Flexibility as a Liability: What Circus Teaches Us about Hypermobility w/ Dr. Emily Scherb

[00:30] Dr. Linda Bluestein: I spent so many years not stretching because I was in so much pain, and I thought that part of the way to get better was to stop doing any kind of stretching. My hamstrings now are so tight, and/or my nervous system is that tight, and I attribute that in part to the fact that I did not stretch at all for quite a few years because I was in so much pain.
[01:10] Welcome back to the Bendy Bodies Podcast. I'm your host, Dr. Linda Bluestein, the Hypermobility MD, a Mayo Clinic-trained expert in Ehlers-Danlos syndromes. Today, we're going to be talking to Dr. Emily Scherb, who goes by the Circus Doc. Circus performers do things that most of us can barely comprehend. They bend farther, fall harder, spin faster, and train through forces that would overwhelm many bodies. But what happens when extraordinary flexibility intersects with instability, pain, dysautonomia, fatigue, trauma, or connective tissue disorders? Today, we're going to explore what circus medicine can teach us all about hypermobility and the human body.
[01:47] After decades spent hanging from trapezes, standing on heads, and dangling from hot air balloons, Emily traded fishnets for the clinic, but she never left the circus. Now known as the Circus Doc, she has transitioned from performer to physical therapist, researcher, and author of the bestselling book Applied Anatomy of Aerial Arts. Dr. Scherb was a guest on the Bendy Bodies Podcast almost 6 years ago for episode 14, and we will link that in the show notes. I think this conversation is going to challenge how people think about flexibility, pain, strength, and resilience. This podcast is for education only and is not a substitute for personalized medical advice. Stay to the end for a hypermobility hack. Here we go.
[03:01] Well, I'm super excited to be back with Dr. Emily Scherb. I talked to you about 6 years ago for episode 14, and we will soon be publishing — or maybe we've already published by the time this comes out — Episode 200. So it's kind of crazy to be chatting with you again after such a long time, even though you and I have worked on a lot of projects together.

[03:23] Dr. Emily Scherb: I can't believe it's been 6 years, but it was a great conversation then. And I'm really excited for the conversation today.

[03:32] Dr. Linda Bluestein: Yeah, me too. For the people who maybe don't know you as well or didn't listen to that episode, can you tell us what first drew you into circus medicine?

[03:41] Dr. Emily Scherb: Absolutely. So I was a gymnast as a small kid, like a lot of us were. And I loved moving my body. I loved learning new skills and new performances. And then I found circus at a summer camp when I was about 10 or 11. And I realized that I could do all of that same skill building, all that same movement in my body. And then I got claps no matter what I did instead of scores. And I was like, oh, this is—

Dr. Linda Bluestein: Ah.

[04:10] Dr. Emily Scherb: This is fantastic. I love this. So definitely a performing artist, right? And so circus has always been a part of my life. And then I went to grad school and always had my eye on, okay, so this is a cool thing I learned about the body, but how does it relate to this passion of mine? I kept trying to make those connections and thought I would see a few circus artists here and there as part of my practice, but it became a huge part of my career and my professional and still my personal life.

[04:43] Dr. Linda Bluestein: And you do so much great education for other circus PTs, other people working in the circus space, which is really amazing. And I'm sure we're going to talk about that more later because I definitely want people to know all the different things that you offer so they can get more information. I want to know what people completely misunderstand about circus performers. What's misunderstood most often?

[05:08] Dr. Emily Scherb: I think actually what's most misunderstood is what circus is. Which sounds crazy, right? We all have an idea in our head of what circus is, and it may be different for each one of us. But that's what's so interesting about circus — it's so very broad.
[05:30] Circus can include the sparkly artist in their sequins performing traditional circus, doing a skill for applause. Circus can be in a theater and have very pedestrian costuming and be very open to the audience and conversational, and the artist can speak. Circus can be tumbling and flipping. Circus can be walking across a stage. Circus can be the musician that's playing with the artist. Circus can be an actor who is creating a role on stage. So circus has a broad, broad definition, and working with circus artists as I do means that you have to understand all those different components.
[06:14] But the other thing that people often misunderstand about circus is that circus performers are just such a small part of who participates in circus. There is a massive explosion — in the best way — of recreational circus. People like me do it for fun recreationally. I have community in circus. I still have that physical challenge from circus. And a lot of the people who are participating in circus are doing it after work, on the weekends, to enhance their lives through physical activity.

[06:54] Dr. Linda Bluestein: I love that. That's so interesting. And what about injuries? What injuries or conditions surprised you most when you entered this world?

[07:11] Dr. Emily Scherb: I think what is different about circus and circus injuries is when they occur and the challenges that are presented to the body. One of the big differences in circus is that we're often working hard at end range of our joints and muscles, which is why it's so appealing for bendy bodies and why bendy bodies are often so successful at circus. But it's also a challenge for anybody, whether it's a hypermobile body or a normally mobile body.
[07:51] In anybody, we're functioning at end range. Our hand balancers and our aerialists all have their arms way up over their heads, and then they're bearing weight or taking traction load. They are loading that shoulder — a very mobile joint, especially in a hypermobile body — and it has to be strong at end range. So we see a lot more presentation of chronic injuries at the shoulder and hip. The acute injuries, like ankle sprains, are similar to a lot of other sports, but those chronic injuries are happening in a range of motion that not many providers are necessarily trained to treat. As a clinician, I was trained in working on the shoulder for normal household tasks and typing on a computer — things in front of the body. I had to extrapolate: how do we take this all the way to end range?
[08:41] The other thing that's different about circus bodies is that in sports in general, we see injuries happening during competition. These soccer athletes are leaving it all on the field during a match. But a circus artist is supposed to look professional, finished, in control — or out of control in a controlled manner — for the audience during the performance. Training is where they're pushing their body as hard as they can. So we see spikes in injury happen earlier in the process than we would with a traditional athlete. And it's very true across the performing arts.

