Dance Wellness

The Hypermobile Dancer

I am delighted to introduce you to Moira McCormack, the chief Physiotherapist (that’s the UK word for Physical Therapist) for the Royal Ballet Company in London, England. Moira is a former dancer who became a PT, and has been working with dancers for over 20 years.  

Several months ago we had an article on stretching, and I promised you a follow-up; a piece specifically on hypermobility — so here it is! We are indebted to Moira for writing this for 4dancers, as she is one the leading experts in this area of dance medicine. 

- Jan Dunn, Dance Wellness Editor



Moira McCormack MSc, Head of Physiotherapy at The Royal Ballet Company in London, UK

Everyone knows that dancers need to be flexible. You can work hard to achieve flexibility but while this is not easy or comfortable it is achievable to a certain extent. However, there are those dancers who do not have to work for flexibility – they can already do the splits every which way, often have swayback knees, a very flexible spine and ‘amazing’ feet. These dancers have an inherited joint flexibility. This means the connective tissue, at cellular level, which binds the body together – joint capsule, fascia, ligaments, tendon, and skin – is not as tightly or evenly knit together compared to other bodies.

Just before you wish you were one of those, you need to know the drawbacks. If you have inherited a global hypermobility (hyper=more than normal) there may be some far reaching consequences.

These dancers also have flexibility where they do not need it – the joints of the fingers which bend backwards to an alarming degree, the shoulders that are extremely flexible and the swayback elbows which look distorted. Also the skin is over stretchy, especially at the elbows and knees and over the back of the hand.

Those dancers find it hard to build strength, control and stability. If joint capsule and ligament allow more excursion (movement), this can lead to early wear and tear or even injury if dislocation takes place.

Good stability around joints is a result of joint capsule and ligament restriction and deep muscle activation during dynamic movement. All dancers need this, but the hypermobile dancer needs it even more, to counteract the lack in ligamentous restriction and protection.

There is a whole range in flexibility of the human body – from a global tightness which we do not find in dance to a global hypermobility which we do see, but it is not necessarily recognised as a condition to be handled with care.

The hypermobile dancer can make beautiful shapes but the coordination required to achieve a speedy petit allegro can be elusive. Balance and correct alignment can also be compromised in the dancer who is struggling with joints that are more mobile than stable. Overuse injuries and trauma can occur and it is the accumulation of injuries that progress the unfortunate dancer into what we call the Hypermobility Syndrome.

The hypermobile dancer who understands the particular requirements of her / his body will find training more logical and encouraging.


As with all dancers, stability and control starts with the pelvis and spine. The deep abdominal muscles and deep spinal muscles targeted in Pilates exercises are isolated and activated (editor note: In Pilates this is called “core control”, and in dance as often referred to as “center”).

The hip joint needs a balance of muscle around the ball and socket joint to stabilize and protect it. Placement and control should not be compromised by height of legs and ballistic (quick bouncy) movements.

The shoulders also require stabilizing, with exercises targeting the rotator cuff muscles to avoid subluxation (where the joint slips out of place just slightly) or dislocation (where it comes completely out of the socket) – especially in young male dancers who are starting lifting work.

The hyperextended knee needs to gain control throughout range, not just in the locked back position, to allow a global control of posture.

The foot requires correct alignment in order to cope with all dance techniques and needs specific foot exercises to develop the strength required for jumping, landing and pointe work. The very flexible foot, although attractive, is harder to control.


The hypermobile dancer finds it hard to gain and maintain strength – the ability to generate force within contractile muscle tissue. For this, high resistance exercises are necessary in the gym using equipment. This ‘cross training’ really is necessary for this particular body type.


This is the term used to describe the body’s position sense…i.e, knowing where you are in space. Good proprioception of the pelvis develops with core stability exercises, which educate correct spinal position. Good proprioception of the knee is developed with balance and resistance exercises and attention to perfect alignment in class. Take care not to rely on mirrors in studios. Instead try to develop better sense of position by improving alignment through careful repetition. Dancers describe this as ‘getting on your leg’.


