9. Educating the Dance Community with Lisa Howell

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

00:00:00 

Jennifer Milner 

Welcome to Bendy Bodies with the Hypermobility MD. This is your guest cohost Jennifer Milner, here with Dr.  Linda Bluestein. for another episode of this dance-specific series. Today, we have a very special treat in store  for you. as we are speaking with Australian physiotherapist Lisa Howell. In addition to being a physiotherapist,  Lisa is an author, speaker, and creator of The Ballet Blog, which has revolutionized how dancers think about  their bodies, injuries, and performance enhancement. She works closely with some of Australia's top dance  medicine specialists and has lectured through Europe, the United Kingdom, the United States, and Australasia  on dance, anatomy, injury prevention, recovery, and performance enhancement. She's also been a guest speaker  at the IADMS conference, which is an international group of dance professionals aiming to enhance the health,  wellbeing, training, and performance of dancers by cultivating educational, medical and scientific excellence.  Lisa is well-respected both nationally and internationally for her work with young dancers, professional dancers,  and dance teachers. Hi Lisa, and welcome to Bendy Bodies.  

00:01:16 

Jennifer Milner 

Hi, Lisa, and welcome to bendy bodies. Start out just by telling us about your background. 

00:01:22 

Lisa Howell 

Hi thank you for having me. Well I grew up in New Zealand, so a lot of people think I'm Australian, but I'm  actually a kiwi. I grew up in a very small town dancing the whole way through my adolescence and things, but  went straight to university to do physio and did my training in New Zealand. After I graduated, I moved to  Australia and thankfully fell right into a job with a dance physio. Before then, I never realized that dance physio  was even a thing. It wasn't really at the time, definitely not in New Zealand, but had some amazing mentors very  early on, and learned a huge amount. I started seeing that a lot of the issues that were seeing in clinic could have been prevented. I wanted to kind of move on and do a lot more educational work out in the community to  actually stop a lot of the issues that were seeing, started doing that in 2005 when I started my own clinic.  

00:02:20 

Jennifer Milner 

In the last 15 years, have just constantly been trying to get more education out into the community so that we  can prevent a lot of the really common injuries that a lot of people think are just kind of par for the course,  because there is so much that can be prevented rather than dealing with it once it becomes a problem.  

00:03:00 

Lisa Howell 

Absolutely. I know that is a passion of yours is trying to prevent them before they happen. What made you  interested in hypermobility specifically? Well, I'm hypermobile myself and I never understood it myself. when I  was dancing. I was actually very inflexible when I was young, which is a lot of people find surprising. They  think if you're hypermobile, you're super bendy and super flexible. A lot of hypermobile people are inflexible  until they learn how to stabilize, or they may be inflexible in certain areas. Once I understood how much my  own back pain, I had severe back pain from about 18 to 26, when I worked out how much my hypermobility  was influencing it and mastered control. So now I'm great, touch wood. That's been a real driver to help teach  people about the many, many factors that affect you when you're hyper mobile, and really practical ways of  actually dealing with it, rather than just accepting it as a diagnosis and suffering. There is so much that you can  do, but it's purely from personal experience myself, not having that information, and seeing so many clients  come in who don't realize how their hypermobility is actually affecting the conditions that they're working with.  

00:03:56 

Jennifer Milner 

Absolutely. I'm glad you mentioned that about, you can be inflexible and hypermobile. I will have so many  dancers come to me and I'll say, "I think you're hypermobile" and they'll say, "no, I can't touch my toes.". I'm  like, your shoulders dislocate three times a year. You know, let's dig deeper. Knowing that, and this is  something that Linda talks about as well, knowing that inflexibility can go hand in hand with hypermobility. It's  so important to know when you're working with hypermobile people. You owned a physio clinic for several  years. You teach workshops across the world. You post videos, you write books, you do blogs, you are so  passionate about working with dancers and educating them, especially pre-professionals and people with  hypermobility. How has your work as a physio and what you've seen during it, shaped your approach and your  focus on what you do?  

00:04:55 

Lisa Howell 

Yeah, I think the constant frustration that I had in seeing the same injuries over and over again, and often seeing  injuries at really pivotal points. Being in Australia, there's not a great professional dance world. A lot of students  have to go overseas to continue their training. Often just before they'd go overseas, something would come up  that could have been intervened or could have been prevented six to 12 months before, or constantly seeing the  same issues over and over again in pre-pointe students, kids coming in for their pre-pointe assessment and being  totally unprepared. And then they would feel devastated because we'd have to say no, whereas the training  should have been happening two years before, so that they're actually prepared at the right time. It was this  constant frustration and feeling like a stuck record of saying the same things over and over. That's originally  what drove me to start condensing things into manageable programs that could be brought in at different stages  during their career. 

00:05:53 

Lisa Howell 

Also I remember having a conversation with my mom, after a couple of years into running my practice. She  said, "Well, Lisa, even if you had existed, when you were dancing, I wouldn't have been able to afford to take  you to you.". A big driver for me has always been to make the information accessible and affordable because in  Sydney I have, there was a very high socioeconomic bracket. Everyone has private health cover. Physio is very  widely used preventatively as well as responsibly. But as I've traveled, I've seen that so many different countries  don't have a health system that actually supports preemptive training. It's trying to get that preemptive training  out of the clinic and into with Pilates instructors, high-level dance teachers ,into the studio so that they don't  have to wait until somebody gets injured and then spend a fortune trying to learn this after the fact. 