[09:23] Dr. Linda Bluestein: That makes a lot of sense. You mentioned joint hypermobility — joints that have greater than expected range of motion — but I also want you to explain the difference between hypermobility, flexibility, and tissue resilience.

[09:43] Dr. Emily Scherb: You're going deep with the big questions today. Especially the word flexibility — that's a big one.

[09:49] Dr. Linda Bluestein: I have no easy questions for you today.

[09:54] Dr. Emily Scherb: Tissue resilience — let's start with that one. It's the tissue's ability to adapt, change, and recover from the stresses that we put on it in daily life or in training. Whether that's the microscale resilience of coming back from a certain movement, or recovering from a hard training session and getting back to baseline — ideally getting stronger.
[10:24] Flexibility. I feel like this one's tough because people argue over definitions and mean different things. Flexibility is how far the joints go. When I talk about flexibility, I'm personally talking about how far those joints go with the person in control. Your active flexibility is the range of motion you can control. Then there's passive flexibility, which may be the range of motion you're able to be pushed into. We need modifiers on the word flexibility to make sure we're all having the same conversation.
[11:03] Hypermobility is when extensibility is larger than the average population. You can be hypermobile and have control of much of that active flexibility. I want hypermobility to involve a controlled flexibility as much as possible. They're different in that flexibility is a definition of how the body moves, whereas hypermobility is talking about joint structure independent of how you're moving it. The joint may be hypermobile and your flexibility is what you do with it.

[11:46] Dr. Linda Bluestein: Okay, I like that. So there's a big difference between somebody who has hypermobility but doesn't have the ability to control that range versus somebody who has hypermobility and does have the ability to control that range.

[12:00] Dr. Emily Scherb: Yeah. Because we can have hypermobile people with very mobile joints that are pretty unstable, but they're actually quite stiff. You can feel pretty locked up as a hypermobile person because your body's working really hard to hold itself together. And if it doesn't have control through that range, it's often not going to allow the body to go there. So the joint can be hypermobile, but the person can feel inflexible.

[12:26] Dr. Linda Bluestein: Yeah, it's really tricky, isn't it? It makes it hard for people to get assessed and diagnosed. If you're trying to assess this person and you go to the very top of the assessment for hypermobile EDS — the Beighton score — somebody might have had surgeries or injuries, or like you said, their muscles are trying to hold on for dear life to stabilize the joint. So assessment for hypermobile EDS can be quite tricky.

[13:01] Dr. Emily Scherb: Absolutely. And that's what's such an interesting thing about humans and the variation across humans.

[13:07] Dr. Linda Bluestein: Right.

[13:09] Dr. Emily Scherb: When I was in school, the answer was always "it depends." Now it's the answer I give everybody else. Humans are highly variable.

[13:15] Dr. Linda Bluestein: Right. Yes. That's so true. What do you think the hidden costs are of extreme mobility?

[13:22] Dr. Emily Scherb: I think there are quite a few. There is a level of awareness and work that goes into everyday movements that if you're not hypermobile, you don't quite understand. Just walking around and existing in the world is physically more challenging. And I think that level of work to hold the body together — if you are born in a hypermobile body and you're functioning in the world that way — you don't even realize how much more effort you're putting in than somebody who is able to just dock their joints and doesn't have to figure out where that position is or use their muscles strongly to find it. So it's that constant low-grade effort that we don't even know is happening.

[14:15] Dr. Linda Bluestein: Yeah. And just because somebody can do something doesn't mean that their body's going to tolerate it well, right? Especially in circus, I feel like people are doing things that might be very good for their body, or might not be.

[14:31] Dr. Emily Scherb: Absolutely. And in circus, hypermobility looks like a big gift, but it comes at that same cost. Yes, you can drop into a split — great. But in circus, you're often not doing a split on the floor where you're supported. You may be doing it between two people's shoulders, one foot on each. And if you don't have the strength and control to hold that together, all of a sudden that mobility you can just flop into becomes something like, oh gosh, I am further than I can control.
[15:03] Versus somebody who has to work for that mobility — by the time they get there, they'll have the strength to control it. Because for people who have to work for their flexibility, the stretching they do is a lot of strength work. Our hypermobile folks have to gain that strength to support joints that may already be hypermobile. And especially if they're starting young in very mobile bodies, they're like, oh look, I can put my butt on my head. And it's like, great. I'm okay with you going there because your body clearly can — but not yet. I still need you to walk through the steps that somebody who can't get there has to go through, so you can build the strength and build the capacity to do that safely.
[15:57] Our hypermobile bodies can bend and move, and that's wonderful and challenging. What's great about circus is it can give the tools to control those bodies through those ranges of motion in a way that actually serves the person in daily life as well, because it'll make those mid-ranges easier because the muscles will be so strong throughout the full range.

[16:20] Dr. Linda Bluestein: So if someone's hypermobile, are you more often having to hold them back and get them to build the strength before they go back to what they seemed able to do very easily?