Balance mechanisms are challenged in the more flexible dancer. Balance and proprioception are a result of accurate sensory information from joints and muscles via the nervous system. There is some evidence that these mechanisms are slower in the hypermobile body, which has to work harder than others to improve. Balance exercises
 in conditioning classes, the use of a wobble board and trying simple movements with the eyes closed can improve this.


Good coordination is the integration of all the above. The hypermobile dancer may struggle with speed and complex technique but repetition and determination produce rewards. (Slower work is their forte which can make the most of their exceptional lines.)

Posture and Alignment

The characteristic hypermobile posture – the rounded shoulders on the tucked under pelvis resting over the locked, swayback knees – is not to be recommended. So much time spent locking into the front of the hips and the back of the knees is weakening. Developing good postural habits – taking posture from class outside the studio with you (without the turn out) – can help with stability and control.


Fatigue can occur earlier in the hypermobile dancer simply because dancing can be more challenging for this type of body. Some aerobic exercise should be part of every dancer’s regime – swimming, brisk walking or using gym equipment.


The hypermobile dancer enjoys stretching because it is easy and feels good. However, stretching for long periods at the end of range can simply encourage instability. Sitting in box splits for too long is not good for hip joints and is unnecessary for already flexible muscles. We all prefer to practise what we are good at, while we should work at what does not come naturally. Instead, concentrate on stability exercises.


Frustratingly, sprains and strains can take longer to recover as hypermobile tissues heal more slowly. You may notice that your skin bruises and scars easily. That is because it is thinner and more delicate than normal. Injuries do heal however, but need patience and following all the same rules.

To conclude, the hypermobile body has a number of challenges but also some valuable advantages. Line and flexibility can be truly displayed once strength, stability and coordination have been acquired. In dance, different body types will require a different emphasis in training. Understanding the hypermobile body means you can train with realistic aims.

BIO: Moira McCormack MSc is Head of Physiotherapy at The Royal Ballet Company in London, UK.

After a professional dance career in classical ballet she retrained as a Physical Therapist and has worked with dancers for the last 20 years. She teaches anatomy, dance technique and injury prevention internationally, with a main interest in the management of the hypermobile dancer.


Dance DIY: All-Natural Antiseptic Spray

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Tea Tree

by Emily Kate Long

Summer is my favorite time to dance. The warm weather makes my joints feel looser and my muscles freer. The more humid air gives the floor just the right amount of tack and traction. Pouring sweat halfway through bare feels like my soul is being washed clean. What could be better?

Unfortunately, all that dampness is prime breeding ground for bacteria, and the added friction inside my shoes causes extra blisters to form where I normally don’t get them. It also makes my shoe bag and my locker smell pretty unpleasant!

Maybe you share a barre with a ripe-footed neighbor, or maybe you’re the one with the stinky shoes. Maybe you’ve put on a costume and wondered if its last wearer forgot to put on deodorant. Keeping dance clothing and footwear fresh is important all year long, but especially in summer when the air gets thicker and the sweat runs faster.

My fix for smelly shoes and costumes is an antiseptic spray* I make at home. Here’s my recipe:

  1. Rinse a perfume or hairspray bottle in hot water a few times to get the residue out. Running it through the dishwasher does the job pretty well.
  2. Fill the bottle with one part alcohol and two parts distilled water. You can use rubbing alcohol, Everclear, or vodka (note from the editor: dancers 21 or over for the Everclear and vodka please!).
  3. Add 30 to 50 drops (two to three teaspoons) of lavender essential oil or tea tree oil. Both of these have antiseptic properties and smell awesome.
  4. Close the bottle up tight and shake to combine the ingredients. You’ll probably notice that the solution gets warmer when everything is mixed together.
  5. Spray away!

A few cautions with this stuff:



Always shake the bottle to re-mix before you spray. The oil will separate to the top of the solution.

Essential oils cause some kinds of plastic to deteriorate. I’ve melted more than one of those all-purpose travel size spray bottles by accident. A bottle that already held something like perfume, hairspray, or cleaner will probably hold up fine.

If you plan to use this on fabric, only spray the inside, or test an area to make sure the spray won’t cause any damage.

For feet and shoes, spray after dancing and on the insides of your shoes only. Let the shoes dry out before you put them away. For that matter, let your feet dry out and cool off before you put them away, too!

