understands where they're coming from. That is important.
Or if that isn't available, when they go to the gym — because a lot of schools now have the physio department, which has a gym, a Pilates department, and then there's the doctor who visits — you've got to go into each department and do your thing and come out saying, I feel better. So often those little hypermobiles are going round and round and round, and in the end they don't like going to the gym because it's a bit boring. And, ah, I don't want to do that.

[43:48] Jennifer Milner: It's boring and it hurts.

[43:49] Dr. Moira McCormack: Yes.

[43:50] Jennifer Milner: So that's what we can't allow to happen.

[43:55] Dr. Linda Bluestein: And if Jennifer's daughter is as creative as Jennifer is, I'm sure they're in fabulous hands. Because I love Jen's creative things that I've always learned from. Every time I go to an IADMS conference, I always go to Jen's workshops if I possibly can, because I always learn something cool and new. We're going to take a quick break and when we come back, we're going to talk about what has changed over the years and what we want young dancers — and young teachers, et cetera — to know. So we're going to take a quick break and we will be right back.
[44:28] Thank you so much for listening to Bendy Bodies. We really appreciate your support. It really helps the podcast when you like, subscribe, and comment on YouTube, and follow, rate, and review on all audio platforms. This helps us reach so many more people and spread the information to everyone. Thank you so much again and enjoy the rest of the episode.

[46:32] Jennifer Milner: We are back and I am Jennifer Milner, here with Dr. Linda Bluestein, and we are continuing to talk with Moira about reminiscing back to our original episode — the very first one — as we celebrate 200 episodes of the Bendy Bodies Podcast. And Moira, I was going to ask you: one thing that I still think people misunderstand is that hypermobility can be both an asset and a vulnerability. How do you balance that conversation when you have it with the dancer, the teacher, the parents, the company director — without fearmongering? How do you do that?

[47:15] Dr. Moira McCormack: Just very positive. The hypermobile dancer makes a great professional dancer eventually, but we really have to be very careful along the way to prevent injury. How are we going to do that? I really put it down to teaching. They have the breadth of movement, they have the huge range, but according to the age and the stage, that range has to be limited until there is control. Of course they love to celebrate that extreme range, but that can't be every day. Training is training, and building strength is part of classwork. Building control is part of your daily class, and that needs to be finely controlled.
[48:25] The teacher really needs to understand the physique, and then understand how the technique is going to match the physique. How can you do that in a class of 40? If there are schools that have 40 in the studio at class in the morning, that is not going to be teaching. You can't teach properly, especially when we're talking about that 13 or 14-year-old adolescent age group. So teaching needs to be in smaller groups, done over time when the teacher has time to understand each physique in the class and teach accordingly — developing a rapport with every single child and having cues to remind each person of their corrections or the things they've got to remember.
[49:35] So I'm asking for something much more difficult than just going in and giving a class. I think it's not understood across the board. And I disagree with it. It makes money when you've got 40 people in the studio, but you can't teach that way.
[50:09] Another bugbear: you can't teach remotely. I don't like that. There's a lot of it happening. It started over COVID and it's still going on. You can't teach remotely. Do any of you teach remotely?

[50:27] Jennifer Milner: I do one-on-ones — I do privates like Pilates remotely. I prefer to be able to work with them in person a few times at least at first so that we can establish things. But it's really slow going. And they either have the mental patience to do it with me and understand we're going to go slowly to make sure they're doing it right, or they don't. Sometimes I will coach a professional dancer online — I have dancers in companies around the country and they'll say, I'm having a lot of trouble with this. And I'll watch them, we'll take it apart, we'll do some exercises to address it, that sort of thing.
I'll also say that I sometimes take class from my favorite studios in New York, from my dancer days, that I get to Zoom in on. I have no expectations of anything except that I'm going to have a good time. I do not find it ideal to have regular long-term instruction dance-wise online. I think there's a lot that's missed, even if you're a really great teacher and you're watching really closely on camera.
[51:42] But just as much, I agree with what you said about having 40 people in class. Those are the studios that require their top dancers to take privates as well. And privates are the only way their technique will be managed enough to keep up with the demands of today's expectations. So it's a perpetual self-feeder — the schools get a lot of money for the big classes, and then they get money for the privates as well.

