16. Empowering Flexibility with Dr. Jen Crane, DPT

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00:00:00 

Linda Bluestein 

Welcome to bendy bodies with the hypermobility MD, your podcast, to learn all about the benefits and  complications of being bendy. This is Dr. Linda Bluestein joined today by my cohost Jennifer Milner. Before  we introduce our very special guests today, a couple of quick reminders, please subscribe and leave a review.  This really helps to grow our audience. Please also email your questions and feedback. This podcast is for you  today. We are incredibly fortunate to be speaking with Dr. Jennifer Crane. Dr. Crane is known for her  innovative approach to injury prevention and performance optimization in circus arts as a dually accredited  therapist and athletic trainer. She spent her career working with athletes and artists of all levels from recreational  acrobats to Cirque de Solei artists and Olympic gymnast. Jen loves leveraging her knowledge on the human  body to exceed her client's circus goals from contortion headsets to dynamic aerial work.  

00:00:57 

Linda Bluestein 

Jen specializes in troubleshooting barriers to goals that you'll never find in textbooks. In addition to her physio  work, Jen is currently training and performing in Montreal with a focus on dance, trapeze, aerial straps, and  handbags Crane. Hello, and welcome to bendy bodies. I'm feeling.  

00:01:28 

Jennifer Crane 

Happy to be here. Thanks for having me. 

Linda Bluestein 

Absolutely. It's great to talk with you again today.  

00:01:34 

Jennifer Crane 

Of course, as always. Well, you have to specify which Jen today. I know,  

00:01:40 

Linda Bluestein 

I know it's so exciting. So Dr. Jen crane, we are so excited to speak with you. You're doing such amazing work  in the space of safely training, hyper mobile athletes and artists. Can you start out by telling us how you got into  working with such a specific population as circus arts?  

00:02:00 

Jennifer Crane 

Yeah, absolutely. The only reason that I'm doing this at all today is because I stumbled upon a rock climbing  gym about seven years ago that had aerial silks classes and I walked in planning to rock climb, and then I looked  up and I was like, Oh, wow, that looks really cool. I think I'd rather be doing that. I started taking aerial silks  classes and really kind of just dove into all of circus. I was at a really interesting point in my career where I had  just finished my residency and had one of my first kind of normal jobs that didn't include working 80 hours a  week at a university. I had some extra time on my hands to really kind of get into a new hobby and I just totally  fell in love with it. I have, I grew up doing dance and ballet. My background is in performing arts and it really  was just a very natural fit for me to transition into, all of the circus arts.  

00:03:00 

Jennifer Crane 

Once I'd been there for awhile and I, had traveled around a bit and taking classes with different coaches and,  worked with different students. I really saw how much of a need there was for a physical therapist or any  healthcare provider who really understood the demands of circus. Because even though it's similar to dance  aesthetically, and there's a lot of crossover, it's, the physical demands are just so different. I kept seeing all of my  circus classmates, getting injured or having like that nagging shoulder issue or back issue. I would always be  like, why don't you go see a physical therapist? that's what we do is help people like you fix their bodies so that  you can perform or train or do whatever you want to do. They would always, the story was always the same and  it was well, like I went to see a physio or I went to see a doctor and they looked at me and they tested me and  they told me that I was strong enough and flexible enough and that they either didn't know what to do with me.  

00:04:01 

Jennifer Crane 

Or they just told me to rest and kind of just gave very blanket advice. I was like, man, that's like, that's a pretty  big gap in healthcare. I was just like, well, I guess, like I was uniquely positioned to kind of fill that gap with my  background. And, as a physio and as an ATC, I've worked with, a lot of, mainstream sports athletes. I had that  background and had my dance background and was doing circus for awhile. I was like, well, I can think outside  of the box, I'm pretty good at that. I might as well give it a try cause no one else's and it turns out I absolutely  love it. And there was a need. It's been the greatest career shift, definitely that I've ever made the choice to go  with.  

00:04:51 

Linda Bluestein 

That's fantastic. I love that story. I love that. And, and the field of circus arts is expanding so quickly and as it  becomes more mainstream for people to try things recreationally and as circus arts begin blurring boundaries  with things like Broadway on Broadway and Las Vegas and such, how do you see circus training changing? Is it  becoming more codified or should it, do you see cross training becoming more mainstream to help athletes who  have worked in such, specific, ranges of motion?  

00:05:23 

Jennifer Crane 

Yeah. It's definitely, that's such a good question. It's a very, there are a lot of different components I think,  involved in that it's definitely becoming a lot more mainstream and people are really starting to see, exactly my story. Like I saw aerial silks at this place or here at this pole studio. It's definitely getting a lot more media  coverage. There's also, like I said, still a huge lack in the healthcare providers who can help us and work with us  and under, at least understand what we need to be able to do. From a sports medicine perspective, it's interesting  because I, from what I've seen, it seems to be that circus arts is about five to 10 years behind dance and  gymnastics. We have a lot of the same kind of history of the art form, where, it's based in kind of more of a  traditional lineage of, my coach learned from this coach who learned from his coach and we've always done it  this way, and this is how it will always be done because history.  