00:06:49 

Lisa Howell 

It was really trying to make sure that what I see is so simple is not being done globally, at all, in many studios.  Trying to get that out as much as possible.  

00:07:02 

Linda Bluestein 

Nice. That makes a lot of sense. In terms of the biggest recurring themes that you kind of covered a little bit but  could you go into just a little more depth in terms of what the big recurring themes are that you see in working  with hypermobile dancers?  

00:07:17 

Lisa Howell 

Yeah. Actually, so 20 years ago when I started practicing, we saw so many foot and ankle injuries and that was  by far the biggest thing that I saw and which is why I did the Perfect Pointe book and The Advanced Foot  Control. A lot of my early work was about foot control and things like that. What I noticed is that as the studios  around us learnt this work, started integrating it, we had far fewer issues in this area, but in the last, especially  five to 10 years with the rise of social media, Instagram, YouTube, Facebook, we're seeing a huge amount more  hip injuries and back injuries. Especially in the hypermobile kids, there is this idolization of extreme mobility.  My real concern is that some of these students who often have an undiagnosed type of mobility disorder of some  kind are being used as the little show ponies and the advertising for studios. The kids don't feel it yet, so.  

00:08:16 

Lisa Howell 

everyone thinks it's okay, including their parents and including some of the teachers, but seeing those kids long term but also seeing the kids who aren't hypermobile trying to copy the kids with excessive mobility and trying  to push themselves into things in their bedrooms, in their lounge rooms, when they're falling around in the  playground, this is really concerning me. The more information that we can get about the differences in body  types and what's appropriate at certain points of training, I think the better, because we're seeing injuries in 12  year olds, 11 and 12 year olds, which we only used to see and professional classical dancers or contortionists in  their twenties or late teens-early twenties. And trying to rehab an 11 year old with a labral tear is really hard  because they just don't have the body awareness or the mastery of their body to do the detailed rehab that is  required.  

00:09:11 

Jennifer Milner 

Wow. Yeah. You, and like you were alluding to you wonder how is that person going to feel 10 years from now,  20 years from now? Yeah.  

00:09:22 

Lisa Howell 

40 years from now, you know, when they are 60? If they're having their first arthroscopy and their first  resurfacing at 14, where are they going to be by the time they're 45? Right. So this is a massive concern. From  the surgeon's point of view, they don't have data on what happens in this age group because it's happened so  quickly. A lot of them are doing procedures on, that they would normally be doing on adults, on adolescents  who haven't even gone through puberty yet. It's a very big difference. A lot of them are kind of, "Oh, we'll try  this and see what goes," but there's no history of it. I think it's a very serious issue. A lot of people don't realize  how dire it is if they're not seeing the long-term injury side of it.  

00:10:06 

Jennifer Milner 

Right. And we did an episode with Dr. Wells, he's a hip preservationist. Dr. Joel Wells is really great because I  totally agree with everything that you're saying. Surgeons understandably are going to be optimistic about the  outcome of the surgery. Maybe it is going to be, you know, a great outcome, but what if it's not, and when  they're that young, and even if they have a great outcome, what's the long range?  

00:10:35 

Lisa Howell 

15 years on each partial one, right? If you have your first at 45, then you've got a couple of revisions into your later years. If you're having your first at 13, you're running out of options for revision by the time you're 50.  Hopefully the tech will better by then, but it's not a great time to start broaching the hip capsule because once  you go in, it's never the same again afterwards. Right. I think also that is something that the kids seem to have  this mentality or will, if something happens, I'll just have an operation and it will be fine. Which I think is a very  scary attitude to have in pre-teens.  

00:11:20 

Jennifer Milner 

That's that was what exactly what he was saying. He was saying, "if you start to go into the hip and they're 13  and 14, where do you go from there?" And it seems with this group of dancers with this generation, like you  said, it's happened so fast. We have no, we have no data behind it to say, "Hey, here's, what's going to happen in  10 years if your first hip replacements, when you're 15.". Right? We don't have anything to help put the brakes  on it yet in the studio level. I think that starting to change, I'm wondering, you're seeing that too,  

00:11:54 

Linda Bluestein 

I am seeing it start to slow down some, in dancer teachers at the more regional level, wanting to bring the dance  science into the classrooms, as evidenced by the fact that people are coming to your workshops.  

00:12:10 

Lisa Howell 

I have a feeling that it's going like this. Okay. So the good side is getting great. So I always introduce my  workshops. I say, "Look, I am already preaching to the converted.". The teachers come to the workshops or the  ones who are already trying to do it safely. They're the ones who've already looked and studied anatomy.  They're trying to find ways of doing it better. The ones who need it most are not there. So it's a divergence. I think that the great teachers are getting greater and getting far more education behind them. Unfortunately,  parents don't know to ask their dance teacher what their qualifications are and what their continued-ed  processes. Even in my own family, I asked my brother whether his, the dance teacher, that my beautiful little  niece was going to had any qualifications. He said, Oh, I'm sure she does. She's got a dance school.  

00:13:03 

Lisa Howell 

I said, "You could own a dance school.". He was, "I had never thought to ask if she has it's her business. Surely  she's qualified to do what she's saying. She's doing.". And I realized, he's a scientist, his wife is an accountant  and a lawyer. They wouldn't dream of doing something that they're not qualified to do. Yet because there is no  restriction on opening a dance school, your local 17 year old can decide to start running classes with zero  training. I think this is something that we need to educate the parents on is how are you choosing the school that  you are trusting that person with your child? How are you going through that process? Because they don't  understand the risks. They don't understand that there are a lot of very unskilled people doing what is a highly  technical and extremely important role. I think a lot of the education needs to be focused actually at the parents.  

