Hyperextension and Instagram

[alison]

That's interesting.  It seems that there's quite a link with ME/Chronic Fatigue Syndrome, too.  The more one researches into co-morbidities, the more one finds.

[Anna C]

3 hours ago, Dancers Dad said:

Interesting. Quite early stage research and simply stating a correlation - but I'm still curious. I'd be interested in the social factors that play a role - eg Do hypermobile people go into training/careers that have a higher likelihood of stress? Also, the definitions of both hypermobility and anxiety are wide open for interpretation. So while I'm interested in this, I wouldn't draw any conclusions.

 

There have long been links between hypermobility and anxiety.  IIRC, one study found that people with hypermobility were around 16 times more likely to suffer with anxiety than non-hypermobile people.  Certainly my daughter was anxious and prone to panic long before she started intensive ballet training.  So no, I don’t think social factors played a role; she simply produces too much adrenaline and her body can get “stuck” in fight or flight mode.

 

A lot hinges on whether someone has some/mostly/all hypermobile joints, or whether they have hypermobile Ehlers-Danlos Syndrome/Joint Hypermobility Syndrome, which often goes undiagnosed and brings with it a whole host of other symptoms, including anxiety, panic attacks, an increased production of adrenaline, tachycardia, chronic fatigue, general dysautonomia, and more, depending of course where one is on the spectrum.  

[Farawaydancer]

1 hour ago, Anna C said:

 

There have long been links between hypermobility and anxiety.  IIRC, one study found that people with hypermobility were around 16 times more likely to suffer with anxiety than non-hypermobile people.  Certainly my daughter was anxious and prone to panic long before she started intensive ballet training.  So no, I don’t think social factors played a role; she simply produces too much adrenaline and her body can get “stuck” in fight or flight mode.

 

A lot hinges on whether someone has some/mostly/all hypermobile joints, or whether they have hypermobile Ehlers-Danlos Syndrome/Joint Hypermobility Syndrome, which often goes undiagnosed and brings with it a whole host of other symptoms, including anxiety, panic attacks, an increased production of adrenaline, tachycardia, chronic fatigue, general dysautonomia, and more, depending of course where one is on the spectrum.  

All of this is what I started to write but you’ve put it much more concisely, thank you!

 

5 hours ago, Dancers Dad said:

Interesting. Quite early stage research and simply stating a correlation - but I'm still curious. I'd be interested in the social factors that play a role - eg Do hypermobile people go into training/careers that have a higher likelihood of stress? Also, the definitions of both hypermobility and anxiety are wide open for interpretation. So while I'm interested in this, I wouldn't draw any conclusions.

The diagnostic criteria for anxiety disorders and hypermobility syndromes aren’t open to interpretation, they’re defined and diagnosed by medics when appropriate. 

[Dancers Dad]

2 hours ago, Farawaydancer said:

All of this is what I started to write but you’ve put it much more concisely, thank you!

 

The diagnostic criteria for anxiety disorders and hypermobility syndromes aren’t open to interpretation, they’re defined and diagnosed by medics when appropriate. 

Thanks Anna C - very interesting. I certainly would like to read more on this.

 

Farawaydancer - The diagnostic criteria for anxiety disorders are spectacularly open to interpretation. (I don't know enough about hypermobility syndromes to comment really, although it does strike me as something that would very much be dimensional rather than easily segregated, discrete conditions).

[Anna C]

This might be of use, @Dancers Dad   https://www.dynainc.org/docs/hypermobility.pdf

 

Also some info here:  https://www.ehlers-danlos.com/2017-eds-classification-non-experts/psychiatric-psychological-aspects-ehlers-danlos-syndromes/

 

 

 

[Dancers Dad]

21 minutes ago, Anna C said:

This might be of use, @Dancers Dad   https://www.dynainc.org/docs/hypermobility.pdf

 

Also some info here:  https://www.ehlers-danlos.com/2017-eds-classification-non-experts/psychiatric-psychological-aspects-ehlers-danlos-syndromes/

 

 

 

👍 Thanks very much - just pinned those to my browser for reading when I have a mo.

[Farawaydancer]

1 hour ago, Dancers Dad said:

Thanks Anna C - very interesting. I certainly would like to read more on this.

 

Farawaydancer - The diagnostic criteria for anxiety disorders are spectacularly open to interpretation. (I don't know enough about hypermobility syndromes to comment really, although it does strike me as something that would very much be dimensional rather than easily segregated, discrete conditions).

Not my experience with the clinicians I work with on a daily basis diagnosing anxiety disorders but maybe your experience is different. 

[Dancers Dad]

1 hour ago, Farawaydancer said:

Not my experience with the clinicians I work with on a daily basis diagnosing anxiety disorders but maybe your experience is different. 

 

🙂 Indeed it is. There is probably no more controversial or disputed book in the world than DSM 5. 

 

But anyway, that's a different discussion.

[Thecatsmother]

There is quite a bit in the literature now about links between EDS etc anx higher levels of anxiety. The article I posted was just an example. My point was more that it goes far beyond overly mobile ligaments, joints etc in many dancers. 