00:06:29 

Jennifer Crane 

So, and I know that's the same story in dance and in gymnastics, we're just still going by that line a lot. I think  just like fairly recently in the past couple of years, has there even been acknowledgement that this is maybe not  the best approach to training and working with circus artists in a coaching or in a healthcare setting? So, yeah,  

there's definitely, we seem to be slowly moving in that direction of, normalizing, cross training and talking  about recovery and treating circus like a sports. I think it's similar to dance and that a lot of circus artists see  themselves as like artists and they don't see themselves as athletes, even though they're the demands that they  put on their body are exactly the same as a high level athlete. I'm, I've started to see the shift in mentality where circus artists, even if they're, recreational artists who are trying to perform or make this their main career, they're  starting to think of themselves as athletes.  

00:07:35 

Jennifer Crane 

And then they treat their bodies differently. That's really cool to see, but we're slowly starting to get on board  with cross-training and kind of the more, the things that are just standard practice and mainstream sports that  haven't quite made it all the way to performing arts and to circus arts.  

00:07:51 

Jennifer Milner 

Well, and do you see in the dance world and Linda and I have talked about this before, do you see, as you talked  about, it's always, this is the way we've always done it. That's why we're going to keep doing that way.  Resistance from the coaches in the form of, well, I had to go through it, so you should have to go through it.  Maybe there are, we are asking circus artists to do such crazy things, but there have to be healthier ways to get  to those crazy things. Maybe there's a reluctance to seek those paths just because, well, went through this, so it's  your turn to go through this? Do you see that? Or is that just,  

00:08:29 

Jennifer Crane 

Yeah. I, I see some different variations of that. There's absolutely kind of this unspoken mentality of yeah.  Circus hurts. We just got to push through it and like, do it, especially like, depending on what skill you're  working on, there are some skills are just known to be very painful because you're hanging from your foot skin  and that's not going to ever feel good, but your nerves do kind of acclimate to that. Your body, like, it's kind of  that it plays out that, but those definitely the unspoken. Yeah, I did it. If you want to, better, you have to do this  too, but I don't see that vocalized a whole lot, which is great. That's a step in the right direction. I think that  beyond that, there's also, and this is one of the things that I advocate for so much. There's definitely been more  of a push to like, let's stop and think like, is that actually necessary? Okay, circus hurts.  

00:09:22 

Jennifer Crane 

What kind of hurt is it productive discomfort or is it non productive discomfort and really starting to at least  introduce that verbiage so that we can talk more intelligently about what we're feeling and if that's normal.  There are definitely so many amazing coaches out there that are really pushing for that too. I think that as people  see that represented, that will start to become and continues to become more of the norm. Nice.  

00:09:51 

Linda Bluestein 

And, and you just touched on, about the good hurt versus the bad hurt. I think that's such an important concept  for everybody, whether you're not doing any athletics at all, versus if you're all the way to, I mean, I think of  circus performers as just being, I mean, that's what they ask their bodies to do is really crazy. I mean, it's, I love  to watch circus performers love watching them. It's amazing. I mean, they have to be incredibly brave to do those things. Do you have any suggestions for determining good versus bad hurt? Do you have tips that you give  people that, cause we can all use help with that? I think,  

00:10:31 

Jennifer Crane 

Yeah, absolutely. This is something that I see so often across all performing arts is I think that mentality is really  ingrained. Something that is really helpful, at least when I like, if I'm having an initial evaluation with a patient  and I'm asking, okay, well you said your shoulder hurts when you do this. Can you tell me more about what that  feels like, what that sensation is? and then, I'll usually start with the, is this, does it feel like productive  discomfort? Like if you keep doing it will make you stronger or better or help you achieve your goals faster, or  does it feel like if you keep doing that thing, it will hinder your progress and that is kind of giving you that  alarm signal from your body. I think just distinguishing, is it good hurt? Is it a productive discomfort or non  productive? And, and or if you keep doing it, will it help you or hurt you just really stepping back to those basic  foundations because we've so many of these artists have just been so conditioned to label any negative sensation  as it's fine pushed through it.  

00:11:32 

Jennifer Crane 

This will make me stronger. It's almost the opposite of what we see in chronic pain patients where everything is  a threat, right? This is like nothing as a threat, but local tissue damage that needs to be addressed. It's like they're  the polar opposites. I think that the first time I recognized that I was like, Oh my gosh, this is fascinating from a  nervous system perspective. From just that kind of total systems approach, I guess, to see how these artists have  literally wired their bodies differently.  

00:12:03 

Linda Bluestein 

Right. That's a big reason why Jen milliner and I are doing what we're doing because we're trying to catch  dancers, circus performers, et cetera, while they are still able to do their sport, their activity, their performing art  and help them be as functional as possible so that they don't end up in chronic pain because one you're right.  Once that happens, then it becomes so much harder to get the nervous system back to a healthy place. So. Okay.  I'm curious, were you always interested in hyper-mobility or did that come along as you dug deeper into,  working with circus artists?  