[52:13] Dr. Moira McCormack: So I think teaching is much harder than people think it is. Ex-professional dancers shouldn't just think, well, I've been in this company, I've been in that company, I can teach — and just move into their next career. You've got to learn to teach. Even if a teaching course is a shortish course — as they do in London — at least all of these suggestions are made to you and you realize, oh, this isn't just a quick walkthrough. There's a lot to it. And then hopefully they start teaching and then start to really progress and learn how to teach.
I did a nine-month teaching course when I decided to give it a go, and then went off and taught. I did a lot of teaching in Japan, which was not the best place to teach because the discipline is so fantastic and they do exactly as you want them to do. You never have to struggle for anything — I was a bit spoiled there. But I did realize at that point, early on in teaching, I don't really know what I'm doing here. I'd done my teaching course, but I still didn't understand what was going on under the skin. And so that's when I did do physio, and then it all started to make sense. I learned from good physios who taught me how important technique was.

[54:19] Dr. Linda Bluestein: When I started doing this work and would sometimes go into studios and give a presentation, it always kind of floored me that, as you said, somebody could just say they're a teacher and start teaching. Some are obviously excellent about learning what they need to know in order to really support their students — because we know that students who are having pain are going to go to the dance teacher first. So it's important that the dance teacher knows what to do. But here in the US, at least, it seems like there's a lot of either competition or pressure that sometimes puts kids on pointe before they're ready, because they feel like, oh, they're just going to go to a different studio if I don't do it, or they give them harder things to do before the technique is clean. And that puts them at risk of injury. So I feel like that competition between schools sometimes causes them to make choices that are not in the dancer's best interest.

[55:21] Dr. Moira McCormack: It's very hard being a teacher. I think it's one of the hardest professions to do well. It has to be commercial up to a point, and to hold onto your students takes that strength of personality, knowledge. You've got to be able to entertain, you've got to have wit, you've got to be able to make them enjoy themselves, you've got to be a psychologist, and then you've got to know what's going on under the skin, and then you've got to really push them so they feel they are actually moving forward. So I think it's the hardest profession to do well.

[55:59] Jennifer Milner: It's incredibly hard. And I think a lot of it goes back to two things that you have talked about. One is developing your eye to understand what you're seeing, and the other is developing your communication skills to be able to communicate and connect. Something that Linda and I have talked a lot about is what makes some hypermobile dancers thrive while others become profoundly symptomatic, or at the very least sort of stall at a certain level. You see those dancers when they're 9 or 10 years old and everybody's like, oh, they're going to be amazing, and then they kind of peak when they're 12 and move on. I think some of the things I see are either you have a good teacher with good communication skills who can see it for the long run and help build them up, or you don't. Either you have good teachers with good eyes — they can see what's going on — or they don't.
[56:59] The dancers I see survive and thrive in the professional dance world are the ones who, when they were younger, had that understanding group around them: teachers, parents who were willing to learn and develop more knowledge about the issue, who had PTs on hand and that sort of thing. What have you seen throughout your career with working with all these levels of dancers as the thing that makes some of them take off and some of them stall out?

[57:31] Dr. Moira McCormack: I think it has a lot to do with psychology and how they're shown to manage those problems, to be encouraged that it'll get better. Something's happened — we'll get through that. We'll manage the problem and move on. There will be those hiccups constantly with the hypermobile physique. But they need to have it explained to them, and yet it's very irksome to hear it all the time: it's because you're hypermobile. So they've got to understand that there is something there, that their physique is a bit different, and that it can all be managed. Not going back to your hypermobility each time, because it doesn't explain anything to a young person. It's the precision. It's, right, we'll do more balance exercises. We'll get that calf a bit stronger. We've always got a way to go. There's always somewhere to go to sort out the problem. And they've got to know that and feel encouraged by that.

[58:51] Jennifer Milner: I think we all agree that dance culture amplifies perfectionism, nervous system dysregulation, overtraining, injury risk, people-pleasing, ignoring the warning signs — and those things can be very heavily present in people with hypermobility and hypermobility disorders. You've talked a lot about the psychology of teaching. What do you wish that every dance teacher understood about hypermobility specifically?