[16:42] Dr. Emily Scherb: It depends. It depends on personality, it depends on age. On average, our younger folks who are less experienced with their bodies are just like, look what I can do, how cool. And I'm holding them back a little, because they're saying, but I can do it. And I'm like, yes, but you're doing your handstand with your elbows nearly touching because they're so hyperextended — you don't actually have the strength to support your body inverted. Explaining that to somebody is hard, because no matter their age they're like, but I can do it already. And it's like, okay, but if we hold you back here and you gain the strength, when you get back to there, you're going to be so much better versus trying to gain strength from where you already are.
[17:38] But then on the flip side, I'll have other folks — they tend to be a little older, they have more experience in their bodies — and they're like, whoa, I don't feel safe. Their body's giving them fear signals of I'm not stable. And then sometimes I have to push them a little and say, okay, we did the steps, we've done the things, now it is safe — or let's do it in a really controlled way.
[18:02] I find myself explaining more often than not that the feeling of being at end range that you're achieving is sometimes your joint shifting a little bit. Can you see that moment? Can you feel that moment? Can we learn to control that moment? Can we push it further and further into your range so that you control it longer and longer?
The shoulder is a really big one. As people bring their arms overhead, we control the rotation of the humerus — that arm bone. We can change the seating of the ball and socket in the joint. There are ways of maintaining more congruency between that ball and that socket, and there are ways of shifting a little to get more range. So they're like, look how far my arms can go. And I'm like, whoa — your joint can go that far, but your shoulder isn't doing that properly. Let's walk through that process together. Because especially with things like pull-ups, when lowering down from a pull-up they'll come to the bottom and kind of shift in the joint to get to that full hang — okay, you're no longer engaged. What are you going to do next? Now you have to find that engagement again. Giving you control through that full range gets you to the next place.
[19:31] So there's a lot of education, and some of that education means holding back and some of it means pushing forward. And some of it is just, hey, I want you to notice this thing that your body does. Can we recognize that? And that is again part of the cost of hypermobility — having to take that extra step to find that — whereas a less mobile person would just stop. Their shoulder doesn't go any further and they don't have to learn that process.

[19:57] Dr. Linda Bluestein: What do you think about end-range training for non-circus hypermobile people? Let's use me as an example. Should we be training at end range, strengthening at end range, or staying more mid-range and strengthening there?

[20:24] Dr. Emily Scherb: I want people to be strong in their mid-range first and expand that range towards their end range as much as possible. If you're only strong in mid-range and you step off a curb and your knee gets a little more hyperextended, you don't have the strength to recover that. So I'd love people to be training through their available range of motion, and yes, I do want people training towards end range. But if you haven't started any strength work, start mid-range first — make sure that in the areas where it's easier to control, you are able to control it.
[21:03] What people don't always know about how muscles work is that our muscles are better at firing in mid-range. The muscles have these little overlapping structures that interact like tiny hand hooks. In mid-range, you've got that nice happy overlap that allows the muscle to get shorter while still having space to get longer. When the muscles contract, it's easier. But as you get to end range, those muscles are already having trouble. It's harder work. It takes more effort to learn how to get strong there. So getting strong in mid-range first is really helpful.

[21:38] Dr. Linda Bluestein: I'm going to use myself as an example again, because why not get a free session out of this? I spent so many years not stretching because I was in so much pain. When I did ballet, I could do heel in hand, I could do the splits every which direction, and I could lay on my back and put my leg next to my ear. I was so flexible. My hamstrings now are so tight and/or my nervous system is that tight. I attribute that in part to the fact that I did not stretch at all for quite a few years because I was in so much pain. I had terrible sciatica and it turned out it was related to a Tarlov cyst. I had the Tarlov cyst surgery and then I got a lot better. But meanwhile, I had stopped stretching for many, many years.
[22:30] What do you think about stretching for people like me — non-circus people — but also let's talk about different buckets: people who are hypermobile but not circus, amateur circus artists, and elite circus artists?

[22:53] Dr. Emily Scherb: Stretching can be really important. And you gave me buckets, so that's great. For our folks out in the general community who are hypermobile, active stretching is my favorite. Going through a range and then actively coming back out of it. For hamstrings, for example, a weighted or unweighted deadlift. It sounds like a big scary weightlifter motion, but it's basically bending at your hips and coming back up — something we actually do all the time. When you bend at your hips and come back up, your hamstrings get the signal: oh, I have to lengthen, but I also have the control to come back up. It helps calm the nervous system down because the nervous system is saying, oh, I'm actually in control. I can do this. I can move through this range of motion.
Maybe it's a laundry basket. We do this in daily life. This is not like I need to go to the gym and lift 50 pounds — but if you want to work up to that, that's awesome. There are people who say don't lift weights for hypermobile people. I am not one of those people.

[24:18] Dr. Linda Bluestein: Me neither. No, I think weights are huge.

[24:21] Dr. Emily Scherb: Please lift weights. You lift weights in your daily life. You lift your child, you lift your laundry, you lift your groceries, you lift your own body off the toilet. We are lifting.

[24:29] Dr. Linda Bluestein: Yes.