This spray can also be used safely in pointe shoes. Again, I’ll emphasize letting them dry out for a few minutes before storing. I also use it to sanitize my foot rollers, Yoga mat, and sometimes even my whole locker.

Smelly feet—or just body odor in general—can become a touchy subject in the studio. Having a community bottle of foot spray has become a good way to make light of the subject of stinky shoes. I’ve gotten into the habit of keeping a big bottle of it in my locker that everybody dips into whenever we need it for footwear or dancewear.

With that, I’ll wish all our 4dancers readers a happy, sweaty, fresh-smelling summer.

Here’s to the heat!

*This antiseptic spray is not intended to be used as a treatment for any type of injury or physical problem–it’s just a freshener!

dancer doing arabesque

Emily Kate Long, Photo by Avory Pierce

Assistant Editor Emily Kate Long began her dance education in South Bend, Indiana, with Kimmary Williams and Jacob Rice, and graduated in 2007 from Pittsburgh Ballet Theatre School’s Schenley Program. She has spent summers studying at Ballet Chicago, Pittsburgh Youth Ballet, Pittsburgh Ballet Theatre School, Miami City Ballet, and Saratoga Summer Dance Intensive/Vail Valley Dance Intensive, where she served as Program Assistant. Ms Long attended Milwaukee Ballet School’s Summer Intensive on scholarship before being invited to join Milwaukee Ballet II in 2007.

Ms Long has been a member of Ballet Quad Cities since 2009. She has danced featured roles in Deanna Carter’s Ash to Glass and Dracula, participated in the company’s 2010 tour to New York City, and most recently performed principal roles in Courtney Lyon’s Sleeping Beauty, The Nutcracker, and Cinderella. She is also on the faculty of Ballet Quad Cities School of Dance, where she teaches ballet, pointe, and repertoire classes.


Integrating Best Practices From Dance Medicine And Science To The Faculty Of A Professional Dance Conservatoire

I am so pleased to introduce our guest contributor, Rachel Rist, M.A., Director of Dance at Tring Park School for the Performing Arts, an hour outside of London. The Tring Park School is one of only 21 schools in the UK selected to receive government funded Dance and Drama Awards. Graduates go on to prestigious careers in all the arts, dance included. I have known Rachel for 20+ years, and it has been a pleasure to watch her emerge as one of the titans of dance medicine worldwide. She is a wonderful role model for teachers and school directors who want to integrate dance medicine knowledge into their training programs, and that is the topic I asked her write about, for this first article (we hope she will do more!!).    – Jan Dunn, MS, Dance Wellness Editor


by Rachel Rist, MA

Twenty five years ago, when Dance Medicine was relatively unknown, as a newly appointed Director of Dance at an elite school in the UK, with a faculty of about 35 dance teachers of varying genres, I had a strong vision of the healthy dance training that I planned for the school. Unfortunately, at that time, nearly all of the faculty had been trained in the ‘old school’ system of ‘dance till you drop’ and ignore injuries, because; ‘that is how we did it in my day…’ This perpetuated the myth of over-reverence for a traditional system of training that was at best brutally strict and, at worst, produced a tremendous drop out rate of injured dancers and damaged performers. The faculty were luckily open to change as many of them had in fact, been injured out of the profession themselves still relatively young in their careers as professional dancers.

Key to encouraging dance teachers to reassess their own practices and looking for ways to implement new ideas, was to find a physiotherapist (PT) whom the teachers liked and respected -  and to then establish weekly team meetings with that therapist and encourage frequent dialogue, have training sessions with them, and ask them to watch classes and rehearsals. The teachers found themselves also asking the PT questions on an informal basis around the coffee machine, or at lunch break, so when he came to lead them in an introductory session in Core Stability, they were already on board.

The next development was to introduce a screening process for the students. This is an increasingly common tool for schools and companies to use with their dancers (Editors note:  See our recent article on this topic.).  It involves looking at the dancer’s body / overall health / technique, and providing feedback for them — in terms of potential areas of weakness that might cause future problems.—i.e, it is a preventative tool.

