64. Demystifying Chiropractic Care with Dr. Carrie Skony

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00:00
Dr. Carrie Skony
It's okay for joints to move and it's okay for them to make noise, especially in our hypermobile dancers. And that's not scary or alarming. It's when we do it forcefully, repetitively, habitually for an effect that is not serving you a purpose long term. It's a short term relief that's probably causing more harm than good in the long run. 

00:30
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. 

00:46
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. 

00:58
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. 

01:13
Dr. Linda Bluestein
I'm Dr. Linda Bluestein and I started Bendy Bodies to educate the hypermobile community. Despite being a physician, I experienced decades of symptoms before being finally diagnosed with hypermobile Eds. I've combined my medical education and personal experience to treat and coach patients and clients to optimize their quality of life. 

01:32
Jennifer Milner
Our guest today is Dr. Carrie Skoney, certified chiropractic sports physician and owner of Perform Active Wellness Dance Medicine. Hello, Dr. Skoney, and welcome to Bendy Bodies. 

01:43
Dr. Carrie Skony
Hi, friends. Thanks so much for having me. I'm so glad to be on here. We're so excited. 

01:49
Jennifer Milner
We are so excited. This is a conversation we wanted to have for a while, but before we dig in, go ahead and just tell us a bit about yourself. 

01:57
Dr. Carrie Skony
Sure. Let's see here. Like you said, I'm a certified Chiropractic Sports physician, which means I got my doctorate in chiropractic, and then I did some postgraduate education in sports medicine and rehab. I have a private practice. I've been in private practice for 17 years in the Chicago suburbs, where I treat primarily dancers, youth, adolescent preprofessional, and professional dancers. I do see other adolescent athletes and active adults, but primarily I treat dancers, which is my real passion. Let's see here. I danced recreationally growing up in a small town. I loved dance. I also grew, like a really big fascination with movement and the human body. I loved the sciences. I got really interested in nutrition and fitness and exercise. And that was all so fascinating to me that I really thank dance for. I had a number of common injuries when I danced, and at the time, this was in the Think. 

03:02
Dr. Carrie Skony
Like a lot of our stories, there just wasn't a lot of help out there and no one really knew what to offer or advice to give. And maybe I should stop dancing and none of that seemed reasonable to me. Of course my parents had always seen a chiropractor and they had recommended maybe you just see a chiropractor and I get really good relief very quickly. And the chiropractor I saw was more of what we would call like a straight chiropractor. So she only did joint manipulation. She didn't have any other significant therapies that she did but that was enough to give me some relief and keep me dancing. And so then I just got really interested like what if there's a way to I could help dancers and I could use a natural approach and I could use my hands and we could talk about fitness and exercise and help other dancers. 

03:50
Dr. Carrie Skony
So then just kind of was like I could do this. In the 90s dance medicine wasn't really a thing yet and so it was kind of a far fetched idea I thought, for me. And then I went to school and then lo and behold they come out and they start working with dancers and it's just been so fun to watch this profession of dance medicine really grow. And I love that I get to use my background in chiropractic specifically to help dancers but my passion is really helping dancers prevent injury, prevent recurrence of injury, empowering dancers to understand their bodies, promote health and wellness and how to care for their bodies, how to train smarter, not harder, those kinds of things. So adolescence is really where I love working with dancers because I feel like we can have the most impact on their lives and the trajectory both their dance career and just their health and wellness in general. 

04:40
Jennifer Milner
I would agree with that and I think we all met for everybody who cares. We all met in 2019 I think in Montreal, right? And it's just been such a joy to be surrounded by medical professionals who have sort of a like minded approach that are thinking what can we do to prevent what can we do to encourage longevity? And I think that's why our group kind of hangs out with each other even though know in space on the internet. So you've been in our circle for a while and we've been talking to you that way. We have been doing this podcast for this is our third season so three years now and several listeners have requested that we do an episode on chiropractic care. And as Dr. Bluestein and I started asking around trying to find somebody who specialized in chiropractic care for hypermobility, it just became very obvious to us that if such a unicorn does exist, we didn't know them. 

05:34
Jennifer Milner
So we do know you though and we absolutely appreciate your approach to care and everything. And you do specialize in dancers, you do work with a lot of hypermobile people. So we thought we would kind of dig into a topic today that clearly needs more discussion and. 

05:52
Dr. Carrie Skony
There'S a lot. 

05:53
Jennifer Milner
Of misconceptions around chiropracty. There are a lot of things that people don't quite understand. So I thought we would kind of clear that up. So let's start with what defines chiropractic care. Lots of people think chiropractors are like the poppers, but that's not the full story. So how would you define chiropractic care? 

06:09
Dr. Carrie Skony
Yes. Right. Thanks. Plus, I just want to say thank you for having this topic on because I get a lot of questions also about chiropractic and I love your podcast and I think you just cover so many great topics. So I'm honored that you would cover this topic and have me on. So thank you both. Okay, so chiropractic, if we kind of have this broad picture of chiropractic is basically a conservative, natural, drug free, kind of holistic minded approach to treating pain and dysfunction of the body. And that's kind of this all encompassing generally, most chiropractors have this picture of like, let's help people restore their health and maintain wellness. Most people think of chiropractic by the one technique that we're most known for, and that's joint manipulation, or chiropractic manipulation. And chiropractic was historically founded on that principle of manipulating joints. And so we're still really strongly known for that. 

07:08
Dr. Carrie Skony
In reality, it's just one technique that we use in a whole wide range of conservative approaches. So going back historically, chiropractic, like in the late 18 hundreds, was founded on basically a philosophy that all the nerves that come out of the spine control all the body functions. And if there's disease or dysfunction in the body, it must because those nerves are not working correctly. And so the philosophy was that perhaps there were bones out of place that were not working correctly and they were interfering with nerve function. And if we restored proper alignment, quote unquote, in the spine, nerves would work better, disease and dysfunction would go away. So that's where chiropractic started. There are still chiropractors who practice philosophy based that way, although a lot has changed in medicine since the late 18 hundreds, and chiropractic has evolved quite a bit since then. And while there is still a lot of benefit to joint manipulation and it is a really powerful, meaningful, conservative way to treat the body, it's modernized quite a bit. 