[24:32] Dr. Emily Scherb: It's those little daily life things. And I think it's even more important for hypermobile folks than the general population because, again, everything takes a little bit more work.
[24:40] But stretching — I don't want my hypermobile folks to sit in a stretch for 3 or 4 minutes. That is going to cause that tissue to relax. Our tissues that are already a little more lax will start relaxing, and the joints are just going to sink into it. The muscles don't have the opportunity to support the joint the way we need them to. So a little bit of passive stretching is fine — and honestly, the research is showing that short-duration passive stretching can work for a lot of folks in combination with other things. Doing a little short-duration passive stretch is totally fine and can feel really nice. But holding those long stretches passively is probably not my favorite.
[25:37] This is actually not that different across the circus spectrum. We really want the strength to go with these motions. Even our contortionists — yes, they do some passive stretching, but they're mostly working in and out of movements. They're working on keeping the leg active as they drop into their oversplit. It's not, I'm going to drop into an oversplit and that's the end of it. It's, I am working really hard to support myself in this position. When they put their head on their butt, it's not that they're sitting there passively — they are controlling their spine and actively pulling their hips into that position.
[26:22] What tends to happen when our ballet dancers retire, or our contortionists retire, is that they stop training and stop strengthening through that full range, and that does tend to make the body tighten up and increase pain. Sometimes, even if you're in pain as a professional dancer or artist working at these end ranges — and that's what's causing pain by the end of your career, which can happen — you may need to back off. But there is a certain sweet spot of load where your body is saying, yeah, I really appreciate that support through that range. As we come back to should I be training at end range — well, you've been training for years to have it. If you don't have the strength now to maintain that, it's going to be a lot harder for your body to get there. And then there are joint changes that happen as we age that are separate from the muscular and musculotendon systems.

[27:25] Dr. Linda Bluestein: Okay, that really helps a lot. I posted this question online and I've gotten such interesting responses from both physical therapists and people who are hypermobile, and people tend to have very strong opinions on the stretching question. So I appreciate that.

[27:40] Dr. Emily Scherb: I think some of it comes down to people's neurological systems and how their bodies respond to stretch and where they are in the spectrum. The further along I get in my career, the more I lean into "it depends," because there is so rarely a right answer. True in physical therapy, true in hypermobility, true in life. There's just so much gray.

[28:04] Dr. Linda Bluestein: Yeah, absolutely. And that's what I love about the podcast because it's really hard in a social media post to talk about nuances — and most things are fairly nuanced. So I love the ability to actually have a conversation and dive deeper. So another question: your colleagues, physical therapists Stephanie Greenspan, Aiko Callahan, and Annie Squires, published the fabulous journal article Management of Joint Hypermobility in Aesthetic Performing Artists. I interviewed them for the podcast too, and we'll link that episode in the show notes. In that article, they discuss how many circus artists identify with their joint hypermobility. I would love to know if you see that, how it can be harmful, and also whether there are any advantages — the pros and cons of identifying as a circus performer through your joint hypermobility.

[29:09] Dr. Emily Scherb: In circus, there is so much sense of identity related to the discipline and specifically to the apparatus or discipline. During the pandemic, there was also a study looking at artists' emotional and cognitive states related to being away from training and away from their apparatus. And they all identified as: I am a trapeze artist. There's so much personality tied in. I think that happens a lot in the performing arts in general — dancers as well. I am a dancer. What do you do on your days off? I prepare for dancing. I'm always a dancer.
[29:54] I think the hypermobility falls into that as well. I'm not on the EDS spectrum myself — when I do circus, I tend to focus on powerful moves, big dynamics and swings. But a hypermobile mover might identify as: I'm a bendy artist. My discipline is defined by putting my feet on my head. It's kind of like in the dance world saying I'm a Cunningham dancer or a Horton dancer or a ballet dancer. It defines how you move through space. So it's not just the hypermobility they identify with — it's how they approach everything they do professionally. I'm going to look at how I can put a backbend into this because that's how I look best performing.
[31:20] The pros and cons: if you can't do that aspect of movement for whatever reason, you're completely redefining yourself. It's not just, oh, I can't put my feet to my head but I can still do aerial hoop — it's that you might have to completely redefine how you interact with your apparatus. So it's a pro in that it helps you define your movement, define your brand as you're marketing yourself as an artist. It helps you choreograph. And a con in that it's also your limitation. And that's not even talking about what it's actually doing to the body — it's just the self-perception and the way you move through space.

[32:06] Dr. Linda Bluestein: I love that. And we're going to take a quick break. When we come back, we are going to talk about how to distinguish between normal soreness, overtraining, instability, injury, and red flags. We will be right back with Dr. Emily Scherb.
[33:30] So we are back with Dr. Emily Scherb, who goes by the Circus Doc. You can find her online as the Circus Doc. And I would love to know how you distinguish normal circus soreness versus overtraining versus injury versus instability versus — oh, I wonder if this person has a connective tissue disorder. Just a small question to restart after the break.