00:12:39 

Jennifer Crane 

I've always been interested in it personally. It's never been in my early career. I didn't like, I, I just didn't work  with patients that had that very often. It was never something I really pursued. It was kind of also something that  like Haman found me and I I'm hyper mobile. I have hypermobile EDS. This is something that like, I've been  pretty lucky personally with how much it has and has not affected me, but it's really, it's like once you see  someone that has EDS or hypermobility or experience with that, like yourself, you can pick them out a mile  away and then you can be like, Oh yeah, like you probably also have this, let me do, let me talk to you more  about this. And, it helps me look at some different things that I might not, if I didn't get that kind of visual cue,  but yeah, it's definitely really fascinating to me.  

00:13:33 

Jennifer Crane 

I think that the Most fascinating thing to me is the stigma surrounding it. The type of education that these artists  get from most healthcare providers is I think so much more done detrimental in general than helpful, because  basically when they're diagnosed, most of the stories that I hear from my patients and my students is something  along the lines of like, yeah, well, they diagnosed me with this. They said that I was very fragile. If I kept doing  what I want to do, that I will break myself. They told me to stop training and I don't know what to do, because I  don't have any information about this. That was really what, like grabbed me and pulled me in to be like, this is  the problem. I need to talk about this. Like, look a little more into all of the issues surrounding this population.  Right.  

00:14:23 

Jennifer Crane 

Basically stop moving and wrap yourself in cotton wool. Right. The worst thing that you can do for yourself, if  your worst thing that you can do. Yeah. Yeah. I have so many dancers that who are hypermobile and when they  retire, they're like, I'm just going to take a month off and just do nothing. A month later they're like, Oh, it hurts so bad. Yeah. You have, you have to keep moving. You have to stay healthy and keep moving in a healthy way.  Yeah, absolutely.  

00:14:52 

Linda Bluestein 

Yeah. And, and you did such a fascinating study a couple of years ago. I believe it was that, when you were  talking about the different, impact that, visits to healthcare professionals would have on people, and I've done  similar kinds of studies, I don't think I've gotten, I don't think I got as many responses as you did, or at least not  as many, really descriptive, narratives from people, right. I mean, you have a really wonderful collection of  these responses. I think we could do a whole entire episode just about that alone. I was fascinated when you  shared that information. There anything from that though that you want to, while we're kind of talking about,  other experiences that people have had and what led you to where you are today? Is there anything else that you  want to add from that study, particularly?  

00:15:41 

Jennifer Crane 

Yeah. Also, I just want to clarify using the word study is like, yeah, this is a, basically like a survey that I  created and put out to all my Instagram followers on my mailing list, asking for those who were performing  artists and had a diagnosis of EDS. I just was really curious what their experience was with healthcare. I think I  got mostly US-based responses, but there are a few that were from Canada and from Europe also, but I was just  really, I was really interested to know if people who had this EDS diagnosis, if they felt that it was something  that was helpful for them that helps to guide their treatment or gave them, or basically what was it, something  that empowered them or was it something that was like a huge downer, like, Oh, I have this disease I'm fragile.  Like everything, like my life is over.  

00:16:39 

Jennifer Crane 

I just wanted to know what the implications of seeking care were, for a lot of different reasons. Yeah, I was just  curious to see what was happening with everyone else. Yeah. I think that the most fascinating thing, or one of  the fascinating things is that almost everybody said, because this is the question that I get, and I'm sure both of  you get all the time from people who are hypermobile that think they have EDS, but they're like, I don't know if  it's worth getting tested, like would getting tested, change anything in my quality of life for, in how I treat this or  do I just like kind of strengthen and be smart with everything regardless. And that's a great question. Especially  if we take a step back and look at a broader perspective of the current situation of us health insurance, where  there are a lot of potential implications of seeking a formal diagnosis.  

00:17:27 

Jennifer Crane 

I know a lot of people are very hesitant to do that because they're afraid that it will give them a stamp of a pre existing condition. That will, alter what care they get moving forward. Whereas people in Canada actually have  the opposite experience where they're like, if I get a diagnosis that will give me access to more care and it  doesn't negatively impact the health insurance side of things, just that I was really fascinated with. Yeah, most  people were really felt that the diagnosis alone was incredibly helpful for them, for at least giving them it gave  them a sense of understanding that what they were feeling was valid, that their symptoms are for a reason. That  there's a name for what they're feeling. There is a path moving forward and they at least now know what types  of questions to ask and what providers to go to get those answers.  

00:18:22 

Jennifer Crane 

I think that when we're just like, if we're experiencing all of the symptoms of EDS and isolation, it can be really  confusing and incredibly helpless, you feel so helpless if you have all these things and you don't know if you're  making them up and maybe your healthcare providers are gaslighting you without trying. It's, it's one of those  really big, mental health issues too. That was one of my most interesting findings from that study, but study  survey. Yeah.  