 

Here is something more linked with young people in general and education.

 

https://www-tes-com.cdn.ampproject.org/c/s/www.tes.com/news/why-you-need-know-about-eds-hsd-and-hypermobility?amp

 

There are very clear ways of assessing for anxiety disorders using DSMV so I think more could be done in this area. My understanding is that especially with things like EDS this is thought to be linked to differences in the autonomic nervous system hence the accompanying problems that can present with this like sleep disturbances, POTS etc.   

[Anna C]

I was watching a video recently of a talk by (among others) hypermobile EDS Consultants at a 2019 conference on Psychological and Emotional Health and they had Q&A afterwards.  An NHS Psychotherapist who works with young people stood up and asked the panel about what, if any, training GPs get on hypermobility disorders (the answer was none).  She herself has h-EDS and says that in many of the patients referred to her for help with anxiety, she sees other symptoms of hypermobility spectrum disorders/h-EDS so writes to the GP to ask them to investigate.  

 

As Thecatsmother rightly says, it’s the autonomic nervous system in HSD/h-EDS (in particular, over-production of adrenaline, dysautonomia, POTS/tachycardia) that is strongly linked to anxiety, which is why meditation, beta blockers, amitriptyline etc *in combination with counselling* work better for these patients than antidepressants/medication alone.  

[NJH]

13 hours ago, Dancers Dad said:

 

🙂 Indeed it is. There is probably no more controversial or disputed book in the world than DSM 5. 

 

But anyway, that's a different discussion.

which is why the DSM -5  is rarely  used in the Developed World , except by  cranks who wish to pathologise entirely normal variation in the human  condition 

[Aklf]

26 minutes ago, Anna C said:

I was watching a video recently of a talk by (among others) hypermobile EDS Consultants at a 2019 conference on Psychological and Emotional Health and they had Q&A afterwards.  An NHS Psychotherapist who works with young people stood up and asked the panel about what, if any, training GPs get on hypermobility disorders (the answer was none).  She herself has h-EDS and says that in many of the patients referred to her for help with anxiety, she sees other symptoms of hypermobility spectrum disorders/h-EDS so writes to the GP to ask them to investigate.  

 

As Thecatsmother rightly says, it’s the autonomic nervous system in HSD/h-EDS (in particular, over-production of adrenaline, dysautonomia, POTS/tachycardia) that are strongly linked to anxiety, which is why meditation, beta blockers, amitriptyline etc *in combination with counselling* work better for these patients than antidepressants/medication alone.  

This is fascinating. Worryingly seems that research and appropriate treatment options may still not be readily available and these conditions (which are no doubt quite common amongst dancers) are perhaps not being easily identified and may take time to establish the correlation between hyper mobility and anxiety. 
This was first brought to my attention many years ago at a talk by the author Lena Dunham who suffers with these hyper mobility disorders and has tried to raise awareness of the anxiety link alongside physical symptoms. 
 

https://graziadaily.co.uk/amp/celebrity/news/ehlers-danlos-syndrome/ Links at the bottom of the article to support groups (no idea if these may be out of date?) 

[alison]

1 hour ago, Anna C said:

An NHS Psychotherapist who works with young people stood up and asked the panel about what, if any, training GPs get on hypermobility disorders (the answer was none).  

 

I'm afraid that doesn't surprise me in the least: there are a number of "suspect" conditions which GPs get no training on whatsoever.  Or sometimes it sounds as what is passed on to them isn't factually accurate: from what I can gather, there are still some medical professionals who actually don't believe in any of these conditions, hence my referring to them as "suspect", and they may pass their beliefs on as "facts" to those following them.  Turning that thinking round is going to take a lot of time.

[Peony]

It may not be in depth but I’m sure connective tissue disorders are covered in GP training but GPs don’t provide specialist care. The important thing is that they can identify a problem and refer on. EDS is quite a rare genetic disorder. Unfortunately the government has made it so that GPs hold the budgets and have to do all the referrals, it would really make sense if your psychologist could refer directly to a specialist service if they suspect EDS but they can’t because the NHS has been set up to run on a private medicine model 

[NJH]

42 minutes ago, Peony said:

It may not be in depth but I’m sure connective tissue disorders are covered in GP training but GPs don’t provide specialist care. The important thing is that they can identify a problem and refer on. EDS is quite a rare genetic disorder. Unfortunately the government has made it so that GPs hold the budgets and have to do all the referrals, it would really make sense if your psychologist could refer directly to a specialist service if they suspect EDS but they can’t because the NHS has been set up to run on a private medicine model 

GP s do not hold the budgets , CCGs  do unless it is nationally commissioned service  (AQP   muddies the waters bit ) 

one of the reasons referrals  go through GPs is  coordination of care 

the NHS does not urn on private model, despite   over two thirds of patient interactions  being, and always having been since 1948 ,  undertaken by private providers under  NHS  bulk contracts

 

[Anna C]

28 minutes ago, Peony said:

EDS is quite a rare genetic disorder. Unfortunately the government has made it so that GPs hold the budgets and have to do all the referrals

Genetic/inherited, yes, but actually h-EDS/Joint Hypermobility Syndrome/Hypermobility Spectrum Disorders are rarely *diagnosed*, not rare.  One young locum GP at our Practice had not heard of it, and was reluctant to do a repeat prescription of a non-addictive, low dose medication initially prescribed by a Consultant at RNOH and well known for helping with sleep and night time pain.

