60. Strengthening Precision with Monica Lorenzo, MS, ATC

Episodes have been transcribed to improve the accessibility of this information. Our best attempts have been made to ensure accuracy,  however, if you discover a possible error please notify us at info@bendybodies.org

00:00
Monica Lorenzo
I like to say that stability allows for more mobility. I know that may be the antithesis for our hypermobile athlete, but it truly is. Stability allows for more mobility because it allows them to actually maybe reach these controlled edges that will elongate their careers, will reduce their injury rates, and will allow them to perform at a grander capacity without that over, looming fear of injury. 

00:40
Jennifer Milner
Welcome back to the Bendy Bodies podcast, where we speak with experts bringing you state of the art information to help you improve your well being, enhance your performance, and optimize career longevity. This is co host Jennifer Milner, here with the hypermobility MD linda Bluestein. 

00:56
Dr. Linda Bluestein
We are so glad you are here to learn tips to help you self manage your conditions and live your best Bendy life. This information is for educational purposes only and is not a substitute for medical advice. 

01:08
Jennifer Milner
I'm Jennifer Milner, a former professional ballet and Broadway dancer, and I struggled my whole career with hypermobility related issues and injuries. Now I train dancers and want to make sure the next generation of hypermobile artists are better equipped to work to their fullest potential. 

01:25
Dr. Linda Bluestein
And I'm Linda Bluestein, and I started this podcast to educate the Hypermobile community because despite being a physician, I experienced decades of symptoms before being finally diagnosed with Hypermobile Eds. I get how frustrating it can be to be gaslit and feel completely alone in your journey. 

01:43
Jennifer Milner
Our guest today is Monica Lorenzo, founder of Romofit and a corrective exercise specialist who has trained lots of dancers, including working with dance teams like the Nick City Dancers as well as the Rockettes and Cirque du Soleil. Hello, Monica. And welcome to Bendy Bodies. 

02:00
Monica Lorenzo
Thank you so much. I'm so glad to be here. 

02:02
Dr. Linda Bluestein
We're thrilled to get to chat with you today. 

02:05
Monica Lorenzo
Likewise. I'm very excited for this chat. 

02:09
Jennifer Milner
Well, so before we jump into the topic that we wanted to talk with you about today, could you just tell our listeners a little bit about yourself? 

02:17
Monica Lorenzo
Absolutely. So I am an athletic trainer based in New York City, and I started my journey as a performer myself. So I grew up in Queens, New York, and a local dance studio. I started dancing and then transitioned into the competitive aspect of the dance world. So I was trained in all different aspects of dance, and then I attended LaGuardia School of Performing Arts for high school as a dance major. And that's where I really deepened my classical training in ballet and the gram technique in modern. And while I was at a dancer in high school, you start that journey of looking for your university. And at the time, this was many years ago, and at the time, the return from an injury for the performing athlete was something that I didn't see. So I fortunately, had never suffered a really bad injury. However, I never saw a performer recover from a bad injury. 

03:10
Monica Lorenzo
Unfortunately, I just saw that the career basically ended. So as I was searching on my journey for university, the fear of a career ending injury was looming over my mind, and I was scared. I said, well, what if something happens to me? How do I feed myself in a post injury world as a dancer? So discussing this with my ballet teacher, actually, at LaGuardia, she said, Why don't you think about the world of physical therapy? If you ever choose to bridge your two worlds between PT, you can work with artists, and that may be an avenue for you to go down in the future. And for some reason, that just didn't seem abnormal to me. It wasn't something that made me say, no, absolutely not. A light bulb went off. So I'm really grateful for that conversation with her, because that then started my journey. 

03:55
Monica Lorenzo
I decided to look into universities that had physical therapy and also dance as well, because I wasn't ready to finish my dance career. I wanted to continue to train, and I felt I was in New York and I had a great variety of performance choreographers, teachers, instructors that I could keep training and look towards building a career as a professional dancer, but supplement with an academic degree on the side as well, just in case I got hurt. I can continue to support myself. That transitioned me into interning at a physical therapy clinic. And at the time, the director said to me, why don't you look into athletic training as your undergraduate degree? I think that would be great. Mind you, I can take a step back. I chose Stony Brook University as my university in Long Island because I could stay in New York City, continue to train as a dancer, and audition and be on that circuit and then attend graduate schools for physical therapy. 

04:50
Monica Lorenzo
So my undergraduate at the time was now biology and business. I never met an athletic trainer. I didn't know anything about that career whatsoever when I started this journey. And so the director of the physical therapy clinic said, why don't you think about athletic training for your undergraduate degree? You're a performer. You're excelling as an aide in this area. You really have passion. And I said, I don't know what an athletic trainer is. What is that? And so he instructed me a little bit about the profession of athletic training. And also the assistant athletic trainer to the Radio City Rockets worked for the same facility on an opposite shift. And he said, I would really love to introduce you to Meg Schneider. She's the assistant at Radio City. And she comes in later that day, and I'll connect both of you, and you're already enrolled at Stonybrook University, which has a great athletic training program. 

05:40
Monica Lorenzo
So ding, ding. I was like, okay, cool. This is great. I'm on the road. And that afternoon, Meg actually came into the PT clinic early. We connected immediately. She took me under her wing and brought me over to Radio City. I learned about their athletic training in house, full care athletic training program that was originated by Raquette herself, Elaine Winslow Redmond. And honestly, within the first day, I knew that this was my calling. This career path was my calling. I made a phone call immediately to the director of curriculum at Sun River University and transitioned into the athletic training program there, and the rest is history. And that's how I became an athletic trainer. I felt that, for me, my full encompassed care of caring for a team was what I thought my physical therapy life would be, if that makes sense. So the injury prevention, working with the team from beginning to end, and having that sideline care was something that I envisioned as a physical therapist. 