00:18:53 

Linda Bluestein 

Yeah. It was an awesome survey. I think that's exactly what happens when other people start when other people  doubt us. I think it's very common to doubt ourselves. Yeah. And then we say we're as well. I mean, all three of  us have had dance as a significant part of our lives. You're used to pretending like, everything's fine. Cause you have to for the audience. Right. You can pretend until you get to a certain point and then you can't pretend  anymore. Cause it's the problems start to get to be too big. So, yeah, absolutely. Yeah. What advice do you give  hypermobile athletes looking for a career in circus arts? do you see hypermobility and a performer and worry  about their long-term ability to stay injury free?  

00:19:38 

Jennifer Crane 

I don't worry about that directly, but I do. If I can catch them early enough in their career, I'm like, Ooh, I need  to tell you a few things before you get out into the rest of the world of health care providers that maybe are more  of the, fragility narrative type. I think that one of the things that's also been really interesting for me to see in  circus and hypermobility in circus is that so many it's exactly like you were saying earlier where starting circus  and starting any activity that has a high strength building component is so good for all of the symptoms involved  in hypermobility and EDS. I definitely, I try to the narrative that I try to tell my patients when I'm working with  them is a lot more along the lines of, okay, so we know you're hypermobile. We know you, whatever diagnosis  they have or don't have, like, we know that this is something that you deal with.  

00:20:33 

Jennifer Crane 

There are a lot of different things that you can do to help manage any symptoms that you have. It's super  important that we work on specific strengthening for circus because you have to work at your end range. If your  body doesn't know how to protect you in that position, if all your stabilizers don't know how to stay strong there,  then you like other people are at a higher risk of injury and people that are hypermobile do have a little higher  risk of that. Really, I mean, that's a risk factor I see across all of my circus patients is if you aren't strong at your  end range, like you're going, you're more likely to get hurt. So I talk a lot. I usually, I talk a lot about that. I talk  a lot about just what the steps are moving forward and okay, you're going to have to prioritize a few different  things, but, and then I also try to spin it towards the good news is the exercises and the strengthening drills that  we're going to do to get you strong and range will also help your active flexibility.  

00:21:33 

Jennifer Crane 

All like all of your tricks will look better too. That's like the easiest thing to get buy-in is to be like, Oh, you  want better inverted splits on your apparatus. Great. Let's do these drills. It'll also help your hypermobility.  

00:21:47 

Linda Bluestein 

That's fantastic. Rather than them feeling like they have to choose definitely. What I want this or that. Okay.  That's awesome. What about your advice with, and your approach to patients depending on age and whether or  not they already have developed some, more persistent pain problem? How does that change your approach to  working with them?  

00:22:08 

Jennifer Crane 

Yeah, I think that age, I mean, it depends on, yeah, it depends on a lot of different factors, but anytime there's  the presence of pain, then, I always want to take a second to talk about, okay, well, anytime your body feels that  pain signal, whatever drills you're doing, aren't going to be productive. That's just something like that's, it's not  going to be the most efficient way for you to further your training right now, even though you're injured, even if  you're not training, there are still so many things that you can do to get stronger and to help rehab this. I really  try to keep hammering on that pain narrative. That more pain is not always better. It's not no pain, no gain.  Depending on how old they are or how long they've been in circus that's, that will sometimes also change the  type of education that I give as far as recovery, especially, as we age, we need, more time in between training,  we need to give everybody's more time to recover.  

00:23:08 

Jennifer Crane 

I think that there are a lot of really helpful metrics that we can use that are very readily available to us in this  world of technology to help understand recovery better. So I usually just talk about that. Say everyone's  different. I rarely will be like, Oh, you're old. I actually don't think I've ever whatever. It would be like older, it's  just like, everyone's, body's recovered differently and this is how you can track recovery. This is how you can  tell when, you're ready to move on to the next training day or if you need another active recovery day. That's  usually some form of that dialogue. So. 

00:23:46 

Jennifer Milner 

I wanted to circle back to something you said earlier, you said that circus has a high strength component. When  people, when outsiders think of the surface circus, they think high Trix component, like that's what they think of  first is what kind of tricks, what kind of flexibility, what kind of weird stuff can they do? so I love that you said  that's kind of what you start with is the strength component, but everybody wants to talk about stretching. How  

do you approach, stretching for hypermobility circus artists, especially in their end range? Like what kind of  conversations do you have with them? What kind of guidelines do you give to them?  

00:24:22 

Jennifer Crane 

Yeah, absolutely. I mean, again, it depends on if this, the person with pain or a person who is hypermobile, but  does not have pain. I think that in the instance of if you don't have pain, I, I think that I've seen the pendulum of  passive stretching swing really far, one direction, and then really far the opposite direction. I think that when I  was growing up and dancing, were all like super gung ho passive stretching. Let's just, sit in our over splits, be  pushed. This is how it's always been done. This is how we will do it forever. In the past five years, 10 years,  maybe I've seen the pendulum swing to the opposite direction of passive stretching is always bad. This will hurt  you. This is damaging only active flexibility. I really think that there is a happy medium. I don't think there's  anything inherently wrong with passive stretching, but I think that where it does go wrong is when people  actually just relax completely in a stretch.  