 

And of late, things seem to be changing wrt what referrals GPs *can* do - especially for MSK problems.  Everything MSK related (with the exception of X-rays) in our Trust has to go to an MSK Triage Service, which itself is quite limited as to what it can refer you for.  In the last few months I’ve had an absolute devil of a job battling red tape just to get a hip ultrasound (rejected), an MRI (rejected) or a referral to see a Hip Specialist at St Thomas’s (must be referred to a local Ortho consultant first, even though I’m already under Ortho Consultants at St Thomas’s). 🤦🏻‍♀️🙄

 

My poor GP is tearing her hair out at the ridiculous hoops we’re both having to jump through.  It used to be hard enough to get a referral to an EDS Consultant when GPs could refer directly; I dread to think what it would be like now.

[alison]

And people wonder why GPs are leaving the profession ...

[Peony]

@Anna C I think there is some debate as to whether hypermobility syndrome and EDS are a spectrum  but EDS is still classified as rare as the majority with hypermobility syndrome don’t meet all the criteria for EDS. Hypermobility syndrome isn’t rare I agree. 

I think unfortunately there are a lot of cut backs due to covid back logs. Hope you get seen soon!

[Dancers Dad]

Some more encouraging research just out...

 

https://journals.lww.com/cjsportsmed/Abstract/2021/11000/Joint_Hypermobility_Does_Not_Increase_the_Risk_of.17.aspx

[Dance*is*life]

I spend half of my classes trying to get my students to lower their legs and correct their turnout and hip placement.  I'm forever explaining that some exercises are better taken with lower legs and that a pure beautiful line is more important than legs round their ears at every opportunity!  It's an uphill slog because of all those instagram and tiktok posts.  Just before corona we were honoured with a visit from Natalia Osipova, who came to dance Giselle.  She gave the most wonderful  master class and really impressed upon the students how purity of line and the quality of arm movements were far more important than flinging legs around and no-one can say that she doesn't lift her legs to perfection!

[glissade]

On 31/10/2021 at 16:33, Dance*is*life said:

I spend half of my classes trying to get my students to lower their legs and correct their turnout and hip placement.  I'm forever explaining that some exercises are better taken with lower legs and that a pure beautiful line is more important than legs round their ears at every opportunity!  It's an uphill slog because of all those instagram and tiktok posts.  Just before corona we were honoured with a visit from Natalia Osipova, who came to dance Giselle.  She gave the most wonderful  master class and really impressed upon the students how purity of line and the quality of arm movements were far more important than flinging legs around and no-one can say that she doesn't lift her legs to perfection!

Yes! I love this.

Is there a danger that this will be lost, do you think? (If future generations of dancers - and audiences - are more concerned with leg height than line?)

[Anna C]

On 01/11/2021 at 22:52, glissade said:

Yes! I love this.

Is there a danger that this will be lost, do you think? (If future generations of dancers - and audiences - are more concerned with leg height than line?)

 

I think we’re ok in the UK while the “old school” generation of dancers coached by people like Sir Peter Wright are themselves coaching younger dancers - I was struck by the recent RB rehearsals for Giselle, where Monica Mason and Olga Evreinoff were coaching Julia Roscoe, Yasmine Naghdi and Matthew Ball.  There was a lot of emphasis on keeping arabesques low, in the proper Romantic style.  Likewise in a Sleeping Beauty rehearsal, the focus was on keeping the arm very classical and following the arm down while lifting the leg into a penché BUT not all the way into a “6 o’clock” arabesque.  I am sure that this will be passed on when Naghdi’s generation is coaching the next, down the line. 

[taxi4ballet]

Something that people often don't realise with hypermobility is that it isn't entirely to do with having ligaments and tendons that are stretchier than normal. In some cases, it is down to the construction of the bones in the joints themselves, which allow a greater range of movement than usual. This is called benign joint hypermobility syndrome, or BJHS. People with completely flat turnout (including my dd) can have a shallower socket in their hip joints, for example, and can do the splits with complete ease with no stretching required at all. What they don't always have is the strength in the muscles to control that extra facility, and for hypermobile dancers, strengthening exercises are considerably more important than stretching!

 

No stretching exercise in the world is going to change the shape of the bones you were born with. All overstretching will do is to cause the joint ligaments to elongate, thus increasing instability in the joint. Not what you want.

Edited November 10, 2021 by taxi4ballet
edited for spelling

[NotadanceMa]

On 18/10/2021 at 09:33, NJH said:

which is why the DSM -5  is rarely  used in the Developed World , except by  cranks who wish to pathologise entirely normal variation in the human  condition 

The DSM and ICD are the two main diagnostic manuals used worldwide and both are in current used. They are not used by cranks but qualified registered clinicians worldwide.