The first step in this effort was to encourage any teachers who wanted to have a screen, free, for themselves. They came away from their personal screen understanding that the more we understand our own bodies, the better able we are to look after and maintain them. Teachers were fascinated and soon even the more skeptical ones were asking for a screen and were very keen to encourage their students to attend one.  The students gained much from the screenings and importantly, came away with an individually designed training plan for their own physique. Alongside this was the In-Service training sessions for the teachers every 6 weeks, often led by myself or invited experts. (All sessions were during lunch times and providing baked goodies was an integral part of ensuring good attendance!)

Implementing Pilates and supplementary training was a natural progression from the screening process, and the faculty could see how valuable this could be for an injured dancer, to maintain range of movement and strength whilst still protecting an injury. The Pilates teacher was also a natural link between the Physiotherapist and the teacher (and importantly, was also an ex- professional dancer herself).  At every development, good communication was vital, as was leading by example.

Implementing fitness training, however, was a lot more challenging. In a school that delivers academic work in addition to elite dance training, finding the time to do this in the packed curriculum was a real challenge. If something new goes into it, something has to come out of the timetable, or we have to work the students harder during their breaks. A compromise was to give a little lunch break time and a little class time to create a slot for the supplementary fitness training. It was 6 weeks before any benefit was revealed, and there was barely a day went by that a teacher, student or parent did not protest at the additional training. However, the outstanding results in improved fitness and condition of the dancers in the annual school show was all the validation it needed.

While working from a solid foundation of committed teachers, maintaining an open dialogue and always encouraging teachers to ask, challenge and find out more, we still needed to ensure that our training systems were in harmony with outstanding quality training of the adolescent dancer. This continues to be done by lesson observations, staff development and training, team teaching, regular training sessions and an ethos of constant evolution and growth. However, the most convincing and exciting outcome was seeing our dancers graduate into national and international level dance companies, go on to have long careers and indeed second careers as Artistic Directors. Longevity of a professional career at a high level was always the goal.

As new teachers joined the dance faculty, they were chosen not only for their experience and professional skills, but also for their interest or knowledge or passion for learning about the body. Gradually, teachers (and importantly, prospective students) gravitated towards the school precisely because the school had a reputation for providing outstanding training within a safe and healthy dance environment.

Now, with an incredible faculty of nearly 45 staff of highly experienced and skilled teachers, our school remains at the forefront of providing healthy dancers who are sought after by leading companies.

Personally, I was inspired by Dr. James Garrick, MD of Saint Francis Memorial Hospital Dance Medicine Division (in San Francisco), who, when I asked how he had become interested in Dance Medicine, replied; ‘it was a bloody-minded ballet teacher…..’

My mission was clear.

Rachel Rist, MA

Rachel Rist, MA

BIO: Rachel Rist, M.A. is the Director of Dance at Tring Park School for Performing Arts in Hertfordshire, UK. She has a Master’s Degree in Performing Arts, and is a published author of a first book, ‘The Injured Dancer’ (1986) and a second book ‘Anatomy and Kinesiology for Ballet Teachers’ (1996) and regular feature writer of many articles for dance magazines. She was President of the International Association for Dance Medicine and Science, (2003 – 2005) and later, Chair of its’ Education Committee. She has twice hosted the annual IADMS conference in 1997 and 1999. She is still a board member of IADMS. Rachel was the Chair of the Faculty of Education for the Royal Academy of Dance, and a member of the Executive Committee. She has worked extensively with Dance U.K, as a member of the Editorial Board for the ‘Fit to Dance?’ reports, 1 and 2 and on the editorial board for the ‘Dance Teaching Essentials’ book, is on the editorial board of the magazine ‘Dancing Times’.

Rachel was on the Steering Committee for the Music and Dance Scheme’s ‘Excellent’ projects, Steering committee for Foundations4Excellence, and Vice Chair of the Council for Professional Dance Schools. Rachel was also a founder developer of a qualification with Trinity International Examinations board on Safe and Effective Dance Practice.

She was external examiner for the dance degree course at Middlesex University and also external examiner for the MSc in Dance Science at Trinity Laban. She lectures extensively nationally and internationally on Dance Medicine and Training.