00:25:16 

Jennifer Crane 

I have no problem with static stretching in the absence of pain, in people who are hyper mobile, if they're aware  of all of the muscle engagements that need to happen from their feet to their core, it's a very active position and  active stretch. If they understand that and can do that and don't feel pain, I'm pretty okay with it. That's how I  usually approach passive stretching. Of course, I mean, my main focus is on active flexibility and range control.  I emphasize that and all of the programs that I create with all my students, but there's often a static stretching  component where it's more of like a long endurance hold. Yeah, I think that the pendulum is probably okay to  return to the middle. I think that most hypermobile people do need to focus way more on active flexibility and  strength and control. Once they have that, then I don't see any problem with holding that position.  

00:26:16 

Jennifer Milner 

I want to make sure everybody heard this because, this is something that I try to work with on my dancers. And,  and when we talk about active stretching, it doesn't necessarily look like active because some people in their  mind active stretching, you're like lunging for your foot and like really working hard to reach your foot. An  active stretching sometimes looks more like exercising. And, and it's hard for me to convince my dancers that  doing these exercises makes you more. So.  

00:26:44 

Jennifer Crane 

Will you just elaborate on that? Yeah, absolutely. I usually have that kind of the patient, who's like, Oh, I don't  know if I believe this. What I'll talk about is the nervous system. I'll say, okay, well, if we think about it from a  systems, can system control perspective. If our body is flexible and can get to this super high end range over  split, but if our body doesn't know how to control and stabilize that position, a you're going to be more at a  higher risk of injury, but B you're also not going to, like, you can continue to stretch passively and relax into  your stretches, but you're not going to make nearly as much progress because your body knows that you're not  strong there. Maybe you'll make some improvement within that session. Typically what I see is after that  stretching session, if they don't solidify it with active and range control drills, their nervous system, just rewinds  and takes those steps right back.  

00:27:45 

Jennifer Crane 

It, you kind of just don't make any progress. It's not efficient. It's a waste of your time and it's, you're not doing  what your body needs. Usually I, I talk about that and how it's actually way more efficient and your passive  stretching will be way you'll get more out of your passive stretching if you're static, hold stretching. If you also  do these active drills. That's great. So, 

00:28:11 

Linda Bluestein 

I w I, I wanted to ask her to elaborate too on this, and because this is so incredibly important because like, this  is, I just feel like this is such a hot topic. Everyone wants more and more, especially now with social media and  all of that. So, in terms of what that feels like, or when you're talking about the drills, could you just elaborate  just further on that, just to give so that for people who like might not know what is it that I'm looking for in my  body when I'm doing this?  

00:28:41 

Jennifer Crane 

I'm sorry, which part? The active flexibility drills, like the end-range control ones? yes, that would be good.  Yeah. Yeah. I usually, I talk about like a standing leg scale, right? So if we, if you're standing and you grab your  ankle and pull your leg towards your head, as far as you can. That's like a, a passive stretch that we see all the  time. If you take that position and you look at yourself in the mirror and see how high your leg is, and then if  you let go of your leg and have to actively hold it there, like how much of a gap is there? Does your leg drop a  ton? If so, then that is the range that you need to work in. What I talk about when I find those specific drills is  like, I usually use that as a kind of snapshot for the buy-in for like, okay, see how much of a difference that is  between when you're holding your leg, versus when you let it go and your muscle have to do that work.  

00:29:35 

Jennifer Crane 

It would be nice if you could just hold it there. Right. You want that? Yes. Cool. Okay. Like then we wind up  kind of back to in that position, what is the, what joint or what area needs to be strong in that position that  currently isn't strong and what other parts might be compensating? So, for example, like our low back and our  low back muscles tend to compensate for a lot of like Arabic skills with, if our leg is behind us and we're lifting  our leg, our low back uses all or contributes a lot to that movement. If we look at how much hip extension we  can get for that position with only the glutes working, so usually I'll assess this in like a lumbar locked position,  or like a modified child's pose with one leg back and kind of sitting on the other leg. 

00:30:25 

Jennifer Crane 

If you can have them lift their leg there and feel how difficult that is compared to that air best that also tells  them, Oh my gosh, like I can't lift my leg at all here. Wow. My glutes are really not doing Oh, okay. Like I get  that. Like, I find that if I can just show them where their area of weaknesses that is super helpful, and then they  can also feel in that isolated and whatever position it is that isolates the body part or the muscle that isn't doing,  what we want it to for that end-range control. If we can isolate that and show it to them and tell them, this is  what it should feel like, engage the muscle that you feel working now that is super helpful to at least help them  understand the importance of it and the relevance. Aesthetically.  