[33:53] Dr. Emily Scherb: Just a teeny tiny one. Excellent. Okay. Let's start with normal soreness. What makes it normal? It's normal when it's occasional. If it's after every training session, it's no longer normal. We are looking for soreness that happens ideally occasionally. If it's more than about once a week, you're probably doing a little too much training and there's probably some overload happening that your body isn't quite ready to handle. Soreness should happen when you have a jump in training — tackling a new skill, a new movement, or increasing the amount or intensity of training.
[37:39] So: normal soreness is going to happen 24 to 48 hours after training, last around 72 hours, and then go away. By day 3 it should be really fading. Day 1, you shouldn't be sore yet. If you're sore as soon as you finish training, that's also not normal soreness. And it shouldn't be happening all the time — you should be able to say, ah, I see why that happened. I started training this new thing. Or I started increasing my training in general.
Overtraining. There are some lovely yellow flags for that, and it's a tough one. Is it overtraining? Is it your body not being adequately prepared? Not enough sleep, not enough fuel, life stress — our interpersonal world outside of training really does affect how training itself is affecting us. And I think with hypermobile bodies, it's easier to overtrain. Again, everything takes a little bit more work.
[37:39] Yellow flags of overtraining: I'm sore all the time. I'm tired all the time and I don't feel better with movement. I don't feel better with fuel or nutrition. I don't feel better getting sunshine or fluids — hydration is huge, and electrolytes are huge for hypermobility. But yeah, we're looking for things just kind of declining, or you're never quite feeling great, or you're never making gains in training. If everything always feels like a struggle, sometimes pulling back allows you to move forward more easily.
[37:39] Also just being cranky. It sounds silly, but being cranky signals that my system is on emotional and physical overload. Not normal soreness would also be: my joints ache. Normal soreness is usually going to be in your muscles — in the belly of the muscle, not down at the elbow or up at the shoulder. That kind of soreness means your joints are taking more of the load, and you may feel it more directly after training rather than 24 to 48 hours later. That's joint soreness, and it means you're pushing things.
[38:14] Some of my more average-mobility folks who are training flexibility and contortion may have this as they're making progress. But my hypermobile folks are much more likely to have deep joint soreness and repeated deep joint soreness, even when they're approaching fatigue — either because they're approaching end range or they're just tired from training or from life. They're not able to support their joints, and they start getting that joint-area soreness.
[39:00] Some of my hypermobile folks — not all — if we make small changes to their training program, have big reactions. They might say, okay, I added this one exercise and I crashed hard. Not a little more tired — exhausted, wiped out. And all we did was add leg lifts, for example. For a hypermobile body, that might be normal, because it's going to send the nervous system into a bit of fight-or-flight overload, trying to figure that out. That can be overwhelming for the neurological system. Of my patient population, that's probably about 10% of my hypermobile folks who really have that big reaction to changes in exercise.
[40:19] So normal soreness: 24 to 48 hours, kicks in, 72 hours it's gone, and it's happening infrequently. Soreness that comes immediately after training, soreness that's more focused in the joints, or soreness that's constantly present — that's a yellow flag for me. If that's been going on for a while, we start asking deeper questions.

[40:43] Dr. Linda Bluestein: And you mentioned yellow flags. What are some red flags that make you think this person may have a connective tissue disorder or something else going on?

[40:58] Dr. Emily Scherb: Red flags are a hard no-go — I really reserve that for more extreme things. A lot of those yellow flags are going to suggest there might be a connective tissue component. If we catch those yellow flags, we're hopefully going to support this person and get them help for whatever is going on — maybe it's unrelated, maybe it's an iron deficiency. But if that's happening, something's going on in the body and either their training, nutrition, or whole self needs to be addressed. So those yellow flags are when you should be reaching out to someone to have a conversation — ideally someone familiar with what you do with your body, and ideally familiar with hypermobility if you suspect that's involved.
[42:17] Red flags — we're talking bigger things. Maybe you're having difficulty with changes of position. Maybe you're getting heart rate spikes, some of those POTS symptoms. Circus involves a lot of rapid changes of position, and that is a lot to handle with exertion. Pain during activity — not soreness, but actual pain: ow, that hurts. That's not a red flag in the sense of stopping circus forever, but it's a red flag meaning you need to seek care. Pain is something you can mention to your instructor, but if they can't clearly explain why it's supposed to happen there, that's when you go seek care.

[43:15] Dr. Linda Bluestein: Okay. And we know that circus performers live with a lot of risk, at least in many types of circus. How does that affect the nervous system?

[43:27] Dr. Emily Scherb: What a great question. I'll try to answer it, though I'm certain there's probably someone who's better at this than I am. I'll talk about it cognitively and behaviorally, because that's really where I see it play out.
From the outside, circus looks like massive risk. But inside, there's progression, there are drills, there are stepwise steps to get you there — good training and good coaching. From the inside, you're slowly building confidence and skill, and the perception of risk really changes. Flying trapeze, for example — terrifying at first. You're 30 feet up in the air, swinging back and forth, with just a net beneath you, dangling from your arms. That's insane. But as you do it, you realize the strength and control you have. You understand how it feels in your body, where the pendulum lands you, how to control the different aspects, where your failure points are, when it's safe to let go, and how to land safely.
Or take a handstand. When you're an adult turning upside down for the first time, it is terrifying. One of the most risky, brave, amazing things I've ever seen was a 75-year-old learning to do a forward roll for the first time in their life. I was gobsmacked. Your vestibular system, you're turning upside down, you're rolling, you don't have that innate understanding of how that's going to work in your body. You may have fear from a history of injuries. You are a rockstar. But a 6-year-old doing a forward roll — we don't think of that as scary. Your perception of risk really changes.
With a handstand, turning upside down is scary at first, but then you learn the baby steps. You can put your hands on the ground and keep your feet on the ground. You can walk your feet up onto something. Oh, my hands can hold me. As I gain more strength, I can do it with a little less stability. Then I'll learn how to twist out of a handstand to land on my feet, step back down, roll out of it. There are ways of getting out of the handstand that make the risk of being upside down less and less. We are actually conditioning our nervous system to be bigger and braver and do more things as we learn that we can control it.
[46:49] So I think of circus as this great resilience tool. It builds not only physical resilience as you gain strength, but mental resilience as you gain skills. There is some research out there on the psychology of circus, and it's really cool because it does talk about that resilience you can build through circus. People who've been doing circus longer tend to have more of this mental resilience, and it may be because of this understanding of risk, this progression, and those little successes that add up to big successes.