06:43
Monica Lorenzo
But realizing that athletic training is really what housed more of that curriculum, I should say, and more of the job protocol. So learning under the wing with Elaine Winslow at Radio City, like I said, really showed me that caring for the performing athlete was more of my calling than being a professional performer myself. So I made that transition about my sophomore year of university, and I never looked back. And I didn't feel like I was losing any part of myself. I felt like I was gaining a greater part of myself. So from that moment once I transitioned, that was it. I knew I wanted to work with performing artists, and I wanted to provide them the care that I had never seen nor received. And I also wanted to provide athletic trainers jobs in the performing arts because as I continued my educational journey and my professional career, I realized that many athletic training roles are lacking in the performing arts, and they are great assets to working in conjunction with all the medical community that works with performing artists. 

07:42
Monica Lorenzo
So that became one of my missions as I continued on and have built my companies and now service dance teams with athletic training programs. 

07:52
Jennifer Milner
Wow, that is a really serendipitous and also very focused and sort of single minded. I don't know if it can be fortuitous and focused at the same time, but that was a really I would. 

08:03
Monica Lorenzo
Describe it like that. 

08:04
Jennifer Milner
Yeah, that was a really interesting path, and thank you for describing it, because I think a lot of people don't really understand what athletic trainers do and don't know exactly what they are, other than someone who trains you, which is not really what you go to school for. 

08:19
Monica Lorenzo
Right. 

08:19
Jennifer Milner
It's not like a correction coach or something, although that's part of it. So that's really great, and there are so many different paths we could go down with you, but we want to talk about your experience with precision dance, which doesn't just apply to precision dance. 

08:33
Monica Lorenzo
Right. 

08:33
Jennifer Milner
It also applies to synchronized swimming, competitive gymnastics, anything that's being part of a team. But if you're training with a team of Arabian horses, it's hard as a zebra to fit in and look like everybody else. Right. So that's where I think your information is going to come in. Really be really helpful. So you're an athletic trainer for the Rockets. You've worked with the New York Knicks dance team. So how is precision dance different than other forms of dance? 

09:02
Monica Lorenzo
Let's start with that. Sure. I would describe precision dance. Each performer is kind of this is my unique description. So each performer is performing within their plexiglass sphere. Does that make sense? So you're in this plexiglass sphere where everybody has their boundary line, and your choreography is fitting within that sphere. Right. You can't really push yourself out of that sphere because now you're out of alignment from your teammate next to you. And I want to say plexiglass because there is some movement. So that movement is your creative edge where you can push yourself all the way to the edges, but you do have to still stay within your sphere in order to execute the movement and the pictures and to execute the creative vision that the choreographer and designer have placed on you as a performer. So that's how I describe that. Whereas I feel in the non precision style of dance, you can push your limits a little bit further, and your own creative edge and your own creative execution will be highlighted rather than you having to stay within this sphere so that you can stay within the imagery that's being placed upon you, if that makes sense. 

10:13
Jennifer Milner
Yeah, that's a great description. 

10:14
Dr. Linda Bluestein
That is a great description. 

10:15
Monica Lorenzo
Yeah. 

10:16
Dr. Linda Bluestein
So how might that make precision dance a bit more challenging for hypermobile dancers than, say, for the dancers in something like Cirque du Soleil or a different type of dance company? I'm just curious, like, if you're hypermobile and you're trying to do precision dance, what are some of the challenges that you might face? 

10:34
Monica Lorenzo
It's a great question. I wanted to actually preface this with my first encounter with somebody diagnosed with Eds wasn't a performing athlete. It was actually a private client of mine. So I also worked for Romo Fit. I worked alongside with a physician and was providing strength and conditioning for athletes to kind of bring them either whether they were at their end range of traditional physical therapy, returning to sport, I would work one one with them to bring them back to their full sport. And that was when I was introduced to Eds and I wasn't introduced to this dysfunction in my education academic career. So that was really interesting for me because, oh, my gosh, now Pandora's Box was open because I said to myself, oh, my goodness. I bet you so and so has this. I bet you so and so has this. I bet you so and so has this. 

11:20
Monica Lorenzo
So all of these performers that had now been in my roster, I felt like I opened up a whole new avenue of understanding of their body and their mobility and being able to let them know to go for further testing and to see if they actually were diagnosed with these disorders or not. And so that really was helpful for me. And that was where I started my educational journey on understanding how to work with a hypermobile athlete was not with a performing artist, which was, like I said, really interesting. And in transitioning this to working with a performing athlete in precision style dance, specifically, if you're hypermobile, a lot of now visuals that we will see is sometimes they'll have slower range of motion I'm sorry, slower execution of hitting that end range of motion or that picture. Right. And they will also then have just moments where they don't have that same proprioceptive awareness. 

12:10
Monica Lorenzo
So their end range is going to feel kind off and they're always going to feel like they're being pushed. I like to use this test, the analogy of remember when we had that tickle test when you were a young child and so you put your forearm out and your friend would tickle you from the wrist and you would have to let them know when they got to the crease of your elbow with your eyes closed. Right. And you're always just like about a few centimeters off from the center crease of that elbow. So I would describe that as the experience that the hypermobile athlete may be feeling, where they feel that they're being told to be put in this one position, but they're not responding to the same cues that their colleague may be receiving. So they have to now realign and reassess their proprioceptive awareness through specific queuing that I will work with them with, or whoever else is training alongside with them. 