00:31:12 

Jennifer Milner 

Thank you. That's a great elaboration on it. I appreciate that. Talking about working on strength, do you  approach strengthening people with hypermobility differently than people who are, do not have hypermobility  and we're talking not just like a little flexibility, but maybe hyper-mobility issues or significant hypermobility.  

00:31:34 

Jennifer Crane 

Yeah. I think anybody with hypermobility definitely needs a lot more supervision for technique in the early  phases of strength training. That's something where you can just education on, okay. You like when you're doing  this, you're standing with your knees locked out, or when you're in this position, your wrist really needs to not  be that deviated to the side here. I think that I find that they just can't get away with nearly as much of a  technical fault in a basic strength exercise as someone without hypermobility. It just, I, they require a lot more  kind of supervision and understanding of what they need to be doing and why it's so much more important for  them versus others.  

00:32:19 

Jennifer Milner 

Along with that, do you see proprioceptive issues as well? 

00:32:25 

Jennifer Crane 

Yeah. It's, so it's really hard to tell in circus, because if we're talking about an aerialist who is an upper body  dominant athlete, all of us have terrible proprioception on the ground upright. It's so different from dancers  where the base level of proprioception is so high in dancers in circus, unless they're a drowned Acrobat. We  kind of, it's a little different, but as far as upper extremity, neuroception, it does seem if I had to take a, if I have  to make like a general statement of what I see with hypermobile circus artists, their upper extremity  proprioception is definitely less than their non hypermobile counterparts, but it's also, it depends on what body  region we're talking about, because it's different of a baseline than a dancer or ground Acrobat. Sure. Kind of  going further with that. How do you approach working with circus artists to have some joint misalignment? So  that's, I mean, that's even less proprioception, I would think, but like working with people who tendency to  subluxate or dislocate, how do you approach working with that? that I think if we're talking about like people  who have common, like patellar subluxations or something like that shoulder.  

00:33:51 

Jennifer Crane 

Yeah. That's harder, I think, to generalize with those types of people. I usually try to talk a lot about the  sensation involved in like the moment or the moments leading up to that happening. Like, can you, because  most people know when I'm in this position, I feel unstable. It's a conversation of, okay, so let's find an exercise  that takes you right up to that point of the start of the unstable feeling and back off and strengthen there and get  strong there. We'll reassess at what point in the range does that feeling of instability happen? And that can kind  of be our litmus test moving forward. Excellent. I love that approach. It's very similar to the active stretching  that you were talking about. Let's find that range of motion and then go right behind that and strengthen that  until we can get to where we want to get to.  

00:34:45 

Jennifer Crane 

That's great.  

00:34:46 

Linda Bluestein 

That's also a lot like when, people that have migraines can get auras, but they can also get pre auras. If you can  treat their migraines when they have the pre aura and not even wait for the aura, it's even better. So, yeah. That's,  I love that's really getting people in tune with their bodies and helping them identify those things. Yeah.  

00:35:09 

Jennifer Crane 

Hearing, yeah. Hearing the thing before the thing. Well, and I have a shoulder that subluxated all the time and  that's how I try to train myself as I go right up to that point. I'm like, Oh, I feel it. I try to work right before that  point just to see if I can get it stronger. Yeah. It's I have the same when I, before I started circus, my shoulders  were so floppy and would sublux when I sneezed it was ridiculous. That feeling like it's crazy how just starting  

aerial training. When I started like maybe six months after I started really diving into a lot of aerial work, my  shoulders never felt better. My neck pain went away. Like it helped me wow. The little issues that were  associated with hypermobility that it's just building muscle is so helpful. Just hypertrophying muscle to support  the joint.  

00:36:04 

Jennifer Milner 

Yeah. That's so interesting because I think about aerials and I'm like, I can't imagine working in silks with my  shoulder, but I should like push myself to try to strengthen it more. Yeah. So go ahead. Sorry. No,  

00:36:19 

Jennifer Crane 

Yeah. I felt the same way before I started. So understand.  

00:36:21 

Jennifer Milner 

That for sure. So, one of the things we wanted touch on was social media and how social media sorta affects of  effects, the younger generation coming up and they see these tricks and they see the crazy flexibility and they see all these amazing things. How, what would you say to the younger performers who are looking at social  media and being influenced by it? what would you say to them about it?  

00:36:51 

Jennifer Crane 

Yeah, that's, it's interesting because I feel like it's probably the same in the dance world where a lot of us in  circus arts who are on social media posts, the best of right. We did that week. What you don't see is all of the 45  minute warmup leading up to it, all of the technical skill prep, all of the times that we've worked with coaches,  you just really see that end result. I think I would just encourage people to recognize that and also to seek out  accounts that also show everything that goes into training, because there are a ton of accountants like that to the  talk about not only like the nice finished product, but how hard it was to get there and how much work went into  it and the thought process and what that looked like. I would encourage them to just take a step back, look at the  whole picture and understand that's such a small snippet of real life.  