08:14
Dr. Carrie Skony
So we don't use the bone out of place. I'm going to speak for myself right now. I don't use the bone out of place theory. I don't often say like, bones are misaligned. It's really just kind of a not accurate description of what happens in the body. We do get joint restrictions, we lose motion, we do have dysfunction and how muscles and ligaments and tendons work. And that can all be addressed with hands on care and joint manipulation. But this idea that maybe a bona is out of place and if we treat the nerves, we can cure cancer, that's all kind of in the past. So chiropractic has modernized quite a bit and now includes exercise and rehab and therapeutic modalities and all a wide range of conservative drug free options to help people live better, move better, feel better. Yes. So joint manipulation is one part of chiropractic. 

09:08
Dr. Carrie Skony
But a lot of times people think like, I'm going to the chiropractor, I'm just going to get manipulated in my joints, in my practice. I have a sports medicine practice and rehab based. So the way I practice looks a lot like how a physical therapist practices. I use joint manipulation, but I also do really comprehensive orthopedic neurologic testing. We do a lot of exercise in my office, functional rehab. And then chiropractic also exists on this big spectrum where I have chiropractic colleagues who go on to specialize in other fields of medicine. So chiropractic neurology, like functional neurology, functional medicine, chiropractic nutritionist, chiropractic radiologists, chiropractic internist, acupuncture. So chiropractic is this base principle of conservative treatment and then you can specialize in a lot of areas from there. Thank you for that. 

10:03
Jennifer Milner
It's helpful to sort of understand that chiropractic is kind of a big, broad umbrella term. So thinking about that and that it's a conservative approach to care, what sort of people tend to seek out chiropractic care. 

10:15
Dr. Carrie Skony
So in a broad sense, again, I think anyone who's looking for maybe a more natural approach to health and wellness. So these are people who don't want to jump into surgery. They would prefer not to take drugs if they can help it. They're more interested in nutrition or supplementation. They generally have an interest in health and wellness. So in a broad sense, I think that draws people to chiropractic. In a really specific sense, of course, we get people who come to chiropractic because they have neck and back pain. So that's the like, I have neck pain and back pain, who would I see? I see a chiropractor. So that's a really or headaches. You know, those are three most common why people would be drawn to chiropractic. Yes. So I see chiropractors treat musculoskeletal injuries across the whole body. So anywhere there's a joint, a muscle, a tendon, a ligament, which is everywhere in the body, we treat that. 

11:11
Dr. Carrie Skony
So for instance, I have people who come to me because they don't want to have laboral repair surgery on their hip yet, or at all. And so we treat hip impingement and hip laboral tears or the outcomes on meniscus. Surgery and rehab are very similar. And so people choose, I don't really want to have surgery on me, I'd rather have rehab. So they come for that ankle impingement, rotator cuff syndrome. So anywhere there's a joint and there's muscles and ligaments and tendons, we can treat that. And generally we get people who are like, hey, I'm willing to put in the work to do this conservatively to avoid the risks of medication or surgery. 

11:47
Dr. Linda Bluestein
Obviously people with joint hypermobility get subluxations and dislocations. But sometimes the way it's presented, I feel like, makes it more scary and makes people think that there's so much that's wrong in their body. And I think that we can be really thoughtful about how we say things that make people have more confidence in their body and more confidence in their ability to get better. 

12:09
Dr. Carrie Skony
I guess. 

12:09
Dr. Linda Bluestein
So you probably see lots of hypermobile people. Some of them struggle with chronic dislocation subluxations. So would they benefit from chiropractic care even if their joints are already what we would say, quote unquote, too loose or which of those patients would likely benefit? Obviously knowing that this is general information, not a one one consult, right? 

12:33
Dr. Carrie Skony
Yeah, great question. If I can go back in hypermobile patients, subluxation is a real medical term, it's a partial dislocation. The problem is chiropractors have adopted the term subluxation in a non dislocation way. So subluxation is a common term. We say sometimes chiropractors are subluxation based, meaning they believe that there is a bone out of place or there's misalignment and they want to correct the subluxation. It's not exactly how that happens and I don't want to disrespect colleagues in my field, but in hypermobile patients we use the term actually subluxation. There is partial dislocations of the joints because of the hypermobility. So certainly we need to be careful about hypermobile patients who are experiencing true subluxations through there and protecting those joints. Well, I see a lot of hypermobile patients and they can benefit a lot from chiropractic. I mean, here's the thing. Joint manipulation is a powerful tool. 

13:34
Dr. Carrie Skony
It can reduce acute pain pretty quickly, even if it's for a short period of time. Sometimes we use joint manipulation to reduce pain in a painful area so that we can then work on stabilization and strengthening in that area. Sometimes if I have someone who has a disc herniation and they can tolerate a joint manipulation, it will reduce their pain enough that then we can do the next step. And I like to use joint manipulation as one step in the process to get to other steps. We're trying to improve overall function on the body and sometimes manipulation is one way that we can do that. In hypermobile bodies they don't always need joint manipulation or mobilization. Obviously there's a lot of mobility in the joint already and with great mobility comes a great responsibility to try to stabilize those joints and be strong through there. 

14:24
Dr. Carrie Skony
So a lot of work I do as hypermobile patients is reframing their thinking about their joints and what they're feeling, teaching them when it would be appropriate that we could move a joint into other ranges of motion and when we should not. Perhaps I use joint manipulation very sparingly with my hypermobile patients when I can or when it's appropriate, I'll offer more low grade mobilization techniques. Some chiropractors use instrument assisted joint manipulation like an activator technique which is a lower force technique for moving joints. That can be appropriate in hypermobile patients. Otherwise I prefer with dancers, especially to work on joint stabilization, retraining the proprioception around the joint, having them not rely on that feeling of that immediate relief that they get from joint manipulation. And so if we can kind of pull them back from that and get them to realize, okay, what my body really is craving is stability and strength. 