12:58
Monica Lorenzo
So we'll break down some choreography cues alongside with their strength training to reevaluate and retrain their proprioceptive awareness in that capacity of that choreography, if that makes sense. 

13:12
Dr. Linda Bluestein
Yeah, that's fascinating. And do you notice a difference in terms of movement quality with hypermobile dancers? Like in terms of speed and the precision, clarity, that kind of thing? 

13:24
Monica Lorenzo
Yes, sometimes you'll find so for my hypermobile athletes that don't have that muscle hypertrophy that have been under trained or haven't worked with a specialist to make sure that they are prepared for this style of dance, you will notice that they're not hitting movements as sharp. That's the best way that I can describe from a choreographer's standpoint where they're not actually able to execute that almost like bounce that you'll receive when you hit an end range with a tight snap, that they have a little bit more of like a rebound to their movement. So they'll hit a pose or they'll hit a picture. And where they're now at the perceived end range of motion and instead of having a solid stop, they'll have a little bit more of a bounce, if that makes sense, or a length to their movement. And then they'll have a lag in transition to the next piece of movement in their choreography. 

14:17
Jennifer Milner
And I see that too, in dance. If someone is hypermobile, especially if they tend towards more Eds or somewhere on the disorder spectrum, their energy sort of dissipates rather than stays in there, ready to be gathered back up and used again. So you see them like they land from a jump and the energy just all goes out and then they have to gather it all back up again to try to move. 

14:40
Monica Lorenzo
Right. 

14:41
Jennifer Milner
Or they'll finish a pose and you'll just almost visibly see the energy kind of continue to sort of trickle off of them. It's really interesting once you know what you're looking at, right? 

14:50
Monica Lorenzo
Exactly. I like that analogy. It's like energy leaking almost instead of being able to contain it. So that really actually brings us back into that plexiglass sphere. Right, so there might be this is another I think we've just come up with a new description. So if we have a little bit of a hypermobile dysfunction, there's almost like there's punctured holes in your plexiglass where you're spewing a little bit more energy out, not being able to sustain that within your circle. 

15:15
Dr. Linda Bluestein
I like that as someone who works with a lot of dancers, but not in the capacity that the two of you are working. I'm working more like on their fatigue and their sleep and those kinds of things. And that fatigue piece is really huge for a lot of dancers. And it really makes sense with what both of you are saying, why they would a potential reason why they could feel that. 

15:37
Monica Lorenzo
Absolutely. And that is a big marker as well. Looking for the fatigue post any type of rehearsal or training. I still think that there are many athletic trainers specifically out there who are still under educated in hypermobility dysfunction and being able to assess this in their athletes. So I think understanding that fatigue is something that is really important to look at when you are evaluating comparing your athlete to the other performers that you may be working with. And then obviously we're tackling nutrition and all of the corrective exercises that go along with working with your hypermobile athlete. But fatigue is something that a lot of athletic, that I've noticed colleagues have missed when it comes into the evaluation process. So understanding that and the energy leaking, I think is a great cue to utilize. I'm definitely going to use that in my repertoire now. I like that a lot. 

16:31
Jennifer Milner
Well, and if people are curious about the fatigue issue, we have done an episode on fatigue for people with hypermobility. So be sure to go back and check that out. I have no idea what episode number it is. Dr. Boostin. Do you remember? 

16:45
Dr. Linda Bluestein
I don't remember the number, but we did two back to back episodes, I believe during Fatigue Awareness Month. One with Bendy bodies, registered dietitian nutritionist Kristen Koskanen, and the other one was with physician Alan Pasinki. And so yeah, I don't remember the numbers offhand, but we can also link that in the show. 

17:06
Monica Lorenzo
Absolutely great. 

17:08
Jennifer Milner
So getting back to training the hypermobile dancer, if you have seen this, if you've seen the energy leakage, if they've come to you mentioned that you help them figure out the cues in a way that they understand and can start to feel in their bodies. What else would you suggest? The hypermobile dancer sort of seeking to do precision work might add to her conditioning routine. 

17:28
Monica Lorenzo
So strength training is everything when it comes to working with all of my athletes. So to back up a little bit, I'm fortunate. Once all of my athletes are hired, we take them through a pre screening process. So the Rockets do this, I've implemented this with the Nick City Dancers and we also service the Brooklyn Nets entertainment teams and the Golden State Warriors entertainment teams. They have full athletic training staff that are caring for their athletes. And so post hire, they are taken through a functional analysis where we're looking obviously through range of motion manual, muscle testing and taking them through then a functional dance screen specific to their style because all these different teams have different styles. And then they receive a strength and conditioning program both that we will work alongside with them and something that they can utilize on their own during their home care practice time. 

18:16
Monica Lorenzo
So strength training for me is absolutely everything. So, like I said, working with each individual athlete with whatever baseline they're providing me at that time is something that I'm going to now build their strength training program on. So hypertrophy of their musculoskeletal system is something that I really want to address immediately. We're always going to make sure that they have proper nutrition and that all of their vitals and their blood work, et cetera, is fully in alignment and they're not predisposed to anything, any overtraining issues that may be outside of our box and outside of their dysfunction. And then once we implement them, then we go directly into our strength training programming. So, preseason for the entertainment teams, I have a good two months where we can work through all of the strength and conditioning. And so we bring them into the gym and we're obviously utilizing your basic strength and conditioning protocols. 