00:37:47 

Jennifer Milner 

Yeah. Every time I see, a dancer that I follow posts, a video of them falling out of a Pirro at, it makes me so  happy because my dancers need to know people fall out of pure wet. The next time you try it, maybe you'll do  seven, but it's good to know that, dusty button or whoever does not always have a great Piero at coming out and  nothing for her specifically, but just you can follow great artists, but also know that what you see is that snippet.  The chance to see them fail is just for the good ones for the good artists. That them saying, well, that didn't  work. What should I try next? So I love that you encourage them to seek out accounts where you can see  yourself trying, and seeing what works and what doesn't work. Sure, sure.  

00:38:36 

Jennifer Crane 

Are there any trends that you have observed over the past few years in circus? I know you've talked about the  desire to kind of codify things. You've also talked about seeing the pendulum for overstretching start to swing.  There anything else that you've noticed that is happening within the circus arts, from kind of a sports medicine  perspective? I think the most interesting shifts that I'm seeing is just the, that shift. That's just starting to happen  where artists are really starting to take their work as athletic work and just that mental shift. Once everything is  kind of reframed through that lens, then I'm seeing a lot more interesting of questions from these artists. It's like,  okay, well you tell me that rest days are important for high-level athletes. And I think that's me. How do I know  what I need a rest day? How do I know if I'm over-training and now this, these questions surrounding that  recovery and periodization, that's really cool.  

00:39:36 

Jennifer Crane 

That's where I'm just starting to see a lot of people get super into disco, going into that realm,  

00:39:45 

Linda Bluestein 

More people doing that. Do you see any kind of a difference in terms of injury rates or ability to heal from more  minor injuries or anything like that?  

00:39:55 

Jennifer Crane 

Yeah, I mean, absolutely surprising. Nobody cross training is so good for everyone regardless of sport.  Shocking. Yeah. Yeah. I think circus is just amplified how helpful it is and in circus, because nobody's cost  training, like there's, this is not a seasonal sport there. If you're a professional artist, often you're touring and  you're, like you tour you around and you get maybe a week break every few months, or maybe, you have 10, 11,  12 shows a week and it's like a really grueling stretch for a long time. If you throw in any amount of  periodization at all, it's just like crazy how much it helps. Like I can't tell you how many messages I received  from artists after I have the really hard conversation with them about, you need to take an active rest week  where you don't train your primary discipline and focus on like nervous system reset and then come back to  training.  

00:41:02 

Jennifer Crane 

The thought of that is horrifying to all circus artists. They just, one of the popular hashtags on Instagram is circus every damn day. It's just such a good example of the mentality in circus, but yeah, when they take their,  when they finally take their rest week after, we have that spirited debate for at least a day or two, they come  back after their rest week and I get a message that says, Oh my gosh, I finally got this skill I've been working on  for a year or, Oh my gosh, I finally trained flexibility or contortion and I didn't have back pain or like, it's  always about unlocking a new skill. That's what I think is so fascinating and just really strengthens the argument  and the via. Because I have so many of these screenshots that I can just be like, look, it's not just me making me  that.  

00:41:57 

Jennifer Crane 

Yeah, that has to be so immensely gratifying for you though, to be able to see that the hard conversations that  you're having and the work that you're putting into it, bear fruit with them, taking ownership of their bodies as  athletes and giving themselves more longevity in their career. It's awesome. It's so, I mean, it's just so gratifying  for me and so empowering for them and everyone's happy and everyone wins well, and I've had so many  conversations with my dancers, like at the end of Nutcracker season, talking about that active rest and saying,  you're not allowed to date dance, go bike riding, go bowling, do something. Right. But don't dance. Just give  yourself that break, do something else. When they do that and they come back feeling better, but you're just like,  yeah, it's great. It's like a positive data point for them. Right. Because all of their skills, if they take a week or  two off, they're still gonna.  

00:42:56 

Linda Bluestein 

Right. Do either do either one of you find resistance, I'm thinking of, particularly for ballet teachers, maybe that,  do you find resistance from other people that are involved in working with these athletes and artists, when you  say take an active rest week, off that, do you find resistance from other people or,  

00:43:17 

Jennifer Crane 

You know, coaching depending on the setting. In like a recreational setting, if like I have a day job and I just do  circus for fun, but I do it like five days a week and I'm really into it. Those coaches usually see the problem and  are like, yes, take the week. Like listen to Jen, do the thing. I don't see, I think it's a little different from dance in  that respect. There, there are certainly some older school coaches that are still like, we'll put up a fight, but  

that's, I like, I'm not going to change that coach's mind. If they've been that way forever, then the patient is really  who I'm invested in changing their minds. I kind of just let that be. And, if I work with a lot of that, coaches,  students over a period of time, and this happened to me when I lived in San Francisco and worked at circa center  there, they watch and they see me working with people and, maybe six months passes and then they're like, Hey,  so what do you think about this person?  

00:44:17 

Jennifer Crane 

Do they need a rest week, one game? like you have to show results because it's healthcare providers have a  really bad name in circus. Like we don't tend to, we don't have a history of fixing things quickly or helping  athletes. We have to kind of show sure that we know what we're talking about. Yeah.  