[59:21] Dr. Moira McCormack: That they learn in a much slower way, that they need a lot of repetition, and that it's sometimes frustrating as a teacher. You've got the corrections in there and they're making the same mistake again and again. You have to forgive them for that and just keep going — gently reminding, gently getting them into the right postural balance. You are patient. You get all of that in at the very beginning when you start teaching the young age groups, and you won't have as many problems later. It's when the posture is off and they're taking their attention in different places that the trouble compounds.
[1:00:27] And I often say, oh my goodness, she's held together by her stiff thoracic spine and her iliotibial bands — and that's the only thing holding her together. There's a lot of work when you get stuck with a dancer like that. But it's a slow process of releasing and strengthening, releasing and controlling, and never giving up, being very patient.
When teachers ask me, what is the key to teaching a very hypermobile physique? Well, there's no one thing. It's a very difficult question to answer. If you've got the eye, you just get that dancer into the right position — each time, no slacking, never allowing them to relax into those bad habits. It's got to be precise in every class, or else you won't progress. And you just keep going with them if you believe in them, if they're really going to go somewhere, you see something there, and they've got the spark and the brain and the intelligence. They're just a bit frustrated with their own bodies. That's when you just have to be patient and keep going.
[1:02:03] I think we are much better now in ballet studios at encouraging rather than saying, that's got to be better, it's not good enough, look in the mirror. We're much better generally at being more positive. It's going with them and empathizing. I look at them and go, do you realize you've just taken on the most difficult of tasks? You want to be a classical ballet dancer — I can't think of anything more difficult to do. Are you sure you don't want to just stay at school, go to university, and have a career when you're 50? But if you want to go to this vocational school, life as a dancer is starting to wane by the time you are 35. Are you sure you want this? And they go, absolutely, I need it. And then you go, okay, we'll do it together. They've got to realize what they're up against. And sometimes I have persuaded people: no, you are really too clever. Stay at that good academic school and just enjoy your dance — you'll be able to do it at university anyway. Don't put yourself through it.

[1:03:40] Jennifer Milner: Well, it's true. There are ongoing conversations that you have with pre-professional dancers. For me, the biggest thing is what you said — I just call it slow and low: low stress, slow development. If the teachers just remember that and stick with them for that long journey, I feel like so much is easier for those dancers. What advice would you give to the parents of a hypermobile dancer?

[1:04:09] Dr. Moira McCormack: Well, first advice to all parents of dancers is: are you sure you want to go through with all this? Because you will feel every stress that your child feels, and climbing up the ladder and achieving is a painful process. So I warn them about that. And then it's: you're the one at home being totally supportive. You don't have to do too much. You just need to be supportive and encouraging, and you have to have a good relationship with the teacher. Maybe don't get too involved. Let the teachers take the stress. Don't try to take on that stress at home — that's not what the child needs.
[1:05:09] But I think that's every parent, isn't it? Especially when the child is ambitious, talented, gets all the right cues in the studio. You also have to be very careful that your child isn't pushed and given a lot of stuff too soon because they're talented. You have to be careful of the recovery. You're at home — you're the one who needs to make sure the recovery is happening. You need to understand how each week and month needs to pan out.
[1:06:06] We all know the parents who want the best for their children — and suddenly the child is working seven days a week and seems to want it and maybe does genuinely want it. But something's going to happen. It's usually going to be anterior tibial stress, or medial tibial stress syndrome, because they're just doing too much and not recovering. Those parents need to be warned: just be careful.

[1:06:45] Jennifer Milner: I'd agree.

[1:06:46] Dr. Linda Bluestein: And what do you think the biggest mistakes are that clinicians still make with hypermobile dancers?

[1:06:52] Dr. Moira McCormack: I think often it's a quick referral to the gym, or a referral of, oh, you must do more Pilates, oh, your lower abs need more work — instead of really finding out what that physique needs. Physios need to be really on it to be able to diagnose a hip correctly. And I'm finding — I don't know what it's like in the States, but over here physios aren't really doing a lot of manual therapy. They're not putting their hands on bodies. It's more exercise-driven. I can't work like that. A patient, especially a dancer, needs tactile input, needs that reassurance. You need to feel those tissues. You feel a calf in a tighter dancer and you feel a calf in a hypermobile dancer — they feel very different. You've really got to feel those tissues, feel those joints. You have to be careful when you're mobilizing a joint because some of those hypermobile joints really move, and that's not what they need. They may need to move those joints in the mid thoracic, but they certainly don't need that in the lumbar spine. So hands-on I think is very important for physical therapists, especially with the hypermobile population, because you can feel how different that body is and you can feel what's moving through there.