19:09
Monica Lorenzo
Queuing, when it comes to my hypermobile athlete is everything. So making sure when we're in any positioning that they're not reaching beyond that range of motion, that they're not putting themselves into a dysfunctional pattern. So working through their muscle activation patterning is something that I really work with when it comes to the hypermobile athlete. A lot of times they now are working on just they're always taught to restrain themselves when it comes to precision style dance. So you see that they're initiating their movement and their energy from their limbs rather than initiating movement and energy source from their core. That's something that I've really noticed when it comes from when evaluating my athletes. And not just the hypermobile athlete, but your typical athlete who doesn't suffer from any hypermobility. So a lot of times core stability and core activation initiation in their biomechanical movement is number one. 

20:01
Monica Lorenzo
And now working with my hypermobile athlete in conjunction next to it's, so interesting when you train them all together in a group style setting, it's a great learning tool for my hypermobile athlete to now see where their unhypermobile athlete, for lack of better terminology, is in body placement, also through movement and muscle activation. So I'm going to give a quick example for a deadlift, let's say, and this works for all artists. Now when we're standing in a deadlift position, so our feet are about hip width apart, and let's say you have any type of resistance that you're holding in your hands as we lower down into that deadlift position, keeping the torso in your flat back. Any dancer who has flexibility can go all the way down to their toes 99% of the time. Now, when we're looking at hip rotation, it's just a simple queuing. 

20:55
Monica Lorenzo
So they don't even realize that they're going into any type of internal rotation at their hips when they're trying to drop all the way down, I'm sorry, external rotation when they're dropping all the way down into a deadlift. So just those typical cues of like, okay, let's just talk about the Add doctors and just firing up our Add doctors and now where are our external rotators, where are our internal rotators? And having them rebalance the way that they're initiating their movement in a deadlift, let's say, just thinking, okay, we have two little tennis balls on the inside of our inner thighs and we're going to tap those two little tennis balls together when we're now in this position, just four degrees down. Okay, let's go five degrees down. Let's continue on. And then coming back up that light bulb of an AHA moment, oh my gosh, I know how to actually control my movement and control my musculoskeletal output immediately shifts the way that they now understand their bodies. 

21:49
Monica Lorenzo
And they don't feel inhibited, they feel empowered. So that's been the way that I've been able to transition training for that hypermobile athlete alongside my non hypermobile athlete. What terminology do you guys like to use. 

22:05
Jennifer Milner
For non hypermobile? We've always just talked about hypermobility and people who are not hypermobile. 

22:13
Dr. Linda Bluestein
And the tricky thing with that is so many dancers are hypermobile, but they might not have an actual syndrome or connective tissue disorder or anything like that. 

22:23
Monica Lorenzo
Correct. 

22:24
Dr. Linda Bluestein
I have heard people say connective tissue typicals, but that's confusing because you can have typical connective tissue but still be hypermobile. Hypermobile, yeah, because hypermobile just refers to the range of motion of a joint. 

22:44
Monica Lorenzo
Exactly. 

22:44
Dr. Linda Bluestein
It is. These things are a tricky conversation to have for a lot of these terms that we use a lot. 

22:52
Monica Lorenzo
Yeah, I realized as were talking, I was like, wow, I knew I was prepared. But now that I'm talking about comparing and contrasting, I'm having a difficult time. I don't want to label anybody improperly. 

23:03
Dr. Linda Bluestein
Well, I think it's fascinating that you're training people in a group setting but yet giving them that individual attention because right, we learn from each other and of course we watch each other in dance class and things like that. But I think it can be really valuable because then you can look at somebody else and see, oh, this is why I'm struggling with this. It just comes so much more easily and more naturally to them because their connective tissue is not as stretchy and then breaks. They have like normal stretchiness and it doesn't break so easily. So I think it's a great way to train people. 

23:48
Jennifer Milner
Absolutely. 

23:49
Monica Lorenzo
I'm fortunate we're training together that there's an open dialogue. So it's not a typical group session where you're just following the instructor along. And it's always a small group of athletes that I'll have together and we can feed off of each other. And I will always ask the question of what sensations are you feeling? Where do you feel this movement? What muscle activations are you feeling at this point in time? So everybody gets to discuss in immediate time and then I will provide obviously corrective queuing throughout and we all learn from each other. And it's really exciting because I learn atypical queuing patterns based off of each individual performer that I can bring into my toolbox and my roulette of verbiage that I like to use when I'm training these athletes. Another function that I have to worry about in all of my athletes is the recovery. 

24:40
Monica Lorenzo
Right. So a lot of times I'm working majority of my athletes, especially on the dance teams, this is not their full time job. So their full time job is either a fitness instructor, they're either professional dancers or they're working in corporate America where they're sitting at their desk for majority of the day. So I do take into account not only are we working on a performance season, which for the NBA is a very long season, so typically a performer is going to get hired in around June, July for their season and then they start rehearsals about a few weeks after their hire. And then games will begin in October. And if you do not go into the playoff season, then you're finished in early April. But if you go into the playoff season, it can go all the way up until June. So that's how long this performance season is. 