15:32
Dr. Carrie Skony
And for a lot of my dancers that come in sometimes, often, I will say often, I'm the first time they're ever even learning that they're hypermobile. I think you guys have talked a lot about this too, of like, these dancers, they just don't know. They think I'm a good dancer, I'm really flexible. My teacher has given me a lot of roles because I'm so good at them. It's like, oh yeah, you have generalized joint hypermobility or very specific joint hypermobility. And they don't know what that means. And there's a lot of education that happens there. I know you guys do a lot of that also. So hypermobile patients answer your question. Yes, they can get joint manipulated in certain circumstances when we're using it responsibly and appropriately, I use it sparingly, if at all. I think it can help with acute pain when our dancers can feel like, okay, this actually does feel like I sublux this today, or I'm getting a lot of rib pain or my low back. 

16:30
Dr. Carrie Skony
And we can get them some immediate relief to move on to the next place. And here's the other thing for hypermobile dancers, that a lot of them are cracking their joints on their own. There's a lot of self manipulation happening in the dancer population, especially when they're hypermobile. And it's understandable, it's very relieving. It gives them a lot of proprioceptive feedback, which they're lacking in their joints. It gives them immediate sense of relief. There's a neurochemical response where they're feeling like an endorphin like response of like, oh, I'm getting pain relief from this. That stretch reflex on the muscle or around the tendons feels good to them. And it happens easily for them. It's really easy for them to click pop everywhere. So a lot of them are self manipulating anyway. And I feel like if that's happening, which I educate them not to do generally, like, chiropractor is a great place to be to do that safely. 

17:33
Dr. Carrie Skony
I'd rather have you stop doing that on your own and see a chiropractor who can tell you like, okay, this is where you need motion. You definitely don't need motion this joint. We're not putting more motion in this joint. You don't need it. You need stability and strength here. And so regardless, a chiropractor is trained to move those joints safely as opposed to when a dancer is doing it by themselves. And they're kind of perpetuating this cyclic pattern of like, stretch a joint feels better, stretch a joint, again, feels better. And you just keep stretching these ligaments and creating more and more instability or promoting the laxity in the joint and that almost always leads to problems. I don't know if I answered your question, but. 

18:16
Jennifer Milner
Can I just clarify something in there really quick? 

18:18
Dr. Carrie Skony
Yeah. 

18:19
Jennifer Milner
You said a lot of dancers want to self manipulate anyway, and so if they're going to do that, they might as well go see a chiropractor and have them do it. I know you, so I'm pretty sure what you're saying is not if you like to twist and pop your lower back, have a professional do it for you instead. You're not saying seek out a professional to do that joint popping that you already like to do. You're saying, we acknowledge that dancers do enjoy that popping feeling, so let's go talk to a professional about why they enjoy that popping feeling where they might need some relief and what they should be doing instead. 

18:56
Dr. Carrie Skony
Right. 

18:56
Jennifer Milner
I just didn't want people to hear that and be like, oh, I'll go to a chiropractor and I can pull up my menu and tell them, do. 

19:01
Dr. Carrie Skony
This, this and this for me. Yeah, thanks for clarifying. It made more sense in my head when I said it, but you said, that lovely. I get dancers who come to me who have been referred to chiropractors already for neck pain and back pain because we know our hypermobile dancers do have quite a bit of neck and back pain at times. And so their first choice is chiropractic. And there are chiropractors who are maybe not as selective in what they do or are maybe only joint manipulation is only thing they offer and everyone who rocks into the office gets the same treatment. And I highly discourage hypermobile dancers from seeking out that type of care. It can be self fulfilling of like I've had patients who are like, well, as young as 1011 years old. I go to the chiropractor twice a week for the last five years. 

19:54
Dr. Carrie Skony
I'm like oh, wow. And why are you tell me why you're here. Well, I'm in a lot of pain. Okay, let's talk about that. Is it working? Is that working for you? Again, joint manipulation can be a tool that we use, but in the hypermobile dancer gosh, I just think we have to be really cautious and I err on the side of not moving hypermobile joints whenever possible. It's uncommon for me to manipulate my hypermobile dancers and I do spend a lot of time educating them about why that is. I want them to know and a lot of them, once they understand what that self manipulation or the chiropractor they're seeing twice a week, what that's doing to their joints and why that might be difficult for a hypermobile joint long term. Most of them are on board right away. Absolutely. Now I get it, I'm on board. 

20:50
Dr. Carrie Skony
I want to preserve my joints, I want to protect my dancing. Yes. 

20:56
Dr. Linda Bluestein
I'm so glad that you brought up about the self manipulation because whether I am seeing someone one one or giving a talk. You see people doing those things constantly. And I have some self manipulation that had become habitual for me. And if you just Google or ask a lot of people, they'll say, oh, no, that's fine to do. But I have the same philosophy that you do that especially if you're doing it repetitively, that's really problematic. And trying to understand why you feel the need to do it is so important. And that's different, right, from spontaneous. Like you just moved and something made a sound. 

21:36
Dr. Carrie Skony
Yes, absolutely. It's okay for joints to move and it's okay for them to make noise, especially in our hypermobile dancers. And that's not scary or alarming. It's when we do it forcefully, repetitively, habitually for an effect that is not serving you a purpose long term. It's a short term relief that's probably causing more harm than good in the long run. There's a lot of room for education there in teaching our dancers about the safety of joint motion and stabilizing their. 

22:03
Dr. Linda Bluestein
Joints, and a quick follow up to that. I feel like a lot of people think if there's a sound, if there's a cavitation or whatever, therefore the joint either was subluxed or it now is subluxed. So can you quickly explain the difference between those? Because I feel like that's an important thing. 