00:44:42 

Jennifer Milner 

That's so fantastic. And, and dance wise, I see which I think you do too. It's either all or nothing. You go to the  doctor that says, stop moving for a month, put on the boot, sit on the couch, eat your chocolate ice cream. In a  month that injury will be magically better. Right. Or you see the ones who are afraid to have to stop moving. So  they're told, keep, just keep going. Just kind of keep limping through class, do the best that you can adjust as  you need to, but do as much as you can because they're so afraid that if the artist takes time off, they're going to  lose everything else. It's that no, there's something in between that you can do. That's going to be smarter and  more efficient and they're going to come back better. That's the hard part for them to grasp until they see it.  

00:45:26 

Jennifer Milner 

Like you said, once they see it, they're there all the way on. Yeah, for sure. Well, do you, is there anything else  you wanted to talk about? Did you have anything else burning on your heart and also where can people find  you? 

00:45:38 

Jennifer Crane 

Yeah, no, I think we hit some great topics of conversation for the hyper mobile bendy buddies. Yeah, so I can be  found pretty much everywhere online, on Instagram is where I'm most active. My Instagram handle is circ  underscore physio and where else I'm mostly just on Instagram, I'm on Facebook nearly as much. And my  website is Cirque physio.com. I do one of the things that I have, that I offer is I have a flexibility program that  really was founded on the principles of hypermobility. Right. Do it has all of the active flexibility drills. It's a  slightly different type of flexibility assessments than we normally do in circus and performing arts where the  question is, can you do a split check? Yes or no? It's more of like a physio perspective assessment. Yeah, that's  also on my website and yeah, I think those are all the places I am online.  

00:46:37 

Jennifer Milner 

That something just because I know several of my dancers probably heard that and were like super interested, is  that something that they can do online? Is it like an online course you can sign up for?  

00:46:47 

Jennifer Crane 

Yeah. It's basically like a two in one educational course product where you just learn things about flexibility  from more of a biomechanics perspective with more of my physio brain. It's also a assessment. It's a guided self  assessment where they go, they log onto their website and they are guided through all of the different parts of a  total body assessment. I look at things that, like a lot of flexibility coaches might not look at like sciatic nerve  tension or hip internal rotation. Both of those things have a big bearing on, hamstring, flexibility and pike and  over splits. I look at, I take them through the whole assessment and then they submit their results. I look at the  results, I look at their flexibility photos and then I make them a customized program that they can log in when  I'm done with that. Just kind of follow along, stretch with the video.  

00:47:40 

Jennifer Crane 

That's most of what I'm doing right now from a flexibility coaching perspective. That's amazing. That's, that  sounds like a great program. I, I think several of my dancers will, are logging on right now as well. I think it's  great for the dancers and the artists who really want to know more about why their body, like, why they're  hitting my toes. It's more of a, like, what's the rationale behind this, teach me more about my body so that I can  implement these things in the future. It's definitely. You really have to want to be, you have to err, on the side  of, I am nerdy and interested in flexibility, accessible vocabulary perspective, but you have to want to like know  a little more, cause it's definitely an investment cognitively.  

00:48:29 

Linda Bluestein 

That, that does sound fantastic because too, if you don't, even if you're hyper mobile and maybe you aren't  dancing anymore or doing circus anymore, and if you don't stretch, then you're going to get tighter and tighter.  I'm glad that you brought up about like neural tension because these are the kinds of problems that oftentimes by  the time they come to me, they're like, yeah, I did gymnastics. I did dance. I did all these things, quite a long  time ago, but now they're so incredibly tight. They go to a regular quote, unquote, regular doctor or regular  physio who doesn't identify them as being hypermobile at all. It wouldn't even be on their radar that could have  been possibly a problem in their past. So.  

00:49:11 

Jennifer Crane 

That's so great. I love that. Well, thank you so much for coming on and for having this great conversation with  us, you have been listening to bendy bodies with the hyper-mobility MD today. Our guest has been Dr. Jen  crane, performing arts, physio, and travel physio with Cirque de Solei, aerialist and dancer and flexibility coach  Dr. Crane. Thank you so much for taking the time to come on Vendee bodies podcast and for sharing your  knowledge with us today. Thanks for having me.  

00:49:40 

Linda Bluestein 

Thank you for listening to the bendy bodies podcast. Please visit our website www.bendybodies.org for more  information, and to access the show notes. If you are enjoying this podcast, please remember to subscribe and leave a review. For a limited time, you can win an autographed copy of the popular textbook disjointed  navigating the diagnosis and management of hypermobile Ehlers-Danlos syndrome and hypermobility spectrum  disorders. Just by giving us a shout out on Instagram or Facebook and tagging at bendy bodies podcast. The  thoughts and opinions expressed on this podcast are solely of the co-hosts and their guests. They do not  necessarily represent the views and opinions of any organization. The thoughts and opinions do not constitute  medical advice and should not be used in any legal capacity whatsoever. We'll catch you next time on the bendy  bodies podcast.