[47:23] Dr. Linda Bluestein: I love that example because when I was young I would do cartwheels, handstands, forward rolls, backbends, all sorts of gymnastics-type things. And you don't think anything of it. But when you were describing that 75-year-old, I had a visceral reaction — oh my God, I'm not 75, but whoa, that's very interesting.
[47:57] What about central sensitization? Do you see that very often in performers?

[48:02] Dr. Emily Scherb: It depends — I know, I know. I do see it. I don't know if I see it more or less than in the general population. It really does depend on their movement and movement history and their nervous system reaction to things.

[48:24] Dr. Linda Bluestein: And probably their injury history and a whole lot of other things. Are there some performers that are actually too good at ignoring danger signals?

[48:37] Dr. Emily Scherb: Oh yes. There are performers who build that risk tolerance, and there are performers who thrive on the risk. And there is a little bit of trying to find the balance between control and letting go to keep themselves safe.
[49:13] So yes, there's the risk tolerance of external danger signals, and then there are the internal danger signals. And our internal danger signals are something that — across the performing arts, but definitely in circus — we have shown repeatedly that circus artists are a little too good at ignoring. To the point where when I talk to my artists, I often won't ask if it hurts when you do that, because it doesn't hurt. It just feels a little different, or it feels weird. What's pain? What's injury? Pain is when I cannot do the thing. It's not often, it hurts when I do this. It's often, I can't do it.
Part of the reason is actually beneficial — pressure on my body is uncomfortable. There's discomfort in circus. I am hanging my whole body weight on my knee, on my elbow. That's pressure. That doesn't feel great, but your brain goes, oh, that's pressure — that's actually holding me up. I can ignore that. That's fine. But then you can start ignoring a sharp sensation when you do a particular thing. That's fine, it's only when I do that. Oh, and now that other thing. And now that other thing. And you keep ignoring it until you're a little too good at ignoring it.
[50:55] So we have that external risk tolerance, the internal sensation awareness, and then where the two meet. Okay, I know I'm past discomfort — it's a little painful. But my performance partner is relying on me and this is tonight's paycheck. So you have those external pressures and internal pressures meeting, especially in our professional performers where you're incentivized in very real, tangible ways to push through.
[51:25] Sometimes there's an internal pressure too — I want to keep up with my class, I want to keep training, I want to do the thing that's fun. Those are real. For my recreational artists, I'm always having that conversation of: where are your values, where do your goals lie, let's talk about the sensations you're having in your body, how risky they are, and what your external pressures are.
[58:18] And then there are our professional performers who say, I can't seek care because I will lose my job. You get good at ignoring that. And when you get to a safe space where you maybe can seek care, you may not have that same awareness of what's going on with your body. So our brains are really good at understanding signals and categorizing them as threat or non-threat. And pain is a production of a lot of different signals in the brain. Understanding what's going on in our body actually takes a little bit of practice to hear those signals.

[58:18] Dr. Linda Bluestein: And like you said, there are so many other factors involved, especially if you are a professional — whether a professional dancer or professional circus artist. People perform through injury; this is a common thing. They'll keep going until they can't anymore. Can we change that? Is there a way to change that culture so that people can speak up and have longer careers? I'm sure it varies a lot — if you're very well-known and well-respected at a high level, maybe you can speak up more easily because you have an understudy. But if you're trying to make a name for yourself, that's maybe harder. What do you think people can do — whether they're the artist or the management — to create a safer culture?

[58:18] Dr. Emily Scherb: I think this is actually currently changing in circus, which is wonderful, at least partially. There has been a shift in the last decade or so where companies have been learning that they're able to keep their performers on the road more easily if they provide care for them. There is a little bit of a tug of war with that — yes, they provide care, but do the artists feel safe in their jobs seeking that care? Some of that is company culture. Some of that is performer culture. Especially our older performers who haven't had access before may think: I can seek care while I'm on the road, but what if that's taken into consideration when I come up for contract renewal? Like they're going to see me as physically weaker and more likely to get injured and be off the show.
[58:18] Our younger performers, if they're coming up through circus schools that have clinical care onsite — which some do now — or if they're used to having companies with care, they're more willing if they have a relationship with the provider. That takes a little bit of time. But if they can get to a place where they're comfortable with the provider, they're more likely to say, oh my gosh, I have an opportunity to get care for that thing I've been ignoring while training because I didn't have the funds to pay for it.
[58:18] So there's a big melange of cultural shift happening in circus, where more companies are providing care or helping folks access care because it probably actually helps their bottom line.
[58:18] There was a circus school — this is about 10 years out of date, which is why I'm comfortable telling this story — that had a physical therapist on staff. All the students ran to the physical therapist and got care. And the circus school said: well, we never had this many injuries before we had a physical therapist. We should get rid of the physical therapist.

[58:18] Dr. Linda Bluestein: Oh no.

[58:18] Dr. Emily Scherb: Because before, they'd send students out to get care in the community, which creates a bigger barrier. So it wasn't that the physical therapist's presence was causing more injuries — it was that they now had access to care. That's the kind of culture I'm talking about. We're realizing that what we're doing is hard on the body — not necessarily injurious, but it needs maintenance. Especially in the training phase where, as I said, folks get more injured. There's more education that has to happen in that training phase about how do you maintain, what is training load, how do we make sure bodies are getting what they need, and is this actual soreness or injury? And that relationship building with providers.
There are a couple of ways we can influence this process and push it further. One is something I am truly passionate about: creating more providers who speak circus. Who have knowledge about the vocabulary of circus, the movements of circus, maybe do it themselves — though they don't have to. The more providers who normalize caregiving and have ways of keeping people active in their sport, the more it becomes: I'm seeking care and it's enhancing my training and making me better — rather than I'm seeking care therefore I have to stop performing right now.
[58:18] I think circus instructors and coaches, especially in that training stage, should be normalizing seeking care. So some of it is: did you know this resource exists? And then on the professional side, it's dollars. Unlike in the dance world, where principal dancers are well-known names and probably a little more supported, that's less common in circus. The general public isn't really aware of individual circus artists — they just see spectacle. So circus artists really do feel replaceable. There is a lot of pressure to stay in.
[59:00] Companies are still looking at: okay, you got injured, we'll work with you to get you back because that helps our bottom line. But if you stay injured too long, if you get injured again — they won't say that's what their decision-making process is based on because they might not even know it is, but there's at least some subtle thought of: this person is a financial risk. That is business. So the professional world's a little tougher. But if we normalize getting care earlier, other than those bigger catastrophic injuries — which happen in circus, and happen in real life — normalizing care throughout the entire process helps. And of course, healthcare systems and having access to care both financially and physically. Having providers available and financial access to care, which is always a challenge. Both of those are how we get better care and keep our artists less injured and performing longer.

[1:00:14] Dr. Linda Bluestein: Totally agree. I want to ask about contortion specifically because I see it on social media and it just looks so painful, and/or I wonder — is this going to be a big problem for this person's spine later on? How do you know if it's safe to be doing contortion, or who can do contortion safely? And like you said, you could get hit by a bus tomorrow, you can step off a curb and get hurt. All of these things involve a certain amount of risk-benefit ratio. So if you're somebody who wants to do contortion, tell me your thoughts.

[1:01:03] Dr. Emily Scherb: Contortion comes down to: do you want to do it, and how much time are you willing to put in? It's hard. People look at contortion and think, oh, those are just bendy bodies moving through space. No — contortion is incredibly difficult and takes a huge amount of strength through the full range of motion to be done well. So it's a lot of time, a lot of effort, and a lot of strength training. And that's what makes it, in my mind, relatively safe when done in that manner — because you're building the strength.
[1:01:41] We will see spinal changes that come with contortion. There's a flattening of the S-curve of the spine. Normally the spine has that swoopy back-and-forth curve — a little rounder in the upper back, a little more concave in the lower back, and the cervical spine follows suit. As people train contortion, their spines will straighten out, which is something I see in a hypermobile population a little bit anyway. But in contortionists, we have documented that. Sometimes the curves will actually start to reverse and go the other way a little bit. So there are bony changes. We'll see different stress responses — just like we see in metal workers or glassblowers, whose hands may have a little more wear and tear. So we may see a little more wear and tear in the spine, in the hips, things like that.
[1:02:33] But otherwise it's not unsafe. It just takes a lot of training and a lot of strength. The problems tend to come as folks age and they aren't able to maintain that strength, but they still have a lot of that joint mobility. So it's a commitment. I think of contortion as a lifelong commitment to strength training, whatever that means to you. It's not something you do lightly or flop into. It's something you commit to and train for.

[1:03:12] Dr. Linda Bluestein: And when it comes to social media — it's so different from when I was growing up. We didn't have social media, people weren't taking photos and videos and putting them online. I worry about what people are seeing, because often they're seeing static images and thinking, wow, this person is doing this amazing thing — but they might not actually be moving that well. Maybe they can get into these crazy bendy positions but they're really struggling to build that strength. What do you worry about?

[1:03:53] Dr. Emily Scherb: Social media keeps me up at night. I do worry about it. With social media and with competitions — and I say that with a little bit of hesitancy because I think there's a lot of good that comes from competitions too — what are we scoring people on? Whether we're judging them by likes and follows on social media or by scores in competitions, I feel like we're pushing extremes. It's easier to judge how far your feet go over your head, or how big a skill is. And it's harder to judge artistry. It's harder to judge on the things that I think really push an art form forward.
[1:04:39] As a performing artist, that makes my heart concerned. I want to see the artistry. Sometimes I can watch someone walk across the stage and it's amazing. I remember a circus act where they were doing something called Cyr Wheel — which is basically a human-sized hula hoop — and they never once got in it. They just rolled it across the stage and it was just so cool. I didn't realize they hadn't done anything in it until after the whole thing was over. And I don't think social media or competitions can glamorize that. It's very hard to judge on that the way most things are structured.
[1:05:24] I think it pushes human capacity and limits further and further. But it also encourages people who aren't prepared to attempt things. We don't know what that person did to get ready for that moment. Is it 2 hours of warmup and 10 years of training? Or is it: I flopped into this, I can't control it, I just did it for the photo? We can't tell.
What we're really talking about is changing societal values and changing how we look at the world. I'm not sure where it's going to go from here. But I also think there's a lot of good that can come out of social media — a lot of knowledge sharing. So it's a toughie. And for every individual listening to this, especially if you're a bendy human, it's taking that control and that strength through your range and not prioritizing the cool trick, but prioritizing the longevity of doing that skill.

[1:06:31] Dr. Linda Bluestein: Right. The longevity. That's what I really want people to be thinking about. So there are probably a lot of parents of young artists — young dancers, young circus performers, young aerialists, young acrobats — who know that their child is bendy. What's the single most important thing you want that parent to know?

[1:07:05] Dr. Emily Scherb: Strength, strength, strength, strength. And if you can have a conversation with their coach, instructor, or teacher to look out for some of those hypermobility things — in circus, dance, and gymnastics, they're kind of used to seeing it. Help educate them, or ideally they already have the education. Hey, they're doing a handstand but their elbows are really hyperextended — can we gain a little strength or control there? Because it's going to help their wrists have longevity. It's going to help their shoulders have longevity.
[1:07:45] Noticing the things you can see from the outside so you can start getting them stronger to do everything else — that's how the longevity stays. Hyperextended elbows, hyperextended knees — use them when you're doing leaps, when you're in the air, when there's not pressure on those joints. That can create a really beautiful line. But when it's in weight-bearing, it needs to learn control through that full range. Control through the full range using strength — that's how longevity is maintained. That's how you make the most out of a bendy body, whether you want to put your foot behind your head or walk across the street.

[1:08:35] Dr. Linda Bluestein: I love that. Having control and strength through the full range, whether you want to walk across the street or put your foot behind your head. Everybody's priorities are different, and that's great. So as you probably know, we end every episode with a hypermobility hack. Do you have a hack for us? Maybe a small shift that can improve how people relate to their bodies, something you wish hypermobile people understood earlier, or another tip for parents or coaches?

[1:09:10] Dr. Emily Scherb: I think movement is magic. It is one of the most important things we do. So if you're having an achy day, if you're having body pain, if you're having a low-mood day — move. I don't care if that's rolling around on the floor. Maybe it's going for a walk. Maybe it's doing circus. But movement can make you feel better. It can lubricate your joints. It can get your tissues feeling happy.

[1:09:42] Dr. Linda Bluestein: I love that, because it can be very challenging if you have hypermobility and especially if you have a lot of aches and pains — everything you do seems to make things hurt worse. So you start moving less and less, and then things start hurting more and more. It can be really hard to figure out how to find that sweet spot of movement. But if you want to be able to move, you have to move.

[1:10:04] Dr. Emily Scherb: And sometimes it's as simple as laying on your bed or on the floor and pointing and flexing your feet, and that's going to rock your body on the ground and just stimulate the system a little bit. Sometimes it can be as small as that. My hack is: move, move, move — move little, move big, but move often.

[1:10:25] Dr. Linda Bluestein: Love it. Can you tell us a little more, before we wrap up, about any special projects you might be doing, any research you're involved with, and where people can learn more about you?

[1:10:39] Dr. Emily Scherb: Absolutely. The easiest is probably where you can learn more about me. I am The Circus Doc on most social media platforms. And you can go to thecircusdoc.com to see all the different things I'm involved in — a lot of educational activities for both clinicians and for movers and coaches, talking about how circus bodies work on the ground and in the air. I also host a symposium and speaker series where I bring in specialists and researchers to talk about the amazing work they're doing, with the goal of getting research and knowledge disseminated into the population faster. The average uptake time of research to practice is 16 years, and if we can shorten that gap, we can help a lot of people. I also do a lot of research translation through my newsletter. If you're interested in circus research and body research, please join my newsletter — again, you can do that at The Circus Doc. And my own research: I'm involved in a couple of projects right now, including some things on shoulder strength testing for return to circus.

[1:11:57] Dr. Linda Bluestein: Lots of things. And you were kind enough to invite me and Dr. Brooke Winder to your last speaker series, which is what led me to point people back to that old interview with Dr. Scherb — and then I realized, wow, that's 6 years ago, we need an updated conversation. So thank you so much.

[1:12:20] Dr. Emily Scherb: I always love getting to sit down and chat with you.

[1:12:23] Dr. Linda Bluestein: This is great. And I feel like clinicians understanding circus and what circus artists do is something that can really help so many people. We have so many sports medicine doctors for other types of athletes. Being able to offer that same kind of care to circus performers — and we have dance medicine for dancers, of course — but circus medicine, I'm so excited to see that field growing and expanding, and you're such a big part of that. So thank you so much for all the work that you do and for coming on the Bendy Bodies Podcast today.

[1:13:01] Dr. Emily Scherb: Thank you so much for hosting me. It's always a delightful conversation, and talking about hypermobility is one of my favorites.

[1:13:14] Dr. Linda Bluestein: 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 and enjoy the rest of the episode.
[1:13:26] Thank you 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 at bendybodies.com/newsletter, or find on Substack at hypermobilitymd.substack.com.
[1:13:39] 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 these conditions that are still widely misunderstood.
[1:13:58] Full video episodes are available every week on YouTube at Bendy Bodies Podcast. As many of you know, my passion is helping people better understand and navigate symptomatic joint hypermobility. In addition to my clinical and educational work, I offer one-on-one coaching, professional mentorship for healthcare professionals, and expert witness services. If you'd like to learn more, please visit the services page at hypermobilitymd.com.
[1:14:22] You can find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, X, and LinkedIn, all at Hypermobility MD.
[1:15:01] We love bringing on guests with unique perspectives to share. However, these unscripted discussions do not necessarily reflect my views or opinions. Furthermore, perspectives expressed within Bendy Bodies media, including this podcast, do not reflect the views or opinions held by Human Content Inc. Although we may share healthcare perspectives on this podcast, no statements made on Bendy Bodies should be considered medical advice. Listening to or watching this podcast does not constitute a doctor-patient relationship. Please always consult a qualified healthcare provider regarding your own care.
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