[1:08:42] Jennifer Milner: You said something about people saying, oh, they need their lower abdominals. I'll get dancers come to me that PTs have said their lower abdominals are weak, or they don't have them or whatever. And I'm like, well, I can see them. You have a lot of really strong muscles, so obviously they exist. What's happening that they're not turning on when they should? I think that's the more accurate question. There's a limit to how many planks and sit-ups you can do that are really going to help if you can't connect those dots. So the exercise portion for me that's most helpful with PT is repatterning. The hands-on, super important. And that repatterning, and teaching them what a good squat feels like — they can do the squats on their own if they need to, but you can't just give them ten squats and walk away. I totally agree with that.
[1:09:43] Okay. The things that we would fix if we could fix everything in the PT world as we're talking about this. What do you hope the next ten years looks like? What gives you optimism for the hypermobility world? What are you hoping for?

[1:10:02] Dr. Moira McCormack: Well, I think we're understanding hypermobility so much better. I still feel there's a group of people who really do get it, but then the young physiotherapists coming up — and now that we have strength and conditioning in classical ballet — I'm not sure they're all on board. I think we still need to be bringing people on and educating them. Sometimes it becomes a fashion and we all learn a lot about it and carry on, but other people are coming up and they're not actually on board and don't know enough about it. So we have to carry on with education, especially for young teachers coming in. And the other professions around the teaching — the Pilates people do understand. They do understand the control. It's just that I find it's lacking when I look at the vocational schools and what they're offering. It should be so much more, and it is more than it was, but it's got to be aimed in the right way with a lot of education. None of it's easy — learning about dancers and dancers' physiques needs that very specific education.
[1:11:49] And in this country we don't have an organization for physiotherapists in dance. And we should. We're working on it. Do you have in the US any sort of organized group that concentrates on dancers and has an educational system put together for clinicians coming into dance? And a vocational school looking to employ different professions in the healthcare department should be asking, have you done your certificate in dance treatment, dance education, dance exercise? We don't have that and we need it. Dancing is very popular — there's so much of it. We have the whole of the West End, the whole of Broadway. I'm not sure we've got the best care for those dancers.

[1:13:14] Dr. Linda Bluestein: Yeah, I agree. I don't think we do.

[1:13:16] Jennifer Milner: We do have colleges that offer certificates in dance medicine specialization. Jeff Russell from Ohio University has a great one — it's about a year long. So I do encourage people to look for that when they're looking for a PT, or some sign that they have worked with dancers in some capacity. But you're right. There is no full governing body for that in the US either.
[1:13:48] And what you're saying about looking forward into the next ten years — it sounds like you're saying the silver bullet still is education. Maybe it's summing it up too tidily to say that since our first episode, we have seen research come a long way. I think we have. I think we've seen so much research. I think hypermobility has really become a more mainstream topic of conversation. And what you're hoping is that in the next ten years, education on that will be just as mainstream. Which is absolutely my hope as well.
[1:14:26] So I'm going to ask you a really fast question — we're going to our lightning round. What's one thing every hypermobile person should prioritize? Just off the top of your head.

[1:14:41] Dr. Moira McCormack: Understanding their fatigue, knowing about hard work and recovery.

[1:14:45] Jennifer Milner: Beautiful answer. That's great. Also education.

[1:14:47] Dr. Moira McCormack: P.S.

[1:14:51] Dr. Linda Bluestein: What worries you the most?

[1:14:55] Dr. Moira McCormack: Diagnosis — lack of diagnosis of injuries. Not the diagnosis of the hypermobility, because we can recognize that, we can measure it. But being able to diagnose the problem and get the correct rehab for that physique. A hypermobile individual will likely rehab in a different way, in a slower way. And they've got to understand that. Clinicians have got to understand it. Dancers have got to understand it. They don't get better really quickly. It takes quite a long time to put in all the facets of that rehabilitation after a bad injury.

[1:15:45] Dr. Linda Bluestein: And what's something that you used to believe that you no longer believe?

[1:15:49] Dr. Moira McCormack: Oh, I find that quite difficult. Jennifer?