Thoughts On Starting A Dance Screening Program

Jan Dunn, MS

Jan Dunn, MS

by Jan Dunn, MS

As summer starts, and many schools / companies take a break until fall (or have “summer intensives”), it made me realize that now is a good time for directors to think about possibly implementing a dance screening program, to begin as things gear up in August -i.e, there’s time to think and learn about it / gather your resources together…Hence this article….

I’ve had the good fortune to be able to start a dance screening protocol at two university dance programs where I was working–one at Loyola Marymount University in Los Angeles (LMU), in 2006, and the other at the University of Colorado-Boulder (UC-B), in 2010. I had known about screenings for many years, from conferences / articles /and listening to dance colleagues about how they worked at their school or company. But my LMU and UC-B initiatives gave me valuable knowledge and personal experience on how to implement such a tool for a dance program with limited resources. This article is written from my own experiences with those programs, and suggestions on how to move forward to implement something similar in your own school / company.

First, what IS a “dance screening”?

It is looking at the dancer in several ways:

Read more


Mirror, Mirror on the Wall: A Dance Teacher’s Perspective

Happy March! I hope spring is making a welcome appearance in your part of the country / world!

We recently had an article on Mirrors in the Classroom, by Sally Radell, of Emory University in Atlanta, GA. The first
article was written more for the dancer — Sally has now written one for us which focuses on mirror use from
the teacher’s perspective.  

It’s so important for teachers to understand the effect mirrors can have – both positive and negative – and how to best integrate them into classroom teaching, for the students’ best interests. As I mentioned in my intro for Sally’s
first article, I always remember the great Betty Jones (Jose Limon Company dancer and world-famous Limon teacher) saying, “mirrors put you outside your body, not in it” — good words to take to heart, and now we have recent research, such as Sally Radell’s, to give scientific support to them!

Happy Spring :)



137_3791by Sally A. Radell, MFA, MA

It’s easy to develop a “mirror addiction” when teaching dance. This is particularly evident when teaching beginning level technique classes. I primarily use the mirror as a classroom management tool to visually “bring all of us together” in the learning of new phrases. I usually have the whole class face the mirror. I stand in front, also facing the mirror, as I demonstrate the new material with the dancers behind me following along. This enables me to watch the students as I guide them through the phrase while simultaneously calling out movement cues to help them through the challenging portions of the material. This can be a particularly efficient use of time in short dance classes where I am always pushing myself to make it through my lesson. However, I have noticed a certain level of dependence on using the mirror in my teaching; too much reliance on the mirror can create problems that are detrimental to students’ technical development and body image.

What are the drawbacks of mirror use in the dance classroom?

  • Especially when I work with beginning dancers, I see that the visual reflection of their bodies in the mirror is a more powerful experience than the proprioceptive muscular sensation of performing a movement. Under these circumstances, a dancer “removes herself from her body” to the point where she cannot learn to fully trust her proprioceptive self. Yet without full access to this movement information, a dancer’s growth can be impeded.
  • Research shows that mirrors in dance classes can contribute to the development of a poor body image for dancers.  Often more advanced students will be more critical of their body in the mirror because they have a more highly developed eye for identifying technical weaknesses. They struggle to negotiate between the two-dimensional reflection of their body in the mirror and their three-dimensional body in motion.  This heightened self-consciousness may cause a dancer to see her body as an object to compare to others in the room. This whole dehumanizing process can cause stress, negative self-evaluation, and ultimately a poor body image.
  • Teaching with mirrors can slow down the development of a dancer’s technical skills, especially in the slower adagio phrase where students find plenty of time for mirror-gazing. The more they focus on individual positions, the less likely they are to learn the flow of movement and the muscular connections a dancer needs for smooth technical advancement.
  • Remember that not all students have the maturity and objectivity to use the mirror constructively. Dance counselor Julia Buckroyd, who is an emeritus professor from the University of Hertfordshire in the UK, reports that most teenage students are unable to see an accurate image of themselves in the mirror. They cannot detach themselves from their reflection in order to benefit fully from the information the mirror provides.

So what’s a dance teacher to do?

Read more