00:13:57 

Lisa Howell 

They can just screen where they're even taking their kid, because they'll often just take it to the closest one that  fits them with a schedule that's easy without realizing the potential dangers.  

00:14:08 

Linda Bluestein 

Absolutely. Like you said, they may be looking, the child is looking on social media, like you said, and sees  these people doing things that they think, "Oh, I want to be able to do that. If I go to dance school, then I will be  able to do that.". I agree with you educating the parents is critically important so that they know. Yeah,  definitely. Yeah. Do you have a go-to shortlist of concepts to tackle in most hypermobile dancers? For example,  proprioception strength, building, things like that. Yeah.  

00:14:41 

Lisa Howell 

The first thing that I, it depends on the student. I treat human beings, not human bodies. It's usually what I say.  So, it depends on what that person needs. One of the things that I focus on first is creating some taping  techniques or offloading strategies to show that human what it's going to be like when they have some stability.  One example I had was an excessively hypermobile 14 year old. She came to see me, her dad's best friend, I'd seen the girls in his family. He said, "Look, you must take her to see Lisa.". She had been to a sports physician  who told her she was excessively hypermobile, she was going to be in pain for the rest of her life, and she  shouldn't do any exercise.  

00:15:23 

Jennifer Milner 

Oh, no. At this stage I quelled.  

00:15:26 

Lisa Howell 

At this stage, I quelled myself, walked out, threw a tantrum, walked back into the room, and started again.  Basically she had been in pain for 18 months everywhere. If she was having headaches, neck pain, shoulders  were dislocating, knee pain, back pain, pelvic pain, and had recurrent stress fractures in her feet. I thought,  "What is the best thing that I can do for you right now?" And I actually use dynamic tape a lot. I dynamic tape  term, with about six different techniques to basically suspend her body. She just looked at me and there's little  tears pricked in her eyes. She said, "I don't have any pain.". I said, "Darling, that's what you're going to feel  when we can get you stable.". And it, she was crying. Her mom was crying, everyone was crying, but she said,  "I thought I was going to be in pain forever because that's what the specialist told me.".  

00:16:15 

Lisa Howell 

I said, "You need to feel what it's going to be like when you don't have it so that you can feel that this is  achievable. The work is slow and laborious and boring, telling you that now. But, if you can experience what it's  like when all of your superficial muscles are not working so damn hard, then you've got an insight into it.". I  often use those taping strategies to help suspend them in the right position as we learn how to stabilize  underneath. The first thing I do is offloading and trying to reduce their pain levels. If they are in pain, I'm not  going to be able to find the deep stabilizers. Then, we work to create a first conscious, but then building towards  subconscious stability in the joints. And stability is not strength. We need to get appropriate timing. It's a very  detailed process. Trying to create, use the muscles that are closest to the joints to become basically dynamic  ligaments because their ligaments aren't able to do that job.  

00:17:14 

Lisa Howell 

Then we kind of aim to look at the reasons driving their poor patterns. I find that by examining their day-to-day  life, we can often pull out certain things that they do during the day that are setting them back for me. I worked  out my worst position was actually brushing my teeth and I'd hyperextend one knee, lock into one hip, and brush  my teeth. By having the taping on, it also gives them more awareness of when they're coming out of their  positions and bringing them back in. Our ultimate aim is have them moving with control rather than embracing  in one position. I think this is where, a lot of people attempt stability exercises, but they're actually over-training  the already overused global muscles rather than finding deep dynamic subconscious control around the joints.  The beautiful thing was within six weeks, she was pain-free.  

00:18:08 

Jennifer Milner 

Oh yeah. She walked in the light.  

00:18:10 

Lisa Howell 

Okay. She walked in, and I was like, "How you going?" And she's like, "I have no pain!" I'm like, "Yes!" But,  you know, she had been given basically a life sentence from the sports physician. The mom was just beside  herself and she actually burst into tears. She's like, this is the first time I've seen my daughter smile in 18  months.  

00:18:26 

Jennifer Milner 

Oh. Don't you find that when you tell them upfront, this is going to be tedious and boring, just so they know  what to expect. And know the parameters, right? I do. I have a lot of hypermobile mobile clients and I do a lot  of the tucks and tilts that you do at the start of the sessions, just deep pelvic state, spinal stabilizers. And they  will say, I feel nothing. And I say, good. They'll, and they'll do it every day for two weeks. I'll say, let's check  back in on that. They're like, "Oh, my back doesn't bother me anymore.". Yeah. Is there a correlation there? And 

Page 5 of 20 

Episodes have been transcribed to improve accessibility of this information. Our best attempts have been made to ensure accuracy,  however, if you discover a possible error please notify us as soon as possible. 

Transcript for Bendy Bodies Podcast, Episode 9: Educating the Dance Community with Lisa Howell 

it takes them a while to see that the boring work equals sometimes nothing, no pain. It's the absence of  something that says that it's actually working.  

00:19:11 

Lisa Howell 

100% and this is something that it's hilarious in the workshops. Cause it always comes up, a teacher going, "Oh,  I'm not trying, I'm doing it. Right. I'm not feeling anything.". I said, "If you are creating that movement and  you're not feeling it, you're using the right thing.". It's such a foreign concept for especially most answers  because we've been taught that we have to work hard. If you are generating the correct movement with no  activity on the surface, then we're actually accessing some of those deeper layers. And this is the mastery  component. You will get awareness of those eventually. In the beginning, a lot of people feel like they're doing  nothing. Again, understanding I do a lot of explanation of the anatomy behind it, what they will and won't feel,  to try and normalize that. It's often such a different style of training then they're used to.  