25:27
Monica Lorenzo
It waves up and down because majority of these performers are only performing at home games. And so that is sometimes we'll have three or four home games in a week and then they'll have a two week hiatus as the team is on the road. So you do fluctuate intensity and frequency. We also then have to take into account not only those performance fluctuations, but their rehearsal fluctuations. So when we're in an intense performance setting, they're still rehearsing multiple times during the week. So they could be on with six days a week, no days off. So how am I transitioning onto that one day off? How am I advising in their recovery? So recovery and training fluctuate throughout the entire season. We're obviously going to be more intense in our preseason training because that's where we can control a little bit more. And then during our higher level of intensity and performance and rehearsal season, we're in a maintenance phase. 

26:21
Monica Lorenzo
That's what I call that training time. We're in a maintenance phase and also instructing our performers on their recovery. So recovery for them is going to look like maintenance, if that makes sense. So we're going to sustain our core stability. We're going to sustain our exercises that are taking us through that range of motion, maintaining our proprioceptive awareness, and then also biomechanically recovering and allowing your tissue to heal and rest. And that's going to include all of your modalities, whether it's Epsom salt bath, whether it's if you have access to higher technologies like Normatech boots, making sure that we're utilizing those on a daily basis. But the basics are going to be your Epsom salt class, understanding when they should be working with myofascial release techniques and when they shouldn't be working with myofascial technique release, and when they should be listening to their bodies. 

27:11
Monica Lorenzo
So that's the last and final piece of listening to their bodies. I've now taught through mindfulness and meditation practices that I implement in all of my trainings. So prior to every single training, we do a quick body scan check in. So I bring us into a full mindfulness practice and at the very end we go into a true meditation. So I bring them into a Theta based meditation where we work on true recovery connectivity with our body, as well as body awareness and emotional awareness. And that final theta healing. And I have found that to be the secret sauce when it comes to working with all of my artists and actually implementing huge injury prevention protocols when it comes to the end of season analysis. So we obviously track everything. And we've been able to show since we started the Knicks entertainment teams in 2009 and up until this day, we've been able to reduce our new injury rate at about 65%, which is huge. 

28:18
Jennifer Milner
That is huge. That is huge. And one of the things were curious about is how you help dancers maintain during a long period. And I think so many people think that if you're training for a year round program, right, for a year round contract, you're going to continue training and possibly change what type of. Leg exercises you do or what type of arm exercises you do, but it's great to hear you lay out that it's a completely different way of looking at it than that, and that you really start out in the beginning. Let's prepare you for the right queuing. Let's prepare you to find your box. Let's get you strong for the things that you need to be strong for. Let's make sure everybody's doing it the same way. Let's get you to peak performance level, and then we're going to start to figure out, how do we maintain that, how do we not get injured, how do we stay healthy, how do we help you recover? 

29:07
Jennifer Milner
So it's not just about continuing to pound, pound with the exercises, right. But learning how to advise the dancers. And this is something that I have to do as well, how to advise the dancers. This is the part where you have to pull back. This is the part where you stop running 5 miles every morning. This is the part where we really focus. This is the part where you buy yourself the Epsom salts and it's part of your training, right? 

29:30
Monica Lorenzo
Absolutely. 

29:31
Jennifer Milner
So it's really important. Thank you so much for sort of outlining all of that. So something like the Knicks is a year round season, and I love that you have, as we said, structured it to fit a certain way with the ebbs and flows and everything. And I think people don't realize that with something like the Rockettes, even though the Christmas season is maybe two months long and not nearly as long of a season, it's still quite intense. And I had friends who were Rockets around 2000, 2004, and they were doing multiple shows a day, and it was incredibly difficult on their bodies. And there wasn't the training program that's in place that there is now. There was still a massive amount of care that had to go into that. And I don't think people realize quite how demanding a season like that can be. 

30:15
Jennifer Milner
So can you just talk a little bit about that for the Rockettes? 

30:18
Monica Lorenzo
Absolutely. That's a great question. And many people don't understand the intensity of the Christmas spectacular. We like to say a beast in its own. These performers are contracted from mid September until early January, and their rehearsal time is about a month to a month and a half. And it's six days a week from 10:00 A.m. To 05:00 p.m.. Sometimes they may have to go over a little bit afterwards, depending on costume fittings, or if we have choreography that needs to be evaluated or processed after. But those are the confines, and they only have one recovery day, and the same is sustained throughout the show. Then once we transition from rehearsals into shows, these performers in New York City specifically, there's two casts that are performing all of the shows, but each cast could perform up to five shows in one day. So that's how at minimum it's two and at most it's five and some days it's never been six, it's always been five has been the cap. 

31:14
Monica Lorenzo
So on a six show day you'll usually have the cast split three and three. But just think about that and that's an hour and a half show and we clocked it. In the past the Rockettes were on the stage for 45 minutes of that hour and a half show and now we're talking precision style dance and you have to be on. So there is no like I'm just going to kind of measly muscle through this performance. You're in a precision style dancer who has to hit these positions and making sure if you're tired, you cannot be off five degrees. Your five degrees have to always be exactly where they have to be. So as an athletic training staff, the way that we would tackle this program is working with the performing artists a little bit beforehand if we can because it's not mandatory for them to work with us beforehand, but throughout the season it's really working on sustainability and working on maintenance. 