22:22
Dr. Carrie Skony
Yeah, the sound doesn't mean much. We start to connect. Like, I heard a sound, it feels good. Something positive really happened. We can manipulate joints and not get a sound. There's fluid in a joint. When you take a joint to its end, physiological range of motion, there's a little bit of basically like a negative pressure effect in the joint. There's gas bubbles that can be released. It creates a cavitation or sound, a popping sound through there. For some people, the feeling is like when we get to that end range, physiological range of motion, that feels good to them. It just so happens there's a pop too, but the pop doesn't really mean anything. But I've seen dancers who crack their toes, for instance. I mean, they have really hypermobile toes and they're cracking their toes over and over again, and they'll keep cracking to try to get a sound. 

23:09
Dr. Carrie Skony
In the meantime, they've get themselves a capsillitis. They have complete stretch ligaments. They have toes that bend past 90 degrees. Their big toe joint is swollen and painful and it's like, stop, just stop. You don't need that. We don't need to crave this sound. The sound we don't correlate as much. 

23:28
Dr. Linda Bluestein
So we know that some people will have asymptomatic joint hypermobility and other people have symptoms related. And it could be that they have ehlers danlos. It could be that they have hypermobility spectrum disorder. They could have a variety of different things. If someone comes to you and you're working with them and they have symptomatic joint hypermobility, does that change your approach in working with them? 

23:49
Dr. Carrie Skony
Yes, definitely. I mean, everything then goes through the hypermobility lens, too. Probably the first thing that comes to mind is that I try really hard to not don't chase the pain because my hypermobile dancers often will set up maybe like a treat plan. I want to see you once a week for six weeks, and let's come up with a plan of what you can work on at home, at the studio. But every one of those times they come in, they're like, okay, today my shoulder and low back, and today it's my ankle, which I can totally sympathize with. But we try not to chase the pain. We try to look big picture of like, okay, here's the deal. I'm going to try to give you some relief today. I'm going to teach you some self care strategies of how you can handle this because you may get these pains again. 

24:38
Dr. Carrie Skony
I'm not going to solve this problem today. This may happen again. Your shoulder may hurt from time to time. Here are some self care strategies. Here are the exercises I want you to do instead. And then we really have to take this big long term focus of like I think sometimes people go to Chiropractors and it's like, I want a quick fix. Like, fix me and I feel better. But then they feel like, I have to go back two days from now because I don't feel good anymore. So in a hypermobility lens, it's like, yes, I want you to be out of pain today so that you can go back to class or rehearsals. But also, I'm going to here to remind you we are looking for long term success with your body and wellness. And so my focus is really reminding them of that every time they're in here's how we're going to work on stability of the joint. 

25:26
Dr. Carrie Skony
Here's the exercises you're going to do. The other thing is, I mean, my hypermobile bodies that come in, they just can't always tolerate as much as other athletes. Hypermobile bodies, as you guys know, have good days and bad days. And so we have to ask, is today a good day? Do you feel like you have a lot of fuel in your tank? Can you give us some effort today? Do you feel like doing some exercises? Should we review what we did last time? And sometimes they weren't able to this last week, hey, this last week, like, man, everything hurt, or I really struggled with this. I didn't get to my exercises like, okay, so a lot of times it's a much slower approach. I don't throw as much at them as I would some other athletes because I just know there's a lot of variables in there. 

26:11
Dr. Carrie Skony
Of course, talking about self manipulation with a hypermobile dancer, we always talk about breaking that habit and not doing self manipulating. So that's always one of my first conversations with hypermobile dancer that comes in. I think I already mentioned of course, like using manipulations theory as my treatment technique with hypermobile dancers or bodies in general, like focusing more on supportive care. So let's talk about what kind of pillow do you have? What kind of mattress are you on? What's your posture like when you're studying for school? Where are you doing your homework? How much time are you spending on your phone? How heavy is your backpack teaching? Here are some taping strategies that you could use for support on your own. You can do this at home. You don't need me to do this. I can teach you how to do it. Joint braces if they need that. 

27:04
Dr. Carrie Skony
Educating a lot about what they're doing in the studio, in rehearsals. A lot, a lot. There's such a big education component, especially if this is all new information to patients and they don't know. I don't even know what hypermobility is. I didn't know hypermobility had a spectrum. So I try not to overwhelm them with a lot of information at once. I try to feed them little bits at a time, like, this joint is a little bit more lax, and this is what that means. And then we kind of progress from there. And because I take a holistic approach then with hypermobile bodies especially, I tend to start to get into more questions about like, what about, do you ever have GI dysfunction? How's your digestion? How's your nutrition? And then I can guide them to the appropriate resources. I have some training in all of those areas, but that's not my lane. 

28:00
Dr. Carrie Skony
So I refer out, let me send them to Kristen Koskinen for nutrition, or let me send you from my functional medicine doctor for a GI workup. Or you have stress and anxiety, let's get you in with a counselor. Let's work through some of that stuff. So I do that with a lot of my patients, but I feel, especially for young bodies and hypermobile bodies, I feel a huge responsibility to be a resource for them and to advocate for them. We talk a lot about self advocacy in the classroom, which is a huge issue. I know you guys know about trying to get them to advocate for their bodies in the classroom. And so I try to be a resource for that and create communication with their instructors. And so, yes, there's a lot that went up when a hypermobile patient comes in. Is this all encompassing? 

28:57
Dr. Carrie Skony
Like, okay, let's pick this apart. And in the end, I look at patients like they're a puzzle, and there's all these different pieces of the puzzle, and my job is just try to help them put the pieces back together. Okay, we have a little anxiety. Let me teach you about that. And then let me point you to resources or the GI or chronic sublization things like that. So we've tried just trying to piece all these things together and help them in that process. That's great. I. 

29:31
Jennifer Milner
Think there are a few different kinds of people that I've run into in regards to chiropractic. There are the people who are like, oh, those poppers, they just want to get you in there. Chiropractic is a huge field, right? You said it encompasses so many different things and you can go on to specialize or do just general chiropracty, I guess. So there are some really bad chiropractors out there, just like there are really bad Pilates trainers out there as well. So some people may have had bad experiences or they may think somebody just wants me to come in twice a week for the rest of my life so they can adjust me. And then there are people who are like, I love chiropractors, they're fantastic, they really help maintain me, they really help move forward. This conversation, hopefully, is shedding some light on the possibilities of what you can get with chiropractic care and with what you can have through it. 

30:24
Jennifer Milner
I have been through chiropractic care most of my dance career and was fortunate enough to work with a really good person early on. And she recognized my hypermobility. And one of the best things she did for me was to arm me with information for when I traveled. So when I was out on tour and having to look up other doctors, she literally wrote notes about how to put blocks under my hips or how to do this and that. And I would hand the notes to them and they'd be like, this makes no sense. And I'm like, it doesn't have to. This is the recipe that works. So just read this. So I think that the education that you're talking about is so key. And the other piece that is really important for me as a hypermobile person who does go see a chiropractor, is the concept of moving really slowly, as you said, because there can be some great days and bad days, but also, as you said, we kind of crave that release. 

31:19
Jennifer Milner
But if a hypermobile person is tight, it's for a reason. There is tightness going on to help stabilize something that is unstable. And what my current chiropractor has kind of learned with me because she wasn't a specialist in hypermobile people, most people aren't is that a little bit goes a long way. And if she does some release work, like soft tissue or anything, you might do just a tiny bit. But if you do too much, then all the joints are like, we're free, and they go running and something dislocates. So it's that constant, a little release, a little strengthen, a little release. And I think that's such a huge important component for working with hypermobile people is understanding you can't go, oh, that whole shoulder is so tight, let me just release all of it because then the arm just falls out of the socket, right? 

32:07
Jennifer Milner
So like you said, education is so important. 

32:10
Dr. Carrie Skony
Yeah, and if I could talk about that for just a second, because I think the conversation I have a lot with dancers is there's a difference between feeling tight and being tight. And it's a really common conversation we have. If a hypermobile dancer comes in and says, like, my hamstrings are so tight, and it's like, okay, let's check. Let's see what's happening. So helping them to understand if there's tightness there in the muscle, it's there for a reason. And you stretching the hamstring or the joint excessively into, oversplits or hanging out in a straddle position is not serving you. It's not fixing the tightness. So if a dancer says, my hamstring is really tight, and I can take their leg to their nose, okay, I just want to say the hamstring is not actually tight, but I understand you that you feel tight. And so we need to understand why is that? 

33:09
Dr. Carrie Skony
That you feel tight. So is the joint craving stability? Have you been really overusing the hip joint? Or maybe the core is lacking some strength and stability? Been overworking in the back. The hamstrings are tightening up. You're feeling attention because your body is trying to create stability in an effect to have a bigger role around the joints. And I think that reframing is just so powerful for them. And I often catch them, and they learn really quickly in my office of, like, they walk in and they say, oh, my neck is tight. And I'm like, let's just think for a second. Like, do we think the neck is tight, or does the neck feel tight today? And they say, you're right. The neck feels tight today. Okay, great. As long as we can reframe that. And I think that helps them understand, like, I don't need to sit in a stretch to fix this problem. 

34:03
Dr. Carrie Skony
That's not it. And then they understand, okay, dr. Kerry gave me all these tools to use. So if I feel tight, what can I do for that? And I can work on my proprioceptive exercises. I can work on joint stabilization exercises. I can work on my strengthening. I can use a taping technique, all of these other things that are actually going to have a positive effect on what their body is craving. So that's something that I use a lot with hyper cancers. 

34:30
Jennifer Milner
Well, and if I'm feeling tight, my back starts to get crabby because I'm so loose, and my chest might start to get tight, right? And so if my chest gets tight, I just want to stretch my chest, and my chiropractor is like, no, you have to strengthen your back. And I'm like, shut up. 

34:49
Dr. Carrie Skony
I don't want to work. 

34:50
Jennifer Milner
I want you to open. But I understand what she's saying, and I would love to just fall in the straddle and stretch, but instead, we actually have to strengthen what it is that's making us feel like we need to fall in the straddle and stretch. So I really appreciate that. Are there issues that are common in people with hypermobility disorders? Because we know people with disorders do have a lot of common comorbidities. Are there some sort of issues that might kind of give you pause in treating a certain issue that you'd be like, let's wait until we know for sure, or anything like that? 

35:27
Dr. Carrie Skony
Yes. So one that I see most often would be, like, lumbar stress fractures because of hypermobility. There tends to be a lot of lumosacral extension. Our dance teachers often exploit that hypermobility. Lots of tricks, and dancers want, I can so I want to take my back this far, my leg this far, whatever. So there's a lot of extra impact forces there in combination with not as much joint support. And so I do get lumber stress fractures quite a bit in the office I can still treat around there. So I wouldn't say that necessarily gives me pause in that area, but it's definitely high on my radar of, like, okay, we need to get this evaluated for sure, and we go for imaging sooner so we can get a proper diagnosis on that. I do see this, but less commonly would be, like, upper cervical instability. 

36:27
Dr. Carrie Skony
So the ligaments, particularly in the upper part of the cervical spine, by your head, anywhere, of course, ligaments can be laxed, but especially there, we have some really sensitive structures through there at the brain stem, at the base of the brain. So we don't want to mess around too much. If there's a lot of suspected laxity in the cervical ligaments, just a lot more susceptible tissues or injuries through there. Some Eds. And hypermobile dancers are more susceptible to, like, a chiari malformation, which is basically like a herniation of part of the brain into the spinal canal. So we need to be aware that those things exist. Hypermobile dancers often have, like, dizziness or fainting. They've syncopy. They'll faint sometimes. And so there's some vascular issues there that we need to be cautious of. So I'm careful just on what techniques I'm using, how aggressively we're working, even on exercise. 

37:33
Dr. Carrie Skony
But certainly with cervical manipulation, I'm much more cautious because of the laxity component through there. Dancers who present with, like, oh, yeah, I'm dizzy all the time, and I faint sometimes, and I have chronic daily headaches. Like, okay, we need a referral. I'm not adjusting your neck today. We need a referral to evaluate further, like, what's happening through here. And maybe that's just it might be, quote, unquote, normal for them because of Pots or anything else, but we want to get that evaluated. What else? I'm really careful around the shoulder because of shoulder dislocations. So I think just monitoring what techniques you do, even exercises, being cautious of that hypermobility and hyperextension in the knees and the elbows when we're doing exercises, or even in the wrists, like if we're doing floor work. Okay. We need to be careful because you may not be able tolerate loading the wrist or the elbows during any of our exercises. 

38:33
Dr. Carrie Skony
So we have to get creative sometimes. I know you guys experience that as well. And John, especially you with your Pilates. 

38:39
Dr. Linda Bluestein
Work, what kind of things make you think specifically? Oh, we need to do imaging for this dancer. 

38:47
Dr. Carrie Skony
That's kind of hard to explain. There's a pretty common clinical presentation, so if someone comes in, we can point to the pain like it's there. It's at L five S one, they can point to it. It's sharp, it hurts during these orthopedic tests, it hurts every time I arch my back. It hurts with jumping. And so we kind of just go through this orthopedic evaluate. This one starts to raise like it starts to check all the boxes. Sometimes we'll do a trial of conservative care, like, okay, let's work on this two or three visits. But if I still have a really high clinical suspicion, and you're getting no relief from the things that I can provide you with stabilization or manipulation, if it's appropriate, or any other technique we're using for pain management, if they're like, no, it's still an eight out of ten pain. 

39:31
Dr. Carrie Skony
Okay. That's a really high clinical suspicion for me. And in reality, in dancers, it's not even the dancers who are just doing hyperextension movements. So particularly dancers who have a lot of mobility, if they have a hard time controlling functionally what their core is doing, and they have a hard time stacking the rib cage, or they're in anterior pelvic tilt, or they're doing a lot of jumping, and that can cause a lot of compression and extension in the lumbar spine, even if you're not in extreme ranges of motion and stress. Fracture, in any case, is a case where the load is greater than the capacity. So there's some mechanical dysfunction, whether it's anatomical, structural, or it's functional because of weakness someplace, the capacity of the body is lower than the ability to handle the load that they're giving it. So, yes, it becomes very apparent when we have dancers who are doing lots of tricks and overarching their back, but it doesn't have to be that. 

40:30
Dr. Carrie Skony
I see dancers who are just training hard and not doing anything too abnormal, but maybe have these other functional weaknesses that lower their capacity tolerate the load, and that can contribute, not to mention, like, growth spurts. And there's a lot of other contributing factors to stress fractures. 

40:49
Dr. Linda Bluestein
And I see that in some well, gymnasts too, right? We see that in gymnasts, of course, but I see that in some of my patients that are not dancers or gymnasts. It seems like those fractures are not that uncommon, or at least in this population of people. 

41:05
Jennifer Milner
Yes, that makes sense. I mean, I can obviously see how exploiting the super flexibility can cause them, but also the impact of it. People don't think about that. But I've seen more impact, I think, originated stress fractures in the low back from gymnasts than in dancers from all of the hard landing they do and the way they absorb it in their lower back. But I could see why that would be an issue in hypermobile dancers, just with the inability to control their spine and absorb the load from jumping efficiently. 

41:40
Dr. Carrie Skony
Yeah, so I could definitely see that also. I think it's something we need to continue to make sure all of our providers are really well educated, which is why what you guys do is so powerful. But when we think about a dance instructor saying, oh, your low back still hurts, okay, go see the chiropractor, it still hurts, okay, keep going to see the chiropractor. And if we're seeing someone who is not really attuned to what the risks are, or looking for those risk factors, or maybe is not doing a full orthopedic neurologic exam, then as dancers, we think like, oh, it's normal to be in pain. My back still hurts. My back still hurts. Still hurts. I had a busy week. My back still hurts. And so I think educating our instructors and educating medical providers more about hypermobility and what to look for, of course I want everyone to understand what the stress that dancers go through, but I think we think about sometimes there are chiropractic facilities that don't do full examinations and you're in and out in five minutes. 

42:48
Dr. Carrie Skony
And I don't want to be disrespectful to my colleagues, but I think it waters down what we can offer in the profession. And I think there's some risk there if we're not really understanding what's walking in the door and we can't just manipulate away pain all the time. At some point we need to be like, okay, what's actually happening here? What is going on? And so, yes, you can go to a facility down the street and walk in and get adjusted. They take walk ins and you feel better and you walk out. But it's such a disservice to what chiropractic is and can offer on whole and also just a disservice to patients of like, boy, you really deserve a full. I mean, everyone does. Of course, every condition deserves a full workup, but it's common now to see like, medicine pop in my chiropractor and pop out, and that makes me nervous for dancers especially. 

43:46
Jennifer Milner
So, as you have just explained, there can be a really wide variety of chiropractic care out there that can be the really great full on, full exam every time you walk in, very comprehensive, including physical therapy, exercises, all of that. And it can be what feels more like a drive through order off the dollar menu and you're on your way again. So for everybody who is not in the Chicago area, which is where you live and would be great to be able to see you, what should someone be looking for when they are searching for a chiropractor, how do they know? 

44:19
Dr. Carrie Skony
Yeah, referrals are a good option. So if you know someone who's been somewhere and they can attest to their experience, that's a good option. I think looking for chiropractors who are certified in additional methods. So like sports medicine or rehab. Generally, if there's a chiropractor who has additional training and certification for sportsmen and rehab, they are taking an active approach to care. It's not a subluxation based, philosophy based care. It is like, okay, we're here to make you work. We're going to work together, we're going to be a team. And so that's a good starting place. As someone who has some certification with sports medicine, I do see chiropractors who do have that and advertise that and still have really quick, non thorough visits. So that's probably not a be all, end all, but it's a good starting place. Let's see here. Anyone who's rehab based, of course. 

45:10
Dr. Carrie Skony
Let's hear, I think, a doctor who takes a detailed history. So my first visits are 60 minutes or longer. So someone who's really trying to understand you as a person, they want to know your full medical background. They're looking at how you move and function. I think that's a good option. You can ask, well, how long do you spend with a patient? If you're interviewing for a chiropractor, how long are you spending with a patient? Generally, like, subsequent visit, we like at least 20 minutes, if not 30 to 60 minutes of care so that you know you're not just walking in and getting adjusted and leaving that there is actual therapies. And you can ask, are there exercises that are going to be prescribed? Does someone watch me do those exercises? Or are you just going to hand me a sheet and send me home with exercises? 

45:55
Dr. Carrie Skony
You can ask, like, you want to do those exercises supervised. You want someone who understands how to squat and how to lift and how to bend. And you want someone to teach you that. You just don't want someone to hand you an exercise sheet and send home, I think, looking for someone who's willing to create a personalized plan for you that is unique to your goals. And some of this stuff is just you have to interview. You go to an appointment, you interview them. It's hard to gain some of this information from a website of what people say online. Let's see here what else? I think staying away from cookie cutter type treatments where maybe there's a scare tactic of, okay, I'm going to go back. I think staying away from chiropractors who maybe do full spine X rays on every patient. It's not clinically indicated to do that. 

46:47
Dr. Carrie Skony
It's unnecessary, it's overutilization. So that's always a flag for me of like, oh, do we need that? Is that clinically indicated? Or someone who uses X rays as a scare tactic. I don't love that. Like, oh, see how this is what a normal neck looks like, and this is what you're like, OOH, this is bad. You just need to come to me three times a week for the next six months and it's like, I would not sign up for that kind of care. You may get some temporary relief from joint manipulation through there, but I think that's not an ideal place for, I would say most patients, but especially for dancers and hypermobile dancers. And you want a doctor who's going to give you some lasting relief. So, like I said before, if you are I have patients that say, well, I've been seeing a chiropractor twice a week for five years. 

47:38
Dr. Carrie Skony
It's like, well, are you getting any significant relief? In some cases, people have serious injuries that require they're in chronic pain and they require care. I get that. But if I have a twelve year old who's seeing chiropractor twice a week and not feeling any improvement after years, something's not working. So I think that's a bit of a red flag. Like, okay, my patients, I generally am seeing them six to ten visits, max. And then if they want to stay on for long term success of performance based care or how are we going to continue to help you manage chronic pain or dysfunction, we can do that. But don't be signing up for those long term care plans. So, I don't know, I think it's really hard to tell from someone's website or from what someone says, because everyone, I think, says the right things, but a referral from someone who's experienced what a chiropractor offers and can speak directly to like, oh no, my chiropractor taught me a lot, I did exercises. 

48:34
Dr. Carrie Skony
Or if you're going to go in and interview someone or have a first visit, those are some things I would look for. 

48:40
Jennifer Milner
Well, and I think there is something too. You said you don't want to go to someone who's going to keep you coming back twice a week for five years. There is something too. When we're working with elite athletes to maintenance care and, as you said, preventative care strengthening. I always encourage my dancers to start seeing a physical therapist before they have a serious issue, so that when they have a serious issue, the person already knows their body and is like, that's not what you normally look like. That's not how you normally are. So I don't mind someone going in and seeing someone and getting help with some Achilles tendinopathy, which is not a small issue, but they think it is, but something small, and then being able to know that person. And I think that when we're working with elite athletes, there is going to be a degree of maintenance care. 

49:28
Jennifer Milner
So high level dancers, especially people with hypermobility high level athletes, will be going to a physical therapist once a month, once every two months for just what we call tune ups, because they are doing extraordinary things with their body right? So there is that component of it, but they shouldn't. It's like a chiropractor that I didn't 100% agree with tried to explain it to me that it was like brushing your teeth, that you do go to the dentist to get your teeth cleaned too, even though you're capable of brushing your teeth, but you have to go to the dentist regularly. And I was like, yeah, but if I have to get my teeth cleaned twice a week, I'm clearly not doing something right at home, right? I shouldn't have to depend on the dentist to do that maintenance for me. 

50:09
Dr. Carrie Skony
And here's the difference, and I think you pointed out this really well of like, listen, I want to be a guide for my patients. And once I have a patient, they generally are with me for a long time. It's just we need to be really clear about what my role is. My role is to help you as new injuries appear, to teach you, to educate you, to treat them as they pop up. I have people who have chronic Achilles tendinosis or ankle impingement. It's like, all right, we're going to treat that. When that flares know I'm here, I'm not kicking you out. I'm not saying it's a bad thing that you need to come see me, because certainly as an elite athlete, like you said, Jen, there's things we need to treat. The difference is, what is our overall goal here? And are we working towards a functional improvement, structural improvements that are long lasting? 

50:52
Dr. Carrie Skony
And when I talk about not signing up for these, like, two times a week for the rest of your life kind of care, I'm speaking specifically of, like, it tends to just be offices that are just doing joint manipulation. And so from my perspective, we need active care. And so if someone's coming to me and we're making objective progress, then, yeah, absolutely stay. I mean, my patients I love my patients. I've seen patients all the way through their youth preprofessional into their professional careers and into retirement. I've been in practice long enough that I've seen dancers on the whole spectrum, and they stay with me and they trust me, and I love that. But we're coming in with like, okay, we're setting clear goals of what we're trying to accomplish, and we're going to be really intentional and personalized about how we're going to do that. 

51:34
Dr. Carrie Skony
This is not a cookie cutter approach to just get you out of pain today and tomorrow, have goals. Like, let's work on this, and we generally reach those goals, and then something else happens, or they have a flare up and they come back and we work on it again. And my job is to just be a guide and a resource for them. They're doing the work. I'm helping them along the way. And I always say to my patients, like, hey, you and me are in a rowboat. We both have an ore. So we're both working and if I'm the only one doing the work, we're going in circles. And if you're my goal is to eventually hand you the ore. I'll jump back in the boat anytime you need me. But my job is to give you the Ore so that you can go and take care of yourself. 

52:13
Dr. Carrie Skony
I don't want you to rely on me forever if you don't have to. I will be here if you need me, and a lot of conditions need that. But my goal ultimately is to try to empower you, to be able to self care as best as possible and have the highest function and optimal health that we can. That's gorgeous. 

52:32
Jennifer Milner
And that was just like pure gold right there. I think I'm going to put all of that on a pillow, empowering someone to have both of the Ores. I know we've talked a lot about Chiropractic care today and I really appreciate your time. Was there anything that you wanted to cover that we didn't get today? 

52:51
Dr. Carrie Skony
Gosh, we covered a lot though. 

52:53
Jennifer Milner
We did, right? 

52:54
Dr. Carrie Skony
All of that about it. I would just say one of my passions that outside of Chiropractic, I think one of my passions is just really like educating instructors. And I know you guys feel this to the depths of you also. It's just there's such a lack of education in our dance instructors about hypermobility that I really face this challenge on a daily basis of how can we get our instructors to help empower our students as well and we can all get on the same page. I'm really fortunate. We have a huge competitive dance community in the Chicago area. I work know probably a couple dozen dance studios. I'm a consulting physician for health issues at many studios and I do have good relationships. But there's still a struggle sometimes even with new teachers, the lack of certification or knowledge about how to work with hypermobile dancers. 

53:47
Dr. Carrie Skony
And I think it would be my passion project that we would continue to educate teachers about understanding hypermobile bodies. I know you guys can agree to all of this, but knowing, like, hey, teachers could be used from the very young age of being able to acknowledge, yes, you're a bendy body. You don't have to diagnose that, but be able to acknowledge we're not going to push you into your end range of motion because that's not necessary, especially at ten or eleven years old. You can really empower kids at a young age instead of exploiting them. I guess that's maybe a bad word, but instead of encouraging, like, so and so can do all the tricks, so they're going to get all the tricks and all the dances and we're going to use that to get points and all of our routines. And we can't afford to have you injured. 

54:35
Dr. Carrie Skony
So if you're hurting, I'm sorry, you still have to be a part of this. No, one can do this role. And I think we set the stage for these young kids at this young age that they have committed their bodies to this practice. I think it's really irresponsible of us, and I think it starts with the teachers unknowingly. I think it's all unknowingly. It's not on purpose. I just think education would go a long way. I have dancers who don't get enough time to eat between classes. And we know hypermobile dancers need more time to digest. They can't eat as much food, maybe they have more sensitive stomachs. And to lump our hypermobile dancers all together with the other population is such a disservice and harming to hypermobile bodies. And so when I see dancers come into my office, I think there's all these other factors that are contributing to your health and wellness that I'm going to educate you on this, and I'm going to advocate for you, and I want you to advocate for yourself, and I want your parents to advocate for you, and I'm going to educate your instructors. 

55:36
Dr. Carrie Skony
But it's just like, man, if we could just get all these pieces together from the get go and have everyone understand, like, okay, a hypermobile body probably is going to complain of pain more. That's not that uncommon. Let's not shame them or call them lazy if they ask if they can sit out, they're having a bad joint day or pain. Let's not make them feel bad about that. We need to understand like, okay, great, yeah, we want to preserve your body. We want you to function optimally. We want you as part of our team. We want you to be successful if that's what your body needs. Your body needs more time to eat or you need more sleep or you need less hyperextension in your tricks or less number of dances. And we want to provide that for you because we care about you holistically as a person, and we want you to be successful. 

56:23
Dr. Carrie Skony
And I just don't see that all the time. It's a lot of like, gosh, you have so much talent. Let's put you in front and center. Let's make you do all the tricks. Let's take your leg whack your leg over all the way over here. And it's like and you're irreplaceable. 

56:35
Jennifer Milner
Yes. 

56:35
Dr. Carrie Skony
And you're irreplaceable. Sure. These kids feel I mean, they're scared. Bring it up. And it's just. 

56:43
Jennifer Milner
We are on that same soapbox. 

56:45
Dr. Carrie Skony
I know you are. I guarantee you we are on that same soapbox. 

56:50
Jennifer Milner
We are working hard to change it. We so appreciate your input and everything that you have to offer in the dance world and being willing to have this conversation with us. Because when we first approached, you were like, I'm not an expert on hypermobility, but we need an expert on chiropracty who works with dancers in a way that aligns with what we think should be happening and works with hypermobility. And you certainly have helped. US understand all of that today. So if people want to learn more about you, where can they find you? 

57:18
Dr. Carrie Skony
Let's hear. I'm on social media, Instagram and Facebook at dr carrie Scony D R kerry carrieskony and my website is Performactivewellness.com. They can find me there, leave messages. 

57:34
Jennifer Milner
Awesome. That's great. And we'll have the contact info in the show notes as well, so people can look at that as well. Well, you have been listening to Bendy bodies with the hypermobility MD. And our guest today is Dr. Carrie sconey, certified chiropractic sports physician and owner of Perform Active Wellness dance medicine. Carrie, thank you so much for chatting with us today. It was a pleasure to have you here. 

57:56
Dr. Carrie Skony
Thank you guys. I love what you're doing. Keep up the hard work. Thanks. 

57:59
Dr. Linda Bluestein
Thank you so much. We really appreciate you coming on today. 

58:03
Dr. Carrie Skony
Of course, if you love what you. 

58:05
Jennifer Milner
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 bendybodies. 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 shared is for educational purposes only and is not a substitute for medical advice, diagnose or treatment. Please refer to your local qualified health practitioner for all medical concerns. We will catch you next time on the Bendy Bodies Podcast.