00:20:01 

Lisa Howell 

There's less feedback when you've got a super floppy joint. If you're not at the end of it, you're not going to feel  anything. I think that's a really important thing for people to realize if you're not feeling it, it's probably a good  sign.  

00:20:20 

Jennifer Milner 

Yes, absolutely. "No pain, no gain," I think tends to be something that, dancers are kind of used to pain,  especially once they've gone on pointe and things like that. I love the way that you approach that. When I  attended your workshop a couple of years ago, and I went through those exercises, it was eye-opening to me,  even as a, mid-adult, I was to realize that you could do things in different using different muscles, but the same  motion.  

00:20:48 

Linda Bluestein 

But the same motion. And so that was really fascinating. Yeah. Yeah. So well, good. You've gotten into dance  studios all over the world. What are one or two takeaways that you wish that every dance teacher knew about  working with hypermobile dancers?  

00:21:03 

Lisa Howell 

Yeah. I think one of the biggest ones is how changeable we are. Watching fatigue levels on dancers is super  important, especially when they're hypermobile. You may find that one piece of choreo or one exercise, if  they're fresh in the morning, they're totally fine. If they are at the end of a long set of day or a long competition  day or a long season, they're not going to have that same performance. Often as we get tired, our endurance  disappears. It even something that at one point in the day, they can do extremely well. They may start to fail  that. Looking at fatigue levels of both training load, time of day, but also their nutritional profile, their sleep  patterns, all of those other things, their gut biome is hugely important to make sure that they're actually being  able to sustain their energy because I find when they get tired is when they get sloppy. When they get sloppy is  when they start going into that risk of injury.  

00:22:04 

Lisa Howell 

Just because they can do it once doesn't mean they can do it all the time, and watching their fatigue levels. Yep.  The other one that I bring up and everyone is so surprised, but then they understand straight away is checking to  see whether your dancers have any abdominal pain. This can be period pain. It can be any gastrointestinal  discomfort, either acutely because they got food poisoning or whether they have any allergies or things like that,  or whether they just have an appalling diet, which some do. If you have any abdominal pain or back pain, it will  actually switch off the deep stabilizes that you need. If they are just about to get their period and they've got  really deep cramping or a lot of pain, those stabilizes are not going to kick in as much. It's not a good time to be  trying to crank an arabesque or bust out six terms.  

00:22:55 

Lisa Howell 

Once the dancers understand this, they're a bit more gentle on themselves because if they can normally do six and suddenly they can't, they'd beat themselves up or hang on. If you're not actually in an appropriate stabilizing  state, there is no way you're going to be able to bust out the turns that you normally do. Especially if we're going  into any extension-based positions, whether it's an arabesque, whether it's a layback in jazz, whether it's a  presage in a position in a contemporary pace, if they've currently got abdominal pain, they're deep stabilizers are  not going to be kicking in like they normally do. They're at a higher risk of injury. This is also super important  for the physios to understand. I had a couple of male physios and one of the courses in Australia, and went  through the risk factors for not having an optimal stabilizing core.  

00:23:45 

Lisa Howell 

We had one woman in the room who had 17 risk factors. We had one physio who had zero and he had this  amazing realization. He said, "Oh my goodness. I just thought people weren't doing the work. They weren't  getting stronger or they'd keep getting setback. I just assumed they weren't doing their exercises. I totally did not  think of how set up is the system to even have that training." And. the fact that a lot of women get scuttled to  zero every single month. Whereas a lot of males, if they are not hyper mobile, they've never had any issues in  their gut. They crawled well when they were young, they've had a very physically active lifestyle, they don't  spend much time sitting. Their core is going to naturally spontaneously fire and any training they do will build  on top of itself. A huge number of people have a dysfunctional system from very early on, and then.  

00:24:39 

Lisa Howell 

it's being reset to zero or negatives every month. We have to understand that some people are more at risk and  the same training won't work the same for all people.  

00:24:51 

Linda Bluestein 

Can you just elaborate slightly on when you're talking about it each month, going back to zero, just because  there's going to be a whole range of people that are listening to this, and that's such a great point and really  important concept. Would you mind just kind of, I'm sure a lot of the physios are going to definitely know right  away,  

00:25:12 

Lisa Howell 

If you have either cramping, discomfort, or strong pain with your menstrual cycle, a lot of people have already  associated that their back gets sore at that time of the month. It's not necessarily that there's something going  wrong in your back, but often the pain in the abdomen will switch off all of the deep baby back stabilizes. Often  the pelvic floor is not as responsive. You may even get some cramping. You may find that you get a stitch more  often because the diaphragm is trying to stabilize. If every month your deep stabilizers are getting what done. If  you don't know how to specifically retrain them. These are those very tiny little baby exercises. We need to  specifically attend to them to get them back online. If you don't know how to do that, or if you miss out doing  that, then when you go back to your normal activities, you won't have the pre stabilization or the least deep  muscles that really helps support your spine.  

00:26:14 

Lisa Howell 

The big muscles will tend to grip on that. Even for a normal person, let alone somebody who has super hyper  mobile back at the more HUD mobile you are, the more we need very detailed control of the deep baby back  muscles to actually help create that stability through the spine. If somebody is very stiff and has really tight  ligaments, they can sit on assisted without even thinking about it. Anyone who has any speck of hypermobility  in their spine will usually hate sitting on supported because it's a very conscious process to try and hold and  position. If you're not doing it exactly right, your big back muscles will get fatigued very quickly. There's a big  difference between people who have bound up tight ligaments and people who have sloppy ligaments in their  spine. Does that explain it?  

00:27:02 

Jennifer Milner 

Yes. Yes. Thank you. That's very, that's very helpful. Yeah. 

00:27:07 

Lisa Howell 

The thing is whenever that pain comes is going, yes, we need to deal with the pain. I personally used to get  ridiculous period pain and traditional Chinese medicine acupuncture resolved heaps of, so is there something  else that we can look at to help reduce the pain that you're having, but also every time you have that pain, we  have to go back to the drawing board and reprogram things in order before we start doing your normal higher  level stability work.  

00:27:38 

Jennifer Milner 

That that makes sense. And, and speaking of working with dancers in therapist setting, we've talked about you,  reaching out to studios and working with them on that level, but, you've spent a long time working one-on-one  with dancers, in therapy setting and they are all so grateful to you for that. What are some of those unique  challenges that face a therapist who is trying to work with a hypermobile dancer or, what are the challenges that  might be facing a hypermobile dancer? Who's really just trying to get back into the studio. Yeah.  

00:28:12 

Lisa Howell 

I think, yeah, that's a very two-sided question. I think I am now so appreciative for the amount of pain that I had  and my hypermobility, because it's taught me to be so much more sympathetic, empathetic and patient when  working with this, I see sometimes if there are therapists who are not hyper mobile themselves, they really  struggled to understand the complexity and the subtlety that is needed because they've never had to do that  themselves. I think there's that issue, from the client side, I think that the hardest thing for them is that it is a  very, detailed and laborious process. I've got better and better at doing it. Now I have a few more hacks. The  way I get people out of pain now is about 10 times faster than how I got myself out, which was very long slow  process because nobody was teaching me and I had to work it out for myself.  

00:29:07 

Lisa Howell 

I've now got ways of making it more subconscious because also when you're dealing with very young students  or people who are not aware of their body, it becomes much harder. I think having the patience to go through the  layers that are needed is super important. One that I think is really interesting is that often people who are super  hyper mobile, they've kind of merged it with their identity as a dancer and all the people who dance with them  and go, Oh yeah, they've got an amazing back. It's so flexi. Often if we're trying to back them away from their  extreme interests positions, they have a bit of an identity crisis because it's almost like, well, who am I without  my amazing back? And it's not that they're not going to have an amazing impact longterm. I am not against  extreme mobility. I am about doing it safely.  

00:29:59 

Lisa Howell 

But often they really struggle. They may be super attentive in the clinic and do everything right. You catch them  on Instagram, cranking their leg up and walking into a backnet. They need to, we need to spend a lot of time  with them looking about the identity that they've created of themselves as a dancer and what they associate with  their kind of superpowers or they're the things that they're great. If you're trying to take away the thing that has  always set them apart, there's going to be a dissonance there. That's something that we have to approach, and  build back over time, because if they have amazing range, we want them to be able to use their amazing range,  but we don't want them pinching into it and getting recurrent stress fractures in their spine. It's something that I  don't think a lot of people think about when they're trying, or they're wondering why the client won't be patient  or won't is not progressing.  

00:30:56 

Lisa Howell 

It's often the stuff that they're doing outside. They're trying to maintain their persona as a dancer, and they're not  wanting to give up that special thing that they've always had.  

00:31:06 

Jennifer Milner 

And it's, and it is partly compartmentalizing. As you had mentioned earlier, you hyperextend when you're  standing to brush your teeth, right. Dancers will do everything perfectly for me, and they will never lock their knee and they will do their single leg work beautifully. Their mom comes in to pick them up and I'll stand in and  talk with her. 60 seconds later, I looked over and they're slumped and their legs are locked. In certain settings  they have the correct posture, but they compartmentalize it. They're working with you, they're going to say, I  have that lumbar stress fracture. I'm going to do all these things perfectly. They're going to leave and they're  going to go, I've done my exercises. Now I can go do the things that my teacher wants me to do, or that will  keep me in the front row as I do the scorpion while everybody else does fancy stuff around me.  

00:31:54 

Jennifer Milner 

Yes, helping them have it permeate their whole life and also see that's not all that they are, is I think really  important. A hundred percent well. Looking at the young hypermobile dancer, your perfect point book, I think  should be required reading for every dance teacher and every dancer who wants to go on point, I handed out by  the dozens and every time I go in and speak to a different dance studio, I say, now get this book, all the teachers  should be using this. Hypermobility has its own issues, obviously with going on points. Do you have advice for  the young hyper mobile dancer who really wants that first pair of Pointe shoes? Yeah,  

00:32:40 

Lisa Howell 

The, the stages that we go through in the book, the first one is looking at range. Often they have no issues with  the range. However building the fine control is something. The, and the deep stability is something that they  usually struggle with, because also the makeup of their tissues and even their muscular structure. Sometimes  they actually don't have, they've got a different, range of muscle fibers available to be used than some of the  others. They will find the strengths and take longer. We need to be very patient and make sure that they are  listening to the people who say you are not yet ready. Even if they think that they are ready. If your dance  teacher and your therapist are saying, not quite yet, please don't go and grab your friends point shoes and try  them because often that happens. Once they do get cleared and they've done all the work and they get on point,  the biggest thing is to not stop all of that deep conditioning.  

00:33:37 

Lisa Howell 

The thing that comes up most for them is pain at the back of the ankle or a posterior impingement. If they're  sinking into their range, they'll often get a compression of the soft tissues at the back of the ankle. This does not  get better by working into it. It won't get better by continuing to press into it. Some of them think, Oh, just  stretch it by pressing into it more. If something's getting squashed and you squash it more, it gets more inflamed,  takes up, more space will get more squashed. The big one for them is watching out for pain at the back of the  end court and reporting it to their teacher and, or their therapist as quickly as possible, because if left unchecked,  then it can become a bit of a problem. Long-term. I'll definitely be flagging that one to keep an eye on when  they start and as they get older and attempting more and more challenging things on point.  

00:34:27 

Jennifer Milner 

Absolutely. Also for them to know that they should never stop their foot strengthening exercises and their ankles  during opening exercises,  

00:34:39 

Lisa Howell 

They will evolve and get more complex. Absolutely. It's interesting because some of them do so well to actually  get their sign off, and then they just totally stopped doing them because I wouldn't see them every week. I'd see  them six months later and they would have done nothing. They'd be back to before I said, honey, you have to  keep going with these so that you are continually reinforcing those good patterns. It is very important that they  continue with all of their little itty bitty baby footsteps and our conditioning to the level that they need to support  the dancing at the level they're doing. The exercises that were fine when they were 11, I'm not going to be fine  when they're 16 and dancing doubled the amount of hours each week. I need to make sure that their conditioning  program evolves as their training does.  

00:35:26 

Jennifer Milner 

Absolutely. Yeah. And, and what advice would you give to students and their parents who have been put on  point? We know this happens, they're put on point, at eight. I know I've spoken with teachers who then the  student comes to their studio and they say, I'm sorry, but we are going to actually hold off. You're too young. Of course the child, they want the point shoes usually, and the parents, they don't necessarily know. Kind of comes  back to what were talking about before, but do you have any specific suggestions when it comes to point work  and parents, and how to navigate that with their child?  

00:36:07 

Lisa Howell 

With the perfect point system and my whole process of pre pointe assessment, I said, it's, if you've got that  situation, it's really good to get the parent in the room and go through the assessment so they can see where they  are passing and failing. Them actually being in the room is super important. You can give them a report  afterwards that parents don't read anything, but having them in the room and seeing them unable to do eight  rises kind of important. I do also have a very practical suggestion for if they are in point shoes and a teacher  thinks this kid shouldn't be in them, but this is going to cause world war three. If we, take them off them is in  the, my beginner pointes program. We have a preparatory exercises stage where they're in the shoes, but they're  not on the shoes. So it's all about building stability.  

00:36:58 

Lisa Howell 

There's a lot of standing flat balance exercises. They're doing seated rises that are entendres in the shoe. I've  crafted a state of exercises where if they are in shoes and they're not quite ready to be doing classwork, it will  highlight their weaknesses and it'll help them build the required strength to actually do the classwork. It's a nice  kind of in-between stage. Cause I've talked to many teachers who have this, they're like this kid has been  working so hard. I know she's not ready, but she's getting really depressed about it. The parents want us to put her up and I want to keep her with this group. This preparatory exercises stage is really handy because even  when they, when anyone gets their first shoes, they should go through it before they do their classwork. It's a  great way to kind of hold them in. They're still in their shoes, but they're actually being shown how unprepared  they are for the next stage.  

00:37:51 

Lisa Howell 

It will help kind of stall them a little whilst you build the strength on all of them, for them to be actually able to  do classwork.  

00:37:59 

Jennifer Milner 

I think the assessment is such an important, tool because parents have so much of ballet is subjective. That girl  is better than this girl. It's so hard to put your finger on why, but to give a parent a checklist and say, if your  child needs these, we can go on point. If not, we can't, they understand that they can help explain that to the  child. Everybody comes out of it happier, and then they have measurable goals that they can try to reach. Yeah.  Understand. That's fabulous.  

00:38:28 

Lisa Howell 

Especially if it's built in, during the couple of years before it even, so it's harder when you inherit somebody  from another studio, right. If you have it within your own studio and you're building them up, it can start two  years before they know what the requirements are to hit before they go on point. It's not that you like little  Sophie better than you like little Charlotte, or if you have guys who are wanting to go into point, they have  exactly the same requirements that they have to check off. So it's not playing favorites. It's a really nice way of  actually honing in on the elements that are needed. It really helps support all of their other training as well. I  think the focus is, and I'm actually planning to redo refilm and reorganize the entire point training work.  Because some, we've revised it repeatedly over the last 15 years, but on talking with a lot of teachers, and  looking at how things implemented in studios and also understanding the kids that I work with in Sydney are  often very well-trained.  

00:39:28 

Lisa Howell 

They've got amazing teachers who are already integrating a lot of the work I've seen in other areas that some of  what I see as the most simple things just aren't even being done. Breaking it apart even more to allow it to be  built into at least the year of training before they're even thinking of starting on point and a very easy to access  way. I think that's important for the parents to understand, there's a studio in Melbourne and she's brilliant. She had a one year program. She now has a two year program. She seen the PDF out to all of the parents, organizes a meeting for them to come in. They get a hard copy and a soft copy of her document, which explains the  process that they are going to go through. If they're going to go on to point the cost of point shoes, the  requirement for extra training, this is what's involved.  

00:40:15 

Lisa Howell 

If you want to be a part of it, great. If you don't want this as part of your training, then let us know now. She said  her, the compliance has been amazing and her kids were gorgeous because they'd been working on it for two  years before they even had their first official point assessment. I think it's really important for the studio to be  integrating it into their processes and building out communication with the parents so that they know why  there's so much more work being done on this. They have kind of a big picture view because most parents  haven't done it themselves. They can, that also feeds friend goes to another school and they just put them up.  Why is this even possible? And the parents who really care about this to their kids will be absolutely delighted  that you are jumping through hoops to make sure they are safe.  

00:41:06 

Lisa Howell 

However it still is absolutely gobsmacking to me that you will have some parents. The therapist is saying this  child is not strong enough for point, the teacher is saying you're not strong enough to point. They remove the  student and take them to another studio where they're allowed on point. I see this as very dangerous parenting. I  will always stand by my gums, and studio owners. Unfortunately if the parent is willing to put their child at risk  in that way, if they're being given all the information, we also have to go, this is now not my problem. If they  had making that decision against the advice of two professionals to take them to somebody else, who's not going  to go through that process. You kind of have to let them go and wish them well. It's something that the ones who  care, struggle so much with, because they know the long-term effect of it and they know how dangerous it can  be.  

00:42:01 

Lisa Howell 

If that parent is going to make that decision for their child, we have to love them and let them go, unfortunately. 

00:42:10 

Jennifer Milner 

Right. Which is hard. But, there's a point at which you can't be responsible and you've given me information and  you do the best that you can to Mel accepted or they won't accept it. Yeah.  

00:42:21 

Lisa Howell 

You will either be super grateful for it or push back. Yeah.  

00:42:25 

Jennifer Milner 

Right, right. I agree.  

00:42:28 

Lisa Howell 

I think there's a very big difference between the parents who have no information making that decision. If the  information is not there, then that's one thing. If the information is there and they're choosing to ignore it, that is  now that yup. Yup. I'm super hard, but I've had to learn to do this.  

00:42:49 

Jennifer Milner 

Well and I've told dancers so many times that there's no one has regretted waiting to go on pointe. Right. They  may regret they didn't get to do this year's competition on point as a ten-year-old. As a professional dancer, no  one has regretted waiting a year to go on point. I had a friend who was a professional dancer. She danced with  them Hubbard street. And so she was a jazz dancer. She got a part with a show that did point work. She went on  

point when she was 25 and it took her a week because she already had solid technique and solid strength. She  was able to go on point and she would dance. And she looked fantastic. And the difference between putting a 13  year old on pointe, who's had that much time with great training and technique and putting a 10 year old on  pointe can be quite significant. 

00:43:39 

Lisa Howell 

I brought up if I had kids who, the kid who walks in and they just look like a principal dancer, this one's actually  going to go the distance. I would pull them aside and say, honey, I'm going to be even harder on you than I am  on your friends. Yep. You want to be a principal dancer. Great. You've got all the goods for it. I'm going to keep  you off six months longer than any one of your friends, because you're going to be on pointe for the next 30  years. That kid next to you is going to be on pointe max two years. Yeah. They're going to stop by the time  they're 14. However you, my darling are super talented. I do believe in you. I do think you can go the whole  way. Six months now is probably going to add about 10 years to the rest of your career.  

00:44:22 

Lisa Howell 

Do you think that's a good trade off? And when you explain it like that, the parents, some of them not so much,  but most of them go, wow, that's a totally different way of looking at I'm. I'm not going to put you up because  you are so good. I'm going to make sure that you have every single thing ticked off. If I've got a recreational kid  who is going to do it for a couple of years, I'm going to be looser on them. If I have that kid who I think is going  to be the next silver year, I'm going to be way harder on you, because you are doing more training. You're going  to be doing it for longer. I want you to stop dancing because you are tired of it, bored of it artistically rather than  because you can't because your feet are destroyed.  

00:45:10 

Lisa Howell 

I find once they realize that they're special in being kept back, it's a totally different ball game. Absolutely.  

00:45:18 

Linda Bluestein 

That's a fascinating way of looking at it. I love that. I say the more talented,  

00:45:23 

Lisa Howell 

The more strict I'm going to be on them,  

00:45:25 

Linda Bluestein 

For sure. Yeah definitely. It's hard because at that age, convincing them that we want to be looking at the long  haul. I mean, we know that it's a particular challenge for, kids that age for anything, whether it's, learning to  drive a car and, playing any athletic sport or anything.  

00:45:44 

Lisa Howell 

Where parents need to be parents. Right. My mom was not my best friend, but she was an amazing parent.  Yeah. Right. I think some parents, blur the line too much. If the it's been laid out, I think parents need to take the  responsibility to make the decisions before, until that child has the acumen to be able to predict long-term  consequences, which usually doesn't happen until at least after 16. We need to be able to make those decisions  and guide them towards having involvement in the decisions themselves. Yes. At the end of the day, you  actually need to parent. If something's is going to be dangerous for your child, if they wanted to sit there and  like their hand on fire, would you let them, if they decided that was a good idea, would you let them know you  wouldn't? You actually need, we actually need to encourage parents.  

00:46:34 

Lisa Howell 

Sometimes I have to put it that blatantly say, actually, I know she wants to, but this is not what's best for her.  Can you please stand up and be a parent and help me on this rather than trying to appease your child and be their  best friend. I usually have the kid out of the room, we'll have to have that conversation, but it's important for  them to hear it. I know don't actually think some of them have that said to them enough. Yes. That, that is the  most. 

Perfect lead in to our next topic. As you're saying about lighting your hand on fire, I'm so excited that this is our  next planned question, about stretching, because this is, again, getting back to the whole social media thing and  people doing the over splits and your book that, was then, your dad did the illustrations and Oh my gosh, that is  such a fantastic book. Everyone should have that book. You teach workshops also for teachers and physios on  flexibility. I would love to hear what you think about stretching for everybody, whether they're hyper mobile,  hypo mobile, a mix of both in different joints. I feel like stretching is like the kind of hot topic these days.  

00:47:50 

Lisa Howell 

Yeah. My flexibility course is not about stretching. It's about understanding flexibility and the multitude of  factors that come into it. I very rarely, I can't think of any time in the last five years where I've given somebody  a static stretch. It's about understanding where flexibility comes from why it's different and different people, the  priority of restrictions that we're going through. First we have to respect bone-on-bone if something is pressing  bone-on-bone yet, I don't want to push into it. I'm looking at the importance of the breasts, because if you're not  breathing, then you won't actually have the appropriate mobility and your upper back, the relationship of your  diaphragm and pelvic floor, deep stabilization of your deep core and most restrictions and flexibility actually  come because they're hiding an instability or they're being overused due to, something underneath not working  quite so. Well. We look at neural restrictions, fascial restrictions and muscular restrictions, but I find I very  rarely given muscle stretch.  

00:48:59 

Lisa Howell 

If it is a muscular issue, we're often looking at retraining that muscle. It's not being overused all the time, but it's  very little about stretching. It is extremely appropriate for hypermobile people. I think we need to be careful  because some people say a hypermobile people shouldn't stretch. You do need to understand your own body. If  you are doing an autistic art that requires mobility, you need to know how to be able to achieve what you want  to be able to achieve safely. Not stretching will actually make you feel much worse. However building the  stability and learning how to manage any restrictions that do pop up and they may change that it may be neuro  one day facial the next. You need to be able to read the differences between those and no super safe ways of  modifying that feeling of resistance without overstretching your joints.  

00:49:52 

Lisa Howell 

I think it's essential for anyone who's hyper mobile. Anyone who's not, it's the same process, but you're just not  as much at risk of injury if you do it wrong. Yeah. It's, I think it's very important for people to realize that  flexibility is not about stretching and this is where the magic happens because some people have been restricted  for years. Even at this last workshop and Calgary, one of the ladies, and she was halfway down her shins when  we started by the end of the day, palms flat nose to her knees. She said, I haven't been here in decades, no  stretching, no pain. No. She woke up the next day feeling totally fine. She came and she said, I thought I was  going to be sore this morning, but I'm totally fine. I said, yes that's because we did it with respectful your body  rather than pushing it to do something that it is so scared to do.  

00:50:42 

Lisa Howell 

I think understanding the way your body puts the brakes on is extremely important in managing flexibility long term, but we definitely need to get away from the linking of flexibility and stretching.  

00:50:57 

Jennifer Milner 

Well, and it's such a, it's so ingrained in the ballet world and the larger dance world, too, that something gets  tight. We stretch it. I have dancers come into me and they say, I worked a lot yesterday, so my calves are really  tight and they'll start to get into the runner's stretch to release their cabs. I'll say, if your calves are tight, let's do  some heel raises. And they're like, no, they're tight. I'm like, I know let's work them through a full range of  motion. Training, reeducating them on, just because something's tight, you're not going to necessarily go into  that full range, stretch and stand there and hold it. Actually working that muscle through a full range of motion  all the way down, all the way up, it's going to be more effective. Once they see the results, like you said, that woman felt such a difference, but getting them to that point where they can see it and accept that and go, yes,  what's next.  

00:51:50 

Jennifer Milner 

That's the hard part. Yeah.  

00:51:52 

Lisa Howell 

Also looking at the multitude of different things. If they do have a fascial restriction dealing with it as a  muscular restriction, isn't going to work. If they have a neuro restriction and you're trying to stretch the muscle,  it won't work. The number of kids who you'll go to, into a roll down into a forward bend and they say, Oh yeah,  my hamstrings are just tight. You ask them where it is. And they indicate their calves. Like honey, they're not  your hamstrings. Oh oops. If it's a neural or fascial restriction, it won't respond with your traditional stretches.  Those traditional stretchers will often make it worse. So we really need to be screening. What is that restriction?  How do we judge the difference between these types of restrictions and what is the appropriate response? When  we feel it, they are amazing then at working themselves out because they actually have the understanding to, and  the awareness to be able to unravel themselves no matter what they've done the day before.  

00:52:51 

Lisa Howell 

Whether they have been sitting lounging around on the sofa on a Sunday, or with, being, sitting in a bus or  whether they were at a competition and they've been doing some crazy things that they don't normally do, being  able to assess their own body and go, what does my body need now I think is one of the most important things.  We can give them as a dancer and as a human being, because whether or not they dance professionally, they're  going to be a human. And they're going to need that, buddy. If they understand how their body works. I think  that is one of the most amazing things we can give them with. Absolutely. 

00:53:26 

Jennifer Milner 

And, when you were talking about, stretching and being able to find what it feels like, neuromuscularly or  fascially, your other book that I hand out a lot is the front splits best book. I will, so many dancers will come to  me and say, I want to get my splits. Like what stretches can I do? And I can say, you can buy this book and you  have to do the things in this book and not look at it and go, there's no stretches and put it aside. When they work  through those different release points, like you talked about, and just troubleshooting all the different things, it  could be, they released their thorax and all of a sudden they drop deeper into