[1:15:54] Jennifer Milner: Sorry, I was thinking about that too. I know some of my approach to things has changed a little bit. I still do stability first — trunk stability and then proximal joint stability and then moving outward from there. But I think I move to loading heavier sooner than I used to. I find that if I can get someone in quadruped position, hands and knees for a shoulder issue, and they can hold that for five seconds, that's more valuable to me than open chain, really light work. So I think I moved to a heavier load sooner than I used to. I don't look for perfection in those unstable joints, because I think the retraining comes faster if we learn to make choices in the midst of that instability. Does that make sense?

[1:16:47] Dr. Moira McCormack: Yes, totally. I agree. Linda, what about you?

[1:16:48] Dr. Linda Bluestein: I realized after I asked the question and Moira turned it around to you, I was like, I kind of hope they don't ask me.

[1:16:56] Jennifer Milner: I had to.

[1:16:58] Dr. Linda Bluestein: It's a really hard question. But I think I'll say what I have mentioned already on this show many times. I mentioned it at the very beginning about mast cells and hormones. When I first started doing this work, I thought: all these people have hypermobile joints, some of them have EDS, not all of them, but some of them have hypermobile EDS. Some have other reasons for their hypermobile joints. And then there's this subset that has mast cell activation syndrome, but it's not that significant. Over time, I have found that more and more people may be presenting with things that are on the lower end of the spectrum of mast cell activation syndrome. It's not maybe as florid — they're not flushing and getting hives, it's not a clear-cut picture. But if they have gastrointestinal complaints, if they get migraines, if they have bladder pain or CRPS or things like that — treating the mast cell really seems to make a really big difference. So that's probably my biggest shift in my thinking.

[1:18:03] Dr. Moira McCormack: Yeah. And it'll be interesting to answer that question again 200 episodes from now, in a few years, and see what we all think, where we've all changed to.
[1:18:12] Well, Moira, one of the things our listeners love is to hear what kind of hacks the experts can offer. Do you have a hypermobility hack — a small piece of advice, a small piece of practicality that people can use?

[1:18:35] Dr. Moira McCormack: I want a hypermobile dancer to be able to stand in perfect posture before they start moving.

[1:18:44] Jennifer Milner: That's amazing. It's one of the hardest things. I love it.

[1:18:45] Dr. Linda Bluestein: It's one of the hardest things. Yes.

[1:18:50] Dr. Moira McCormack: Just stand there and get that crown of the head over the front of the calcaneus, and your hypermobile knees under control with the inside thighs working and the lower abdominals coordinated — and just that. Honestly, I tried with a group of physios to look at a series of children about 16 years old and asked each dancer to stand there in normal posture, just parallel, best posture they could think of, then turn out. We marked them in parallel and then in turnout. And everyone had such different ideas about it. These were really good dancers in a top school and well taught. And honestly, I found it very difficult to get those physiotherapists to understand and agree with each other about each posture. I was slightly worried about that. But that's the first thing I think we should be looking at. The hypermobile physique does find it difficult, depending on the age and stage, to just get that first perfectly coordinated position — whether you're standing in first or standing in fifth. If we haven't found that, we're not going to be able to move properly. They've got to be able to start that way and finish that way.

[1:20:36] Jennifer Milner: So I will say: I think it sounds demanding, but I also think it's a really good hack. Whether you're a dancer or just a person who is trying to get to the mailbox, I think it's a great hack to just practice on purpose — good posture. Our joints have ADHD. They just run everywhere. And trying to mindfully stand in good posture and not let your brain wander and your body puddle — I think that's a great hack and it'll just become commonplace. That's an excellent hack. I love that.

[1:21:15] Dr. Linda Bluestein: I love it too. And as soon as you started to say that, I was thinking, oh my gosh, this is so much harder than a lot of people realize. Because when I've watched classes and I see people standing in the back of the room, they are often sinking into their hypermobile joints. They're so tired.

[1:21:16] Dr. Moira McCormack: They're just hanging there. And you tell them, you know the number of hours every week you're standing there with your joints unsupported, standing on one hip — you are hanging on that hip or hanging into the back of the knee. That is a weakening process and we are trying to strengthen you. So in between all the choreography and all the classes and all the performances and all the rehearsal, it's still got to be there. Every step is an exercise, I say, as they leave the room. Remember — every step is an exercise. And if they're still not getting it, I take them to the stairs and say, right, take every step, go up there, and I want to see everything in place all the way up and all the way down.

[1:22:32] Jennifer Milner: Okay, I will never come take class with Moira. She's going to be too hard.