32:05
Monica Lorenzo
So the strength and conditioning is not elevated during the season, it's on maintenance mode. And then we're also addressing obviously any issues that they may come in with because they do receive a prescreening and the level of intensity is going to be less. But postseason is really where we're going to fire things up for them when it comes to building hypertrophy on their musculoskeletal system and also addressing any predisposition that we're seeing that may have happened throughout the season. So we'll do obviously a postseason decline. So recovery base and then an increase in their training and strength and conditioning because if they are returning the following year, you'll see those athletes that are working with us and working with our programming come in much stronger and their energy levels are elevated. Their instance, I'm sorry, their instance injury is reduced and they're able to get through these seasons really almost pain free recovery is involved for every single athlete. 

33:01
Monica Lorenzo
We have ice baths at all of the locations making sure that they are utilizing all the recovery protocols that we have in place. But yeah, no one really understands how intense the Radio City Christmas Spectacular really is when it comes to performing athlete. And they are fortunate enough to have a full gym in the 9th floor of the music hall and that's based right off of our athletic training room. So performers can come in and utilize that space and they luckily have us to advise them on how to properly care for their bodies throughout their season so that they're not predisposed to injury. Whereas if they were left without any care whatsoever, they may be pushing themselves to beyond their limits and that's where injury would occur. 

33:41
Dr. Linda Bluestein
And I'm curious to ask if you've noticed the muscle hypertrophy I think is so important and jen and I have talked to a lot of different dancers and some have so much difficulty building any muscle. Have you noticed that the hypermobile dancers that they sometimes have more difficulty building muscle? And if so, how do you handle. 

34:01
Monica Lorenzo
Obviously, and then also your traditional dancer, especially through these intense seasons where we had spoken about this really off air, where they lose so much weight during the season because it is a really difficult intensity protocol. So nutrition is going to be our biggest base. So we're making sure that they are on a proper, that's where we'll now refer out. And I work with sports nutritionists and majority of the time I want to say maybe just one or two times this wasn't the answer. But majority of the time implementing proper nutrition supplementation has always allowed for better hypertrophy when it came to then strength and conditioning. And that was the missing piece was nutrition and sleep actually when those two things were addressed differently. And I have to say, mindfulness and meditation has been something that I have noticed in benefiting all of my performing athletes when it comes to any positive changes that they want to make for themselves. 

34:59
Monica Lorenzo
I haven't tested this in an athlete that I felt was unable to sustain hypertrophy of their musculoskeletal system. But I will be a little bit more aware now in the future. But I can say that those three things are how we have addressed any issues. So working on that and then strengthening conditioning afterwards has always been a beneficial aspect to that athlete. 

35:24
Jennifer Milner
Excellent. And we will have your contact information and your website and everything in our show notes here that'll be for people. 

35:31
Monica Lorenzo
To do because it is really individualized. And I think something that's difficult for me is I look at every single individual athlete, obviously as their own unique person and I almost sometimes feel like I may be reinventing the wheel when it comes to working with each artist. And I think that's just something as a practitioner, I don't know if you feel this experience, but sometimes I feel almost drained in the sense because I want to make sure that they're receiving the exact prescription and protocol that they need for themselves. And I find that is really what works though. So sometimes as a practitioner we may feel a little bit like we're over exerting because if you're dealing with a large population or a large company and you're giving this individual, each individual athlete is receiving their own prescription, it can be a little bit draining. 

36:19
Monica Lorenzo
So what I would recommend as a practitioner is it's really important to just kind of regulate. What I've now transitioned into is kind of regulating like I have my little offsets, so my little pillars that I would build upon. So I have obviously my hypermobile athlete and then I have athletes that don't have mobility at all and then I have your athletes that are in your traditional phase and then also a stylistic pillar. So those pillars are what I build off of. I've kind of built those platforms and then I can work. And once I place each performer in one of those pillars, then it makes it a little bit easier to now transition into their personalized training protocols. Because I think that's one thing that we want to give everything that we possibly can as a practitioner, but we may have leaky energy when we feel like we're either prescribing the same thing over and over again. 

37:10
Monica Lorenzo
That's not working for that athlete, or you may be kind of overthinking or starting from the very beginning when you're evaluating your individual athlete. 

37:21
Dr. Linda Bluestein
That makes sense. And another thing that we've really wondered about is when dancers are asked to work on less than ideal surfaces, if they're doing guest performances on concrete, on grass, astroturf, things like that, how do you strengthen and prepare dancers for jumping, turning, et cetera, on those surfaces? 

37:43
Monica Lorenzo
Oh, I love this question. I love this question. So we actually will make sure number one is the shoe, obviously. So the shoe format is something that I work with all of my individual performers. We then at times have actually purchased different flooring so that we can train on that different flooring. So we have had for the Rockets, we actually had flooring that was placed for the Thanksgiving Day Parade. We had patches of that flooring available to us so that we could train on what that would feel like. We have also tackled they will not perform on wet floors. That's something that if there is any type of wet flooring, if we can't control the amount of moisture, then there's times that those performances have been canceled. Yes. And so the way that we STeng train also now on the opposite side, working with my dance teams, their flooring from their rehearsal space is always different to the court performance. 

38:43
Monica Lorenzo
So two ways that I train for that, obviously, I'm always going to start off with working on a lower load. And then eccentric training is where I've found that to be the secret sauce to make sure that we can transition easily from, let's say, a sprung loaded floor to a flooring that has an ice underneath it. So a lot of these arenas will have ice for their hockey rinks underneath the hard flooring of the wood floor for basketball. So a lot of times what I'll do is we'll work on eccentric loading and eccentric training and then work into our pliometrics. Built off of work. Yeah, exactly. So we'll work on our pliometrics finally and then transition to the floor space so that they now understand how to reduce their load. When it comes to decelerating off of any jump, move, turn, et cetera, that's been huge, is really, actually retraining their deceleration phase with all of their pliometrics. 

39:36
Jennifer Milner
That is really scientific, and I hope people understand that there's a lot more that goes into this than just, well, let's just jump higher, or let's just jump less and hope we don't get hurt. 

39:47
Monica Lorenzo
Thank you. Right? No. Yeah. The deceleration is what's more important when it comes to the injury prevention. And actually, a lot of performers don't realize that when they have the control over their deceleration that their acceleration and their height and their capacity and their jumps and turns increases. I like to say that stability allows for more mobility. I know that may be the antithesis for our hypermobile athlete, but it truly is. Stability allows for more mobility because it allows them to actually maybe reach these controlled edges that will elongate their careers, will reduce their injury rates, and will allow them to perform at a grander capacity without that over looming fear of injury. 

40:32
Jennifer Milner
So do you encourage young dancers to so we're going to kind of segue away from working with dancers who are currently on the team right. And professional. If there are dancers who know that they want to do precision dance or that they want to dance for a sports team, do you encourage the younger dancers to focus on their favorite dance style and then be really good at it and hope that gets them hired? Or do you encourage them to try a variety of dance styles, maybe even some other sports when they're at a younger age? I know you've talked about this topic before, but we would love to hear. 

41:03
Monica Lorenzo
What you have to say on that. Absolutely. I encourage youth dancers to do everything. I also encourage them to try traditional sports soccer, track, volleyball, et cetera. It makes them a much more well rounded performer and a well rounded athlete. I really encourage performers, if they want to be on a dance team. Obviously, precision style dance is something that they should train in. Jazz is usually the base of that style of performance, but ballet is always the structure of all of our performance as well. So making sure that you are a well rounded performer is important. As a youth athlete, I want them doing all different things. I don't want them to overtrain. I don't want them to work into sports specialization. I want them to avoid sports specialization because that's what's going to predispose them to injury. That's where we now form poor biomechanical patterning. 

41:54
Monica Lorenzo
Right. So if these youth athletes can transition their bodies from all different types of surfaces, all different types of strength training, all different types of endurance training, stressors against the body in different aspects I mean, we all know this is something that I obviously advise. I can't tell you how many times I still will attend a competitive circuit and talk about injury prevention, and I sadly still get resistance or no education on what strength training or cross training for the performing athlete consists of and how the misnomer of taking a jazz class or a ballet class or a tap class. Still, staying in the realm of dance consists of cross training and that education. That's the hard part for me. Still, I always think we're a little bit further along and I get surprised when I receive the raised eyebrows from either a parent or an instructor. 

42:57
Jennifer Milner
Who. 

42:57
Monica Lorenzo
Doesn'T understand the necessity of transitioning the body from all different aspects of resistance and obviously training cycling, period. So that's something that is really important. And I'm trying to keep driving this home to our youth athletes because it really is everything also thinking about. I mean, we have all the dance that's moving forward in the world and we have break dancing that's now going to be in the 2024 parasolmics, which is so exciting. These youth athletes are now looking at these older athletes and saying, oh my goodness, now they have a little bit, something maybe different to aspire to your break dancers who have always performed thought more of themselves, more of street performers, are now going to be Olympic athletes. So the level of training and consistency is going to change at the youth level. So I'm hoping that these youth athletes understand that they have to cross train in order to have long careers. 

43:50
Dr. Linda Bluestein
That definitely makes sense that early sport specialization can be so problematic. So I really appreciate you sharing that information. 

44:00
Monica Lorenzo
Thanks. Sorry, that was a little long winded. 

44:02
Dr. Linda Bluestein
No, not at all. 

44:03
Jennifer Milner
No, it's so important. 

44:05
Dr. Linda Bluestein
Yeah, super important. Super important. And we've obviously touched on a lot of different areas and a lot of different things that you do. But I'm sure there's so much more that you do that we didn't discuss. Are there any certain things that we didn't talk about that you would like to include? 

44:23
Monica Lorenzo
Yeah, one last thing that I've implemented over the last few years as well. I work with predominantly female athletes. My male athletes have come a little bit later in my career and they are majority of my breakers and they're hypermobile and immobile in many aspects. So that's been really fun to now utilize a new brainwave and a new part of my brain to work with break dancers who perform these crazy tricks and they move their bodies in these amazing ways, similar to way that our Cirque du Soleil athletes work. But breakers in particular because majority of the time are self trained and they're not working in a traditional training style. They're just taught to get their body to do whatever it can do. Can't even perform a basic squat. So now working through biomechanical retraining with these artists, but also maintaining their level of performance and just helping them work on stability around their mobility is huge and been really exciting for us as well as athletes, as athletic trainers. 

45:25
Monica Lorenzo
And then the last thing that I've implemented over the last few years has been for the female athletes is cycling their hormones, cycling their training. I'm sorry, around their hormone patterning around their menstrual cycle. And that for me was a personal journey that I've now been able to implement with a lot of my performers. And it is something that's really important with your female hypermobile athletes as well. I think it's important to look at their menstrual cycle and look at their training cycle and understanding how to work through that. So there's your easy phases to break it down. Obviously you have your early follicular phase during your menses and you want to make sure that's more of like a yin style of training so it's more restorative. And obviously they can't change their performance level around their hormone cycling. So what I do is just take their cross training into account and that is where I'll prescribe more restorative practices. 

46:16
Monica Lorenzo
Then we move up into our you start to ramp up after Mensies into your early mid follicular and late follicular phases right before Ovulation, where you want to increase your training a little bit more so we can move into full body weight exercises or low level intensity exercises, elevating your strength training. Then we move into Ovulation and we can really fire things up and you start to transition into maybe like a hit style where you'll elevate your cardiovascular output, elevate your strength training output as well. And that'll also now transition after Ovulation into your early luteal. And then you want to start to scale down towards your end luteal phase. Right before mensis again, is where you decrease your intensity so that we can prepare for that for your Mensies. And that's just like a day or two before your mensis cycle is supposed to initiate, is where we'll scale back down. 

47:06
Dr. Linda Bluestein
I really love that I hear from so many dancers that they feel even more joint instability shortly before the onset of their Mensies. And so I think that's really great that you are working so intentionally through those different phases. And of course you're working with a lot of dancers, so I'm sure you're educating them so that they can also be changing up what they're doing at home. But that's really fabulous. And as you were talking, I was remembering that if someone has less than normal mobility, we would call that hypomobility. And there is research showing that if someone's hypomobile or hypermobile that they have higher injury risk. But the interesting thing is, like you just said, a person can have some joints that are hypermobile and some that are hypomobile or some that are normal mobility. So when were talking earlier about what's the right word for normal mobility in medicine, usually it's eau would be the I don't know how you would pronounce that though, that would be hard. 

48:11
Dr. Linda Bluestein
But normal mobility. 

48:15
Monica Lorenzo
Absolutely right. Taking all this into account is necessary, and educating the performer on understanding this area of your body or this joint is hypermobile. This area is hypombile is huge for them because then they realize, oh, I actually have to work through a little bit more mobility through my oh, I didn't understand that my hip couldn't externally rotate this far. So I've been hyperextending my back in order to make sure that I can make this position happen or a picture happen. And that education for them is huge because like I said, education period is obviously freedom. So allowing these performers to take autonomy of their own bodies, I personally, as a performer, felt that my autonomy was me being able to execute choreography. It was still at the expense of how I was being viewed by my choreographer. Where I think now we are able to transition, where performers feel autonomy in their own bodies and they are able to now communicate that well with choreographers. 

49:17
Monica Lorenzo
I've actually noticed a transition in culture, if that makes sense, where they feel that they can now express their limitations or express their desires or express where their bodies are at that current moment in time. And it's respected now by choreographers and respected now by directors. So that especially during, let's say, a rehearsal phase or a creative building phase, that they're able to show up the way that they need to at this time. And they don't have to push themselves into an injury phase because the choreographer and director understands that they're doing the work, that they can then reach that level of performance. Right. And it also helps to have healthcare professionals, which is why it's really great to have athletic trainers available and in programming, like we have provided for the Knicks and in programming that's provided for the Rockettes, because now not only can the performer advocate for themselves, but the healthcare practitioner can advocate. 

50:15
Monica Lorenzo
So we're right there on the sidelines able to discuss with my directors. Choreographers so and so is experiencing this limitation today. They either have this injury or they are feeling X, Y and Z that may predispose them to injury. So we're going to scale back their output in accordance with whatever prescription we have for that day and then that's respected. And that only makes the choreographer director's life so much easier. They don't have to worry about having to transition this performer out if they're injured or it allows for, let's say, a swing to come in and work that day so that performer then can return to their show much faster than they would have if they were sustaining or suffering from a long term injury. 

50:56
Jennifer Milner
Well, I 100% agree. I think that communication and education are what's going to change the dance world and the arts world beyond it. Right. I mean, every way that I'm working with a dancer, whether it's as a ballet teacher or a coach or a trainer, my whole goal is body autonomy, right? Like, we want them to have autonomy over their bodies. And for any artistic athlete to have that autonomy over their bodies, to be able to do the things they want to do to be able to recognize what's going on so they can speak up about it. So that's a really important part. Thank you so much. I know a lot of people are going to want to find out more about you and to be able to reach out to you. How would they be able to find out more about you? Where can they find you? 

51:38
Monica Lorenzo
I am at Romofit R-O-M-O-F-I-T on all social media platforms. And that's the best way to reach out to me. Shoot me a message and I will get back to you. 

51:49
Jennifer Milner
Excellent. Well, you have been listening to Bendy Bodies with the Hypermobility MD, and our guest today has been Monica Lorenzo. Monica, thank you so much for being here. We have learned so much from you. 

52:01
Monica Lorenzo
Thank you. My pleasure. I learned from you guys as well. Thank you. 

52:04
Dr. Linda Bluestein
Yeah, we love this. Super, super helpful. And I know we're going to get a lot of people that are really going to gain a lot of benefit from hearing this conversation, so thank you. 

52:16
Monica Lorenzo
I hope so. Oh, my pleasure. Thank you so much. 

52:20
Jennifer Milner
If you love what you learned, follow the Bendy Bodies podcast to avoid missing future episodes. Screenshot this Episode tagging us in your story so we can connect. Our website is WW bendybodies.org and follow us on Instagram at bendybodies. We love seeing your posts and stories, so please tag using hashtag bendybody. Please leave a review and share the podcast to help us spread the word about hypermobility and associated conditions. This information is not intended to diagnose, treat, cure or prevent any disease. The information and shared is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment. Please refer to your local qualified health practitioner for all medical concerns. We will catch you next time on the Bendibodies podcast.