Preparing for Competitions: A Round Table with Kristin Koskinen RDN, Linda Bluestein MD, and Jennifer Milner NCPT

[00:35] Kristin Koskinen, RDN: I think at the end of the day, what we're talking about here — as we talk about competitions and being ready for these long, long-haul events — is that preparation is so important. Whether we're preparing our foods, whether we're preparing by calling ahead and making sure hotels have a refrigerator in them, whether we're preparing by getting enough sleep, by training correctly, preparation will do so much to get us ready for those competitions.
[00:59] And then when we're in the competition phase, we've all been talking about how much it's about maintenance — really trying to maintain our energy levels, really trying to maintain our stamina, trying not to overdo things where we can, and being as smart and efficient as we can during it. And then afterwards, give ourselves the rest that we need. Make sure we're eating those nourishing foods to rebuild our bodies. Make sure we're taking that time to sleep, making sure we're taking time off from the dance so that we can really give ourselves the recovery time that we need.
[01:26] So we have to look at it not just in that isolated pulling those 2 or 3 days out. We have to look at the beginning and at the middle and at the end of it in order to have a really successful competition or event weekend.
[01:55] Welcome back to the Bendy Bodies Podcast — the podcast where we speak with experts bringing you state-of-the-art information to help you improve your well-being, enhance your performance, and optimize career longevity. This is co-host Jennifer Milner here with the Hypermobility MD, Dr. Linda Bluestein.

[02:12] Dr. Linda Bluestein: We are so glad you are here to learn tips to help you self-manage your conditions and live your best bendy life. This information is for educational purposes only and is not a substitute for medical advice.

[02:24] Jennifer Milner, NCPT: I'm Jennifer Milner, a former professional ballet and Broadway dancer, and I struggled my whole career with hypermobility-related issues and injuries. Now I train dancers and want to make sure the next generation of hypermobile artists are better equipped to work to their fullest potential.

[02:41] Dr. Linda Bluestein: I'm Dr. Linda Bluestein, and I started Bendy Bodies as my second podcast to educate the hypermobile community. Despite being a physician, I experienced decades of symptoms before being finally diagnosed with hypermobile EDS, and I too have been gaslit and felt completely alone in my journey.

[02:58] Jennifer Milner, NCPT: For today's podcast, we are deviating from our usual style a bit and doing a roundtable conversation with Bendy Bodies' own team member Kristin Koskinen, founder of Eat Well Pros and registered dietitian nutritionist. Hey, Kristin, welcome back to Bendy Bodies.

[03:13] Kristin Koskinen, RDN: Thank you. It's always good to be with you too.

[03:16] Dr. Linda Bluestein: We love chatting with you.

[03:18] Jennifer Milner, NCPT: Yes, we do. Honestly, I'm not sure how this conversation is going to devolve into just sort of a free-for-all with the three of us, but everybody just stick with us. Kristin, before we dive into our topic, can you tell the listeners who may be new to you a little bit about yourself?

[03:35] Kristin Koskinen, RDN: Sure. My name is Kristin Koskinen. I'm a registered dietitian nutritionist. I work with dancers and hypermobile people to find best solutions for their performance and health needs, and I'm delighted to be part of the Bendy Bodies team.

[03:50] Jennifer Milner, NCPT: Excellent. You always have so much wisdom to offer us on nutrition and how people can fuel their bodies, and simple steps that we can take to live our best hypermobile lives. So today we want to talk about competitions and how to sort of prepare for them and get through them — not just barely by the skin of our teeth, but in as healthy a way as possible.
[04:11] I often get questions on how to prepare for competitions, and I know Kristin is constantly asked for tips on how to get through those long days. Kristin posts really great information on her Instagram account, kristin_koskinen_rdn — just throwing that out there now, although I'm sure we will talk about it later as well. She's always posting great information on how to get through those long days. And Dr. Bluestein is also asked about pain management and how to be ready for stress on the body. So we just thought we would put our heads together and share our combined expertise on this topic all in one big discussion.
[04:46] Hopefully this information will be helpful whether you're heading into a big convention weekend, you're going to be doing a long ballet competition, a cheer competition weekend, or even the Olympics — even though I know it's not the Olympics, but you might be listening in an Olympics year. So we are here to talk about preparing for that long haul and what it takes to get through an intense few days.
[05:09] Before we dig in, Dr. Bluestein, why might people with hypermobility disorders need to do a bit more planning and preparation for a long competition weekend?

[05:18] Dr. Linda Bluestein: I think the big thing is that a lot of people who are walking around with symptomatic joint hypermobility might be dealing with a wide array of symptoms that are not optimally controlled. They might be dealing with pain, they might be dealing with orthostatic intolerance — so they have difficulty with upright posture, and when they go from sitting to standing, they get dizzy — and they might have GI symptoms, which I'm sure Kristin's going to talk about.
[05:43] So anything that they can optimize would be really, really helpful before competition. If they've noticed that they get injured more easily or they recover more slowly, you definitely want to pay attention to those things. You want to get everything as optimal as possible — really focus on your technique, your sleep, and all of the variables that you can possibly get under control.

[06:05] Jennifer Milner, NCPT: That is right. We all should be doing that, but when we're talking about people with hypermobility disorders, there are people out there with a wide variety of symptoms that are not being well controlled. So it's great to try to get those under control before going into what is going to be a really stressful time on the body.
[06:26] And if we are going to talk about any kind of competition or intense weekend, we have to start with the time before the time. This means that if you first start thinking about how to get through your competition the night before the kickoff, then you're already behind. So when should artistic athletes first start thinking and planning for a competition? Kristin, let's start with you. At what point should someone plan their fueling — not just for daily needs, but for an upcoming competition?

[06:57] Dr. Linda Bluestein: Right.

[07:00] Kristin Koskinen, RDN: A month in advance isn't too soon, for a number of reasons. First, we want to pull the lens way back. The first thing I want to know is where's the competition? Because if you're going to be changing time zones, we want to take that into consideration. If you have travel, we need to look at that. If your competition's in your hometown or a short way away, that makes things a bit different.
[07:26] If you're going to be traveling and possibly crossing a time zone, a month in advance isn't too far out. And if you're consistently competing, this should be part of your repertoire — it's not a tag-along. This should be built in. So I'm going to speak as if you're traveling and may be crossing a time zone.
[07:43] The first thing we want to look at is what are you going to be doing to prepare for that destination. You may need to scout things out and know what's available to you there, and that can take some time. So in that time frame, it's about having time to plan for practical matters — where can you get food, what are your accommodations going to be like, do you need to drive to get things, is there anything near the venue where you're going to be performing. That's all on one level.
[08:11] And then there's the idea of preparing your body. The nice thing is bodies are adaptable. You can start to do things to prepare yourself — to eat and drink — so that your body's ready. We want to know what works for you. If we know what works for you, we don't need to worry about what doesn't, because we know what does work and we want to stick with those things. That can take some time to figure out. You may try things and they work. You may try things and they don't work so well. So having some time to figure those things out is great, and after you've done it once, it takes less time for subsequent events. But a month I think is good — maybe more.

[08:54] Jennifer Milner, NCPT: And that's true, because it's not like you're going to eat one bowl of spinach and become Popeye. We can't expect that instant reaction from superfoods. How might someone change their intake in order to be more well-prepared for the weekend? Might they try to up certain nutrients to have them already stored in their body? Might they change their carb to protein to fat ratio? Or might they just try to continue doing whatever is optimum for them?

[09:24] Kristin Koskinen, RDN: Hopefully we're doing all these things to optimize nutrition all the time. Your nutrition will impact your training, and better training means better performance. So these are things that you want to have in motion all the time — that's part of the long game with your nutrition strategies.
[09:39] As you get closer to the time, you really need to look at your training and rehearsal schedule. If you notice that you're in the studio more, or if it coincides with work, holiday, or school changes where you have more stressors on board, those are things to address. Stress — whether physical or emotional — can increase the demand for certain nutrients, including magnesium, sodium, vitamin C, and B vitamins. So we want to be mindful of those things and make sure you're getting enough in advance of your performance.
We know that when you get to competition, things may not be ideal, and we're going to do the best with what we have. So in that time leading up to it, it's not about being perfectionistic about your eating, but recognizing whether there are things you need to pay particular attention to so that when you get to that competition, you don't have a gap. Nutrients of focus would definitely be vitamin C, sodium, magnesium, B vitamins — and there are others, like zinc and vitamin D. It's all of them, but those are some that stress hits hard.

[10:49] Jennifer Milner, NCPT: Absolutely. Let's move to our non-fueling preparation. Dr. Bluestein, are there steps that people can take in advance of a grueling few days to better handle the physical challenges?

[11:00] Dr. Linda Bluestein: One of the things that I think is most challenging for dancers particularly — and other performers who may often be rehearsing late in the day, or especially when they go to a competition and have really long days — is sleep. Our bodies are designed to be asleep when it's dark outside and awake when it's light outside. The circadian clock controls everything in the body, all of our hormones, and our body functions optimally when we are able to follow a circadian rhythm — getting up every day at the same time, going to bed every day at the same time, getting good quality deep sleep.
[11:37] We also know that injuries are related to fatigue. The more fatigued you are, the more sleep deprived you are, the more likely you are to get injured. And you're also going to heal better from injuries if you get more rest, because sleep is truly restorative. In order to heal optimally, you really need good sleep.
[11:56] This is where it's so challenging when you're at a competition and you're dancing for 14-hour days. Dancers are so often dancing late into the day, and then they come home and have something to eat. By the time they get to bed, it can be later than would be ideal — because you also don't want to eat and then go right to bed. If I were in charge of competitions, I would definitely have the days shorter — probably a lot shorter — so that people could get more rest. What often happens is people run on adrenaline and get through the weekend, but then they crash. Things that happen after you crash — you realize you really are injured. At the time, you're so distracted. You're aware of the pain maybe, but you're able to push it back into the background, and you're not fully aware of how injured you are until afterwards when those endorphins go back down. You can get headaches, and you realize just how much pain you're in.
[13:06] Also, your immune system can really take a hit when you are pushing your body that hard. You're not sleeping, you're focusing on external factors. Competition, of course, involves being judged externally. And so one of the things I really work with dancers on is listening to internal cues — really paying attention to what your body is trying to tell you. Is that pain sensation trying to tell you that you need to work on your technique? Is there some nagging injury, and if you modify your technique, maybe those tissues won't be under so much strain? And I'm sure Jen is going to talk about this later — technique and things that you can do in that regard.
[13:46] I think one of the best skills that dancers and other athletes can acquire is really listening to the body with the right ear — not right as opposed to left, but the correct ear — so that you can interpret those bodily signals appropriately. We can really learn from previous experiences as well. If in the past you had some discomfort and then after a competition you were really injured and it took a while to recover, try to learn from that. Don't get into the anxiety part of it, but be analytic and think: what is my body trying to tell me? Is this potentially serious, or is this more minor?
One last thing on this — I see people at competitions come out, ice something, and then go right back in. That makes me crazy, because you can't feel that part of your body, and it's cold and stiff and you're more likely to get injured. So don't just cover up the pain. Don't live on nonsteroidal anti-inflammatories all weekend. Don't live on acetaminophen all weekend. Don't live on ice all weekend, because those things just cover up the pain and don't actually get to the root cause or help prevent injury.

[15:05] Jennifer Milner, NCPT: A whole bunch of people just said, "I don't want to listen to this anymore." I have been to so many conventions and competitions where there's literally an ice station and the dancers just keep coming by to grab them and throw them on their bodies. And they say, "If I can't take anti-inflammatories, how am I going to get through the weekend?" Never fear — we are going to talk about that. But right now we are talking about what you can do before the competition.
[15:33] As you said, it's so important to learn to listen to your body, and you have to develop that before the competition. You've got to develop that inner ear to be able to sense what's going on and make those judgment calls. Now it's time to go see the PT. Now it's time to ease back on my workout. Now it's time to get that technique checked out. That's a great thing we often miss when thinking about how to get ready for a competition — learning to listen to yourself and judge what you need.

[16:02] Dr. Linda Bluestein: Yeah, and ice isn't always a bad thing. Lots of athletes use it, and when we get injured, we get inflammation, and inflammation isn't a bad thing either — it can help heal an injury. Everything in moderation. Jen, I'm really curious to know: when do you start working with a client on preparing for a competition?

[16:27] Jennifer Milner, NCPT: Honestly, months ahead of time. I consider August and September to be the start of our season. When we first start that season, we do a complete new discussion — no matter how many years they've been with me. What are your goals? Let's look at your body. What are you feeling? What do you wish you were doing better? What are you proud of? And then we sit down and look at the season they have. We know YAGP submissions are going to be due this month, the pre-competition will be this month, audition season is going to be January, which means reels need to be ready by a certain date. So we're really looking at that whole season and what we need to be ready for.
[17:09] Most dancers start working on their variations and solos months ahead of time. If they start in August or September, I get to know — are you doing the Raymonda Dream variation? Are you doing Laurencia? Are you doing Gamzatti? That will definitely affect how I train them. Do I need to train them for those big buoyant jumps? Do I need to train them for slow adagio? Are you doing Giselle? We need to work that standing leg. So we'll start looking at it months ahead of time.
[17:43] A big part of what I do is teach them how to work through their own schedule. We talk about periodization — how we're going to start digging in and pushing harder early in the stage, and then hit that point where we're really just trying to maintain. So if a competition is in January, we're not busting our tushies in December. We ease back on that throttle — partly because it's Nutcracker — and we say, let's look at the whole month of January. Where can you take a few days off? Which is really hard for dancers, but where can you get one or two days in a row to really let your body rest? As we get close to that competition, we're going to do sessions that are more like dynamic stretching and release sessions rather than "let's work your core really hard."
[18:31] So we really look at that overall arc and try to first get exercises that will complement the choreography they're doing, and then talk about when to push and when to ease back. When I see technical things come up — if we're working on Gamzatti and I see that her landings aren't great, and then she tells me her calf is really bothering her — I'll make sure she gets into the PT, gets some work done on her calf, and then we'll work on technique and ask, well, what are you using instead? Where are you landing from that you shouldn't be?
[19:05] So it all fits together, but ideally it's going to be months ahead of time. We're also going to talk about preparing a warm-up for that day — a 20 to 30 minute warm-up outside of just a dance class that targets the things she needs to target. So she'll have it in her pocket ready to go. If it's a guy doing Basilio, then we know he's going to be ready with a nice loose spine and ready to do those fancy turns and all the big bravado that goes with it, because he's got a warm-up that has worked for him.
[19:45] So we really want to make sure we have as much time as possible to prepare for these competitions. We all have a bit of different input on how to get ready, but we all agree — you have to get ready, and there has to be time spent getting ready.
[20:01] So we're going to pretend that everybody has taken our advice, has gotten an amazing amount of sleep, has eaten an optimum variety of nutrients, has worked with their trainer, and has prepared as best they can — and the competition is finally here. Kristin, do you suggest eating differently the morning of a competition? Do you say eat a big breakfast because who knows when you're going to eat again? Do you say go light? What do you usually say? Because I know this is something that stresses a lot of people out.

[20:35] Kristin Koskinen, RDN: It's going to depend. And that's always the answer.

[20:38] Jennifer Milner, NCPT: This is what I love about you.

[20:39] Kristin Koskinen, RDN: It's always the answer.

Dr. Linda Bluestein: So then we reel it back again.

[20:40] Kristin Koskinen, RDN: So ideally, when you're preparing, you need to know what the hours are. A lot of times people have a general idea of the time frame they're performing, and when we know that, we can start dialing in. This ties back to what I mentioned before — the body is adaptable. So we don't want to change anything when we get to performance or competition. We've already figured it out by then, and we want to do everything as close to what we've done at home as possible.
[21:14] As a dancer, for the most part, we can control the bookends of meals — breakfast and dinner. They're bookends because you can eat early enough and late enough that you can manage them. They're not necessarily ideal sometimes, and we have to work around sleep and those kinds of things, but for the most part, the schedule is less likely to interrupt those if we're conscientious. So that means that well in advance of getting there, you need to have practiced eating breakfast.
[21:58] So many dancers say, "Oh, but I'm not hungry in the morning and I don't like to eat in the morning." I get it. And I'm not saying breakfast is the most important meal of the day. What I am saying is that when the bulk of the hours of the day have limited availability for nutrition and hydration, we have to control what we can control. That's where those times tend to come in. If you are accustomed to eating breakfast at 6:30 or 7 AM, it can be helpful. When you have later nights, that may not always be the case, and that's okay — that's something we work with.
[22:41] When you're at your competition, generally speaking, you want to do something similar to what you do at home. You want to eat foods that feel familiar, and this rolls back to that scouting activity. If you're traveling — and I'm going to act as if you're traveling, because that's where people get really stressed out — the first thing I have my dancers do is find out where the venue is. Then we look at a map and see what's available. Do you have grocery stores, mini-marts, Target? Is there food in the hotel? Do you have a refrigerator in your hotel room? These are some of the basics we want to cover, because that may even determine when you fly in. Some people want to fly in a day early to get things in place.
[23:26] If there are restaurants you may be frequenting, ideally try those out at home first. People are sometimes surprised to hear me recommend McDonald's, but McDonald's is consistent. If you have McDonald's in Dallas, Tampa, Seattle, or Denver, you're going to get a very similar product. If you're accustomed to it and your body is used to it, you're going to be in good shape. An Egg McMuffin and an orange juice can be a really good option, and it's pretty consistent and widely available.
[24:05] For some people that feels too risky or doesn't meet their needs, so you may need to have shopped ahead and have things in the mini fridge in your room. But you have to call your hotel and make sure there is a mini fridge, and if it comes stocked, ask whether you'll be penalized for pulling things out. Some people will get a cooler or even travel with one — checking it as luggage — so that when they get there, they have what works for them. Minimizing that stress can be important.
[24:31] Things you can have for breakfast — anything works, really. Some people just feel more comfortable with traditional breakfast foods. Easy things to get include pre-peeled hard-boiled eggs, English muffins, various bread options, yogurt. Just make sure you've tried it at home first.
[24:50] Should you eat a lot or a little? That's going to depend. What are you performing? Do you have an adjudication class early on? Do you have a nervous stomach? If you have a nervous stomach, you may lose your breakfast if someone's pushing, "You have to eat, you have to eat." Don't do that. Let's see what we can do instead. Again, try things at home to see what you tolerate.
[25:13] For some people, they don't tolerate anything at all, and that's not ideal. This is where sports drinks can come in really handy. Find one you like, find one that's readily available or that you can pack with you. Powders that you can pack in your bag and add to your water bottle are good. I like the ones with sugar — it'll give you some energy in the morning if that's all you can tolerate.
Another option if you really struggle is to swish and spit — and then brush, because you'll need to brush your teeth anyway. This is not optimal for dental hygiene, but it can be enough to give your body a little lift if you need it. This is for people who really struggle with high anxiety prior to performing.
[26:00] Other things that also address hydration: blended foods or drinks. Chocolate milk if that works for you, boxed smoothie drinks, yogurt — which you can turn into a parfait, or grab a parfait from the hotel breakfast area. Applesauce pouches and veggie pouches can be really handy and easy on a lot of people's stomachs. Jell-O is really easy, it provides some liquid and some sugar. I'm not wild about the dyes in it, but sometimes we need to think about the here and now. You can travel with it, pack it in your dance bag.
Some clients make protein bars and muffins and protein balls that they know their body likes. They will make them in advance and pack them — whether in their carry-on or checked baggage — so that when they get where they need to be, they have what works for them. I use bento boxes a lot for travel because they bring that sense of home and consistency, and the dancer can use them like a vending machine, picking and choosing what they need in the moment. Fruit is another easy option — if you can get it in the morning and salt it, that's going to help with hydration.
[27:26] So to reel it back to the original question: do what you do at home. You're not at home, but replicate as much as you can from what you do at home. Check your schedule and adapt accordingly. We have a nutrient timing framework where we work things back from performance: the closer we come to training and performance, the more we lean on carbohydrates. The farther away we are, the more we include fat, fiber, and protein, which tend to slow digestion.
[27:54] And if you're shifting time zones — say you're on the West Coast flying to Tampa, so there's a 3-hour difference — you decide: are you going to adapt to a Tampa schedule, or are you going to keep your body on a West Coast schedule and eat accordingly because that's when you feel good? There's a lot to consider and I don't have one answer. I never do. But those are some of the things we work through with dancers.

[28:30] Jennifer Milner, NCPT: I love that. And what you said at the beginning — number one, prepare, and number two, manage the variables — is so great. It's really true that the two meals you have the most control over are breakfast and dinner, or the start and end of the day. Call them whatever you want — eat steak in the morning if that's what you usually have.
And as you said, you want to practice this at home. Train it. See how you feel, see what works for you. You're training yourself fuel-wise just as much as you're training yourself physically. That's really great advice.
[29:16] I know I'm so excited for this next question because I love your answers. Moms of my dancers who go to 3 and 4-day conventions are often like, "We don't know what to do. Our daughters are dancing for 14 hours. They get 15 or 20-minute breaks at most in between each thing, and they're running to put on another costume. There's no refrigeration. We don't know if there's a mini fridge. We don't know how long Grubhub will take — and they don't have time to eat Grubhub anyway. How do I keep this kid eating? What do I do to fuel them?" So — how do you fuel throughout that impossibly long day?

[29:54] Kristin Koskinen, RDN: Okay. And first of all, if you choose to pack Jell-O — no, don't pack red. Don't pack anything with red dye. We're fine with convenience foods because they play an important role, but not red dye. It's going to stain your mouth and could stain all kinds of things. That's a no-no.

[30:10] Jennifer Milner, NCPT: The white tutu.

[30:11] Dr. Linda Bluestein: Yes, the white tutu.

[30:12] Kristin Koskinen, RDN: Yeah, so we're going to stay away from that. One thing the moms can do is take a team approach. If you have a parent who's willing to coordinate, it can sometimes make things easier. Depending on your budget, one person can organize. And it depends — are you driving or flying?
[30:27] If you're able to get there by car, you can pack a cooler and you've got a lot more options. If not, you can even get a cooler when you arrive. Get a relatively inexpensive cooler, and if 3 or 4 families are dividing the cost, it starts to break down to about what you'd spend on Grubhub tips, right? So it's really not that big a deal.
[30:48] Things you can do: we want to test all of these things at home first. And dancers sometimes work better when it's a community thing — when this is what we do, this is part of our preparations, just like Olympians don't wing it. They have a dietitian bringing food and fueling options to them. This is how high-level athletes work — whether it's Division I or Olympic athletes, there are dietitians creating meals for them, having the options ready. You can do that too.
[31:34] Now, I don't expect dance moms to know how to plan all of this, because they've got a lot of other things to do and this isn't their profession — it's mine. But you can consult with someone and we can figure things out and make it pretty easy. We want to have things that we know work, taste good, and are tolerated — meaning they don't make you sick, gassy, or woozy, and they don't give you a peak and crash. Practice these well in advance.
[32:05] Target can be a great option, and there are Targets in most places. If it's big enough to have a competition, it's big enough to have a Target. You can even shop in advance. Things you want to have on hand: pretzels, Goldfish crackers, string cheese. String cheese is actually shelf-stable — people don't know that, but it is. You can think in groups like quick carbs, protein, and hydration foods. These aren't our normal categories when we talk about fueling, but we're going through a short, intense period. This isn't the time for big green leafy salads — you don't have enough bites for that. It takes too long to chew and there's no refrigeration for it. We really need to shift our mindset: what's the goal here? The goal is to keep energy and provide as many nutrients as we reasonably can in a confined space.
[32:59] If you can get a cooler and you're allowed to have one in the venue, that can be really helpful. If you can only have shelf-stable things, that's fine too. Wash fruit ahead of time and bring it in baggies — grapes, oranges, apples, bananas. Most fruits are shelf-stable. Put them in individual baggies so they're easier to grab and go. If you have a room that acts as the team kitchen and kids can go there to grab their things, great. If someone's there to give reminders — "Did you grab your water? Do you have your hydration packet?" — that's helpful.
[33:33] You can make emergency snack kits in advance in sealable bags. One parent can be in charge: "Maddie's dairy intolerant, so we're not putting that in hers, but we have this option for her instead." Pack them up so the kids can eat what feels good to them and have that autonomy. And if a kid needs reminders because they'll just forget to eat — they're too excited — that's okay. Set a timer. If their stomach can't handle solid food, go to a liquid version and minimize the steps. Minimizing chewing can be helpful. Make it tasty, too. That's one of the reasons sports drinks are really effective — they're palatable. Having things that they enjoy is helpful. This doesn't mean sending a vending machine of Oreos and Skittles — that is not going to serve them well.

[34:37] Jennifer Milner, NCPT: "Crappy doodah." That's a technical term.

[34:44] Kristin Koskinen, RDN: But we can find a lot of foods that are tasty and easy to work with. If you've done it in advance, if you've worked it through, then by the time you get there, it's a non-stressor.

[34:53] Dr. Linda Bluestein: Order the food ahead —

[34:55] Kristin Koskinen, RDN: Put in your online order, have it delivered to your hotel, have it ready for pickup so that you're not arriving and spending 2 hours discovering, "Oh, they didn't have what we expected at this particular store." You can do all that. One of the great advantages that came out of quarantine was delivery. Stores do that really easily now, and at Target you can get produce and all kinds of things. And you can pick up your hair gel that you forgot while you're there too.

[35:25] Jennifer Milner, NCPT: And your nail polish remover and anything else that comes up.

[35:31] Kristin Koskinen, RDN: Right.

[35:34] Jennifer Milner, NCPT: I had a competitive cheerleader who said she just existed on Pixie Stix and Red Bull. And I was like, I feel like there's a better way to get through this. So these are great tips. And if anybody wants more information on this, Kristin has created some really incredible posts on shelf-stable snacks and tips for long competition days. Please check her Instagram page for more details. She's got some great information on it.
[36:04] So we're at the competition, we're powering ahead. Dr. Bluestein, what would your suggestions be for people who are worried about a flare or an injury? Are there any tools they can bring with them, just in case?

[36:23] Dr. Linda Bluestein: One of the things that is important to be aware of, just like the listening to the body thing, is where is your autonomic nervous system? We all have — there's actually a connection to the gut — the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is fight, flight, or freeze, and the parasympathetic is rest, digest, and restore.
[36:49] A lot of dancers are perfectionists. We go into competitions wanting everything to go well. If you can, in advance of the competition and then while you're there, learn how to tune into that parasympathetic part of your nervous system. That will help you with digesting your nutrients and help bring yourself back down. We know statistically that a certain amount of anxiety will help your performance, but once you get past that level, your performance actually starts to deteriorate and your risk of injury goes up.
[37:28] So get familiar ahead of time with sensing where your autonomic nervous system is. When Kristin says you feel like you can't eat anything, if you're in sympathetic overdrive — in that fight, flight, or freeze — your stomach is not wanting to accept food. Think about it: if you're running from a saber-toothed tiger, you shouldn't be eating at the same time. You want to be able to tap into that vagal part of your nervous system and calm things down before you go on stage, or when you arrive at the competition and you start seeing all the other dancers and think, "Oh my gosh, they all look so much better than me and I don't think I'm ready for this."
[38:13] You also want to think about pacing like marathon trainers do. They peak their mileage in advance of the marathon — they don't keep running 26 miles right up until race day. So if you have a nagging injury, give it a little bit more rest beforehand. Maybe you were running through your variation 8 or 10 times a day, but in the few days beforehand, ease back. When you're there, go through it mentally, go through it as much as you need to — but not more. Most of the work is done before you get there.
[39:00] Make sure you have your as-needed medications with you. If you have asthma, make sure you have all the inhalers you might need, even if you don't normally need them at home. As Kristin pointed out, if you're traveling, there could be different allergens in the air. Maybe you have allergic rhinitis, eczema — all those mast cell-related things that we know are more common in people with hypermobility. Make sure you have your topicals and your antihistamines. If you take Singulair on a somewhat as-needed basis, have it with you. If you take an H2 antagonist like famotidine, definitely have that.
[39:46] One thing I wanted to mention from what Jen was talking about earlier — the planning and the executive function that goes into all of this. Before we started recording, the three of us were talking about neurodivergency and how common that is in people with bendy bodies. All of this planning might be an extra challenge for dancers and other hypermobile people. Having someone like Jen, or any of us, in their corner can really help with the planning and take care of a certain amount of the work so that they just need to handle the last part of it.
[40:25] And especially since a lot of these kids are under age 25, they still have a huge amount of frontal lobe development ahead of them. Their brains are still evolving — not that they don't evolve throughout our whole life, but those kinds of supports can be really helpful.

[40:40] Jennifer Milner, NCPT: Absolutely. And just as with food, the time to try something is not during the competition. If you've never taken a Benadryl and you're having an allergic reaction at the convention, it's probably not best to pop one there for the first time and find out how it works with you. Again, you want to test things out. If you do have some sort of mast cell disorder, make sure you've got those tools already ready to go and that they're all known quantities. And along with that — if you have a latex allergy, bring your own tape if you think you might need it.

[41:22] Dr. Linda Bluestein: Right. And taping, braces, and sleeves can be very beneficial, especially when you're getting to the competition. If you have some swelling, putting on a compression sleeve can help get that more optimally controlled — and there are so many different types available now. Same thing: try it out ahead of time. See what level of support works best for you, what parts of your body do best with additional support.
That can also help with proprioception. We know that people who are hypermobile are not as good at knowing where their body is in space without looking. And at a competition, you've got all this sensory input — it's overwhelming, you're paying attention to so many things — so you're not going to be as aware of where your body is in space. Every single tool you can have, whether it's tape, a support sleeve, or bracing, can be really helpful. And Jen, I want to know — what do you tell clients to help them get through a long weekend?

[42:33] Jennifer Milner, NCPT: Well, sometimes I tell them not to do it. I feel like there are too many competitions out there sometimes, and people need to learn to pick and choose.
[42:42] But on the topic of picking and choosing — I tell them to pace themselves, first and foremost. If they're doing a big competition or convention weekend, they might be in 4 pieces in half a day, or 10 pieces over the entire day, constantly going from a solo to a trio to group numbers. So I really want them to figure out how to pace themselves. Some of that means preparing beforehand to make sure they have the stamina — not just to get through one number, but to get through a whole day. You might feel great after your first variation, you might feel great after your second, and then if you have your contemporary solo that night, you might think, "I've never done all three in one day." So make sure you know what your stamina needs to be ready for.
[43:34] And then when you're at the convention, you've got to hold yourself back until you're on stage. It's so much fun to run around backstage with your friends, hear a song and think, "I used to dance to this," and go full-out. Or at a ballet competition, when they give you that time on stage or in the practice room for an hour — that's not the time to run through your whole variation 3 or 4 times full out. That's the time to work on your trouble spots, mark through it body-wise, go through it full out with your upper body. If you have 16 fouettés in your variation and you've already done 48 of them in the practice room and on stage because you just want to get them right, by the time you do the next 16 your leg is literally too tired to do them again.
I also encourage dancers to be selective about optional classes. Sometimes there are bonus classes offered that you can take just for the sake of taking them. Everybody wants to be in front of the guest judges and guest teachers. But if you go and take a ballet class on a hard ballroom floor and you're competing an hour later — you've done a full 90-minute class, you rush into the preparation room, you give yourself another warmup because you feel like you need it — and then you're exhausted. If it's not required, maybe you don't take that class. Maybe you take a different class another day and still try to get what you can out of it. But pick and choose, because you really want your peak physical effort to come when you're on stage with the curtain up — not 10 minutes before.
Have a set warm-up, like I talked about before — those few things that you're already so familiar with that you do them and your body feels more comfortable. Dynamic stretches, something to get your heart rate up, something to address whatever you need to address — your turnout, your standing leg, your balance, whatever it is.
[45:42] Bring your release items with you. Bring that lacrosse ball, your little foam peanut, whatever your favorite things are, so that you can dig into those spots that might get tight.
[45:53] I also tell my dancers — if you have a 5 or 10-minute break, lie down and put your feet up the wall. Just to encourage that blood flow. 5 minutes with your feet up the wall is going to help calm your nervous system, get some of that swelling out of your legs, and do a lot for you. And then you can get up and keep running at full tilt again.
[46:16] Talking about feet up the wall and swelling reminds me of hydration. Something that's hard when you're doing a big long day is figuring out where your breaks can be so that you can hydrate as much as you need to, but not need to use the bathroom in the middle of a big group number. Kristin, what are your tips for staying hydrated?

[46:45] Kristin Koskinen, RDN: It's going to vary a little bit. I'm sure you're surprised to hear that.

[46:49] Jennifer Milner, NCPT: Shocking. N equals 1.

[46:53] Dr. Linda Bluestein: Yeah.

[46:53] Kristin Koskinen, RDN: It really depends on your schedule. If you have 2 or 3 pieces in the morning and then a big break and something in the evening, that's going to look different than if you have 10 pieces spread across the day. So you have to take those things into consideration.
[47:12] If you have short amounts of time between things, one thing you can do is use food for hydration — hitting the nutrition component and the hydration component in one thing. Things like melon, applesauce packets, and chocolate milk are going to give you nutrition. If you salt your food, it's going to help with hydration as well. Salting fruit or veggies — I particularly like fruit because it tends to be lower in fiber and provides more ready energy — that salt is part of the hydration process. It's not just the fluid, though of course that's important. We need the salt too. And a bit of sugar helps you absorb and utilize the water — we want the fluid to actually be absorbed, not just pass right through.
[48:08] Having some salt and some sugar in what you use for hydration is helpful. Salted fruit is good, or a sports drink alongside something. Pretzels with water is good because you're getting the salt. They don't have to be in one convenient package, but pairing them is helpful. Chocolate milk is actually a decent source of sodium, and sodium is the primary electrolyte we want to replace from sweat. So that works if you can get it in short periods of time.
And for hydration — avoid fire-hosing, meaning taking massive amounts at once. That'll leave you feeling sloshy and it can make you need to use the bathroom. You're just going to take in more than your body can absorb. So pace yourself on drinking too. Taking sips throughout is good. Pay attention to getting hydration in the morning, and if you have a gap or in the evening when you're done and can have a bit more, that's when you may want to say, "I'm going to drink closer to 16 ounces here because I've got a lot of time after."
[49:17] Otherwise, taking sips and small bites throughout the day can be really helpful. And if it would count as a liquid going through TSA, it counts as a liquid. Things that melt at room temperature count — ice, frozen things, fruits are pretty liquidy. You can think of smoothies, and again, Jell-O — which surprises people.

[49:39] Jennifer Milner, NCPT: Yeah, those are all great. And I love that it harkens back to what you said earlier about controlling what you can control. Drinking a fair amount in the morning — not 10 minutes before your first thing, obviously — and drinking a fair amount in the evening, doing that long-view hydrating, is so important.
[50:00] So the competition is over. Yay, well done! What happens now, Kristin? How do these competitors help their bodies recover food-wise?

[50:14] Kristin Koskinen, RDN: Sure. One of the things we want to do is replenish what we've lost during the day. Hydration is one of those — getting enough fluid, which will vary depending on the person. If you had 2 pieces that day, that's not quite the same as if you had an adjudication class and 10 pieces. Hopefully you've been able to get things in over the course of the day, and then we want to make sure you've had a minimum of at least half your body weight in ounces of fluids over the course of the day.
[50:43] Using tart cherry juice can be really helpful — it's readily available in a lot of stores. Tart cherry juice can help with relaxation, it can help with sleep (which is important when your schedule is off), and it helps with the recovery process. If you have some cacao you can take with you and mix into some warm milk, and you have a microwave in your room, that brings in magnesium, it's relaxing, and it can help bring things down.
[51:14] You definitely need to eat. If you haven't had a proper dinner break during the day, you need time to refuel. We want to make sure your glycogen stores — that's how your body stores carbohydrate — are refueled. You need some carbohydrates at the end of the day, and you need some protein. This is the time when it's most ideal to have foods you can sit down and chew mindfully and slowly. That may be when you have the big, beautiful salad, or when you get more fiber. Again, don't introduce unfamiliar foods. Avoid Taco Bell — that's a sports dietitian-level warning. Avoid going off the rails just because you're done for the day.
If you have another competition day tomorrow, what you do in the evening prepares you for Day 2, 3, or 4. It's not "woohoo, let's go off the rails" — it's "okay, now we're going to get ready for Day 2."
[52:11] When we're looking at hydration, if you're old enough, avoid alcohol. This is not a time for drinking. And anyone can access caffeine, so I want to address that too. If you're leaning on Red Bulls, Celsius, or any drinks that come with caffeine, it's not recommended. We can use caffeine strategically for performance. It's not recommended for kids under the age of 12, and for people over 12, a maximum of 400 milligrams a day. By the evening recovery time, you need to have cut off your caffeine — for most people, by noon. Some people metabolize caffeine more quickly than others, and you may or may not know which camp you're in. This is not the time to start bringing those things in. I definitely recommend avoiding energy drinks because they most often have additional components that may not play nicely with your body and can negatively impact your sleep that night — which, as Linda has mentioned, is imperative.
[53:16] Making sure you get protein at the end of the day can also help with sleep. We want to do everything we can to bring things in, keep things calm, and plan that ahead too, so that dinner isn't a rush or an afterthought. Know what you're going to do. Is it going to be a little picnic in your room? Do you have a reservation somewhere? If you're going to eat as a group, please have a reservation — don't try to wing it. You don't have time for that.
This is where a support team can be so important. The dancer needs to worry about dancing. If the coach, parents, or anyone can take the burden off and say, "We have a reservation at this time — review the menu, make sure it meets everyone's needs" — great. If there isn't time for that and everyone's eating in their rooms, that's fine. Just take care of your dancer. Don't leave them to make decisions after they've been making decisions all day long.
[54:21] They're emotionally drained, psychologically drained, physically drained. It's a wonderful gift you can give them — to nurture them. It takes the pressure off and allows them to eat and rest and recover. It's not babying them per se. It's really being an important part of the staff. When I get coaches or companies that want to incorporate nutrition into their process, I'm always really grateful, and I know the dancers are too. They find it comforting, and they can relax as much as possible.

[55:02] Jennifer Milner, NCPT: As much as possible. Yes. Well, Dr. Bluestein, we know that there may be a lot of aches or flare-ups of comorbidities after pushing the body to its limit. What do you recommend post-competition to help the body recover? We've finished our 3 long days and we're crawling back home. What are some things people can do?

[55:29] Dr. Linda Bluestein: In addition to all the amazing things that Kristin recommended, some of the other things that can be helpful involve the acronym RICE — but I like to use PRICE. I add a P in front. The P stands for protection. So if you have a nagging ankle, some ankle instability or an overuse injury, and now it's more flared up after the competition, put on that sleeve to help reduce the inflammation, use some more tape, do something to protect that part of the body.
[56:03] The R stands for rest. Depending on how flared up it is, there are actually 4 stages of overuse injury. Does it hurt just during the activity? Does it hurt during and afterwards? Does it hurt in the middle of the night? Is it waking you up from sleep? If an injury is waking you up from sleep, that's a far more serious situation than if it just hurts during or after the activity. Pay attention to how much the injury is bothering you, and rest accordingly.
[56:40] I love what you said, Jen, about putting the feet up against the wall — that's positively brilliant, whether you have issues with your ankles, knees, or anything else. Ankle injuries are extremely common amongst dancers — I forget the exact statistic, but it's something like 80% of injuries in dancers involve the ankle. When you think about it, we put our ankles through a lot, and there's not a lot of muscular support for them. So rest is really important. The body needs rest to heal an injury. Rest doesn't mean stopping everything — it might be relative rest. Like Jen said, maybe you're going full out with your upper body or doing some other things, but really resting that specific part of the body.
[57:34] Ice can be used in moderation — no more than 20 minutes at a time, and you're not trying to cover something up. You're looking for signs like swelling, redness, discoloration. Is this a little exacerbation of an existing overuse injury, or did you really do some damage and this needs to be evaluated? If it's waking you up from sleep, if it's getting really swollen and discolored, get it checked out.
[58:15] C stands for compression — so again, sleeves and those kinds of things can really help a lot. And E stands for elevation. Feet up against the wall, or sleeping with your legs on a pillow. Obviously they don't always stay there, but that's the idea.
The second thing I'd recommend: supplements like magnesium, vitamin C, and vitamin D. I measure blood levels of vitamin D and monitor them pretty closely, keeping them closer to the upper limits of normal — not in the single digits. A lot of doctors, if you're not in the single digits, they think you're fine. But we want to have a comfortable, good level. Vitamin C is something we need more of when the body's under stress, whether during the activity or afterwards, so we want to make sure we're supplementing well.
[59:13] And then the other things I mentioned earlier, like sleep, are really important so that the body can recover from the intense load you've put on it. Jen, what things do you recommend people do after a competition?

[59:29] Jennifer Milner, NCPT: First and foremost, rest — just as both of you have mentioned. I work very hard with the studios and companies I work with to make sure they give their dancers a day off afterwards. Which sounds like common sense, but many times is not the case. Sometimes studios feel like, "We've got another competition coming up in 2 weeks, we've got to keep going." But after a Friday, Saturday, Sunday of dancing 14-hour days, you have to take a day to let your body rest and let your brain rest — to be something other than a dancer.
If you've been away all weekend doing a cheer competition, and you're driving back all Sunday night, racing to school, and then heading to a 4-hour cheer practice — that's a lot. Giving yourself that time off from dance, cheer, ice skating, whatever it is, is really key mentally as much as physically.
[1:00:29] And then when we do start moving again, I like to do really mindful training. I sometimes teach a post-show recovery class for companies or studios that have been working really hard. It's a way to reset the nervous system and check in with things that might have gotten tweaked during the long weekend. Then we can start moving again and ease back into class.
[1:00:54] I know some people think, "Just jump back in and push through the soreness." I don't want people to stop moving completely — lying in bed for 24 hours isn't the answer — but we do need to let the body take that time to heal itself and then start moving in a really mindful way.
[1:01:06] And then I want to talk about what worked, what didn't work, where did you run out of gas, what could we do better next time, what did you think was great about your solo or your variation, what do we want to work on for the next one. Having that post-game recap is really helpful. Just having that conversation is super helpful.
[1:01:39] Speaking of conversations — I know this is one of the longest ones ever. I feel like we could be teaching a 5-hour workshop on this topic. But before we wrap up, this has been so great and has had so much information in it. Was there anything I didn't ask, or anything we left out, that you wanted to make sure was covered?

[1:01:57] Kristin Koskinen, RDN: I think we covered a lot.

[1:01:57] Jennifer Milner, NCPT: I think we did cover a lot. I'm kind of proud of us for getting through so much.

[1:02:03] Dr. Linda Bluestein: We did cover a lot. There was one thing I wanted to mention, which was getting back to the topic of inflammation. There are different ways to approach it. If you've had extra load on the body, it's not uncommon to have inflammation, and again, inflammation isn't a bad thing. But I prefer to resolve inflammation differently than just reaching for a prescription anti-inflammatory, which does give you that quick reward and often does feel good fairly quickly.
[1:02:33] If you can use things like fish oil — or aspirin, for those over 18 given the risk of Reye syndrome — again, never try any of these things for the first time at the competition. You want to make sure you've tried them in advance. There are things that can help resolve inflammation. Melatonin has anti-inflammatory properties. Using things that help resolve inflammation — they actually call them resolvins — rather than taking a prescription NSAID, which can be hard on the gut and the kidneys, and especially if you're not optimally hydrated or if you've had gut issues (which we know are quite common in people with hypermobility), some of the other approaches to inflammation can be really beneficial. I would agree with that.

[1:03:17] Jennifer Milner, NCPT: I think at the end of the day, what we're talking about — as we talk about competitions and being ready for these long, long-haul events — is that preparation is so important. Whether we're preparing our foods, whether we're preparing by calling ahead and making sure hotels have a refrigerator in them, whether we're preparing by getting enough sleep, by training correctly, preparation will do so much to get us ready for those competitions.
[1:03:47] And then when we're in the competition phase, we've all been talking about how much it's about maintenance — really trying to maintain our energy levels, really trying to maintain our stamina, trying not to overdo things where we can, and being as smart and efficient as we can during it. And then afterwards, give ourselves the rest that we need. Make sure we're eating those nourishing foods to rebuild our bodies. Make sure we're taking that time to sleep, taking time off from the dance so that we can give ourselves the recovery time that we need.
[1:04:13] So we have to look at it not just in that isolated 2 or 3 days. We have to look at the beginning, the middle, and the end of it in order to have a really successful competition or event weekend.
[1:04:31] As we wrap this up, you've all given so many great pieces of advice. Where can people find you if they want to hear more? Kristin, what about you? Sorry.

[1:04:42] Kristin Koskinen, RDN: Sure. You can find me on my website, which is eatwellpros.com, or on Instagram at kristin_koskinen_rdn.

[1:05:02] Jennifer Milner, NCPT: Excellent. Dr. Bluestein, what about you?

[1:05:04] Dr. Linda Bluestein: People can find me at hypermobilitymd.com, or of course the podcast at bendybodies.org. I'm most active on Instagram, and I'm also on Twitter and Facebook as Hypermobility MD. And then of course, Bendy Bodies as bendy_bodies. And what about you, Jen?

[1:05:22] Jennifer Milner, NCPT: People can find me on Instagram — I'm pretty active there at jennifer.milner — or on my website at jennifer-milner.com. So there are easy ways to find all of us. We all check our socials and our email. You can absolutely reach out if you have questions.
[1:05:39] You have been listening to Bendy Bodies with the Hypermobility MD, and our guest today for our panel discussion was Kristin Koskinen, RDN. Kristin, thank you so much for coming in and gabbing with us on this really, really important topic. Thank you.

[1:05:58] Kristin Koskinen, RDN: I love it. Thank you so much for having me.

[1:05:58] Dr. Linda Bluestein: It was great to chat with you.

[1:06:00] Jennifer Milner, NCPT: Yay!

[1:06:03] Dr. Linda Bluestein: If you love what you have learned, follow the Bendy Bodies Podcast to avoid missing future episodes. Screenshot this episode and tag us in your story so we can connect. Our website is www.bendybodies.org, and follow us on Instagram @bendy_bodies. Leaving a review, following the Bendy Bodies Podcast, and sharing the podcast helps spread the word about hypermobility and associated conditions.
[1:06:28] This information is not intended to diagnose, treat, cure, or prevent any disease. The information shared is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Please refer to your local qualified health practitioner for all medical concerns. We will catch you next time on the Bendy Bodies Podcast.