[1:22:39] Dr. Moira McCormack: But it's just making someone think. And they do start to think in between sessions. I say, right — now you're going to walk down Tottenham Court Road and think about that big toe. Just think about it inside your trainer as you're walking along. It'll activate so much. It'll activate that arch. I'm sure it does. I'm convinced.

[1:23:02] Dr. Linda Bluestein: Right. The whole saying about what fires together wires together. The more that we practice whichever habits, the more they're going to wire. So I think that's really, really important. And before we go, can you tell people where they can learn more about you? And if you have any special projects or anything that you want to share?

[1:23:22] Dr. Moira McCormack: Well, I don't do social media. I just toddle along and see my patients. I don't write a lot. I will be trying to finish a book. But I don't actually do social media, so I'm really not a fashionable person.

[1:23:43] Dr. Linda Bluestein: If somebody is listening to this and they are in London — you're in London, correct? — and they want to work with you, how would they find you?

[1:23:52] Dr. Moira McCormack: Through the UCL website and also through the ISEH — the Institute of Sport, Exercise, and Health — part of UCL. We're in the middle of London on Tottenham Court Road. I see dancers of all sorts, all ages, over here, and I can be contacted very easily through ISEH. If anyone's visiting — I have a student coming in a couple of weeks who's coming to interview me about injury and teaching. She's from the States and she's coming over to finish part of her master's. So I'm here and she found me. I'm very happy to see anyone who's passing through.

[1:24:59] Dr. Linda Bluestein: Well, I can't think of a better way to celebrate our 200th episode than to have both of you here. It's been such a fantastic conversation. Before we go, Jen, do you want to quickly let people know where they can find you?

[1:25:11] Jennifer Milner: Sure. You can find me on Instagram at @jennifer.milner, and my website is jennifer-milner.com.

[1:25:19] Dr. Linda Bluestein: And you and I are doing a program together in July —

[1:25:23] Jennifer Milner: Yes.

[1:25:29] Dr. Linda Bluestein: July 23rd, which is a Thursday, right before the EDS Society Conference. So if anyone is interested, please contact one of us and we will give you more information.

[1:25:39] Jennifer Milner: Yes, that will be in Dallas, Texas, so it will be live. You can learn live and in person from Dr. Linda Bluestein.

[1:25:43] Dr. Linda Bluestein: Live and in person. It's going to be fun. Okay, great. Well, thank you so much to both of you for taking the time to talk with us today and share your incredible wisdom with our listeners. It's been a really fun conversation.
[1:26:10] Thank you so much for listening to this week's episode of the Bendy Bodies Podcast. If you'd like to go deeper, I share additional education, clinical insights, and resources in my newsletter, The Bendy Bulletin, which you can find on Substack at hypermobilitymd.substack.com. You can also help us spread the word about connective tissue disorders by leaving a review, sharing this episode, or sending it to someone who needs it. These small actions truly make a difference in raising awareness about conditions that are still widely misunderstood.
[1:26:38] Don't forget, full video episodes are available every week on YouTube at Bendy Bodies Podcast. As many of you know, I offer one-on-one coaching and mentorship for both individuals living with connective tissue disorders and people caring for them. You can learn more about these options on the services page at hypermobilitymd.com. You can find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, X, and LinkedIn, all at Hypermobility MD.
[1:27:01] As part of our collaboration with the UVA Ehlers-Danlos Syndrome Center, we also want to share some of their helpful resources. For questions or appointment inquiries, you can contact the UVA EDS Center at [email protected]. Again, that's the letter R as in Robert, UVA EDS Center at uvahealth.org. You can find answers to common questions at uvahealth.com/support/eds/FAQ.
[1:27:32] Our incredible production team is Human Content. You can find them on TikTok and Instagram at Human Content Pods. As you know, we love bringing on guests with unique perspectives to share. However, these unscripted discussions do not necessarily reflect the views or opinions held by me or the Bendy Bodies team. Although we may share healthcare perspectives on the podcast, no statements made on Bendy Bodies should be considered medical advice. Please always consult a qualified healthcare provider regarding your own care. For more information about the Bendy Bodies Program disclaimer and ethics policy, submission verification and licensing terms, HIPAA release terms, or to get in touch with us, please visit bendybodiespodcast.com. Bendy Bodies Podcast is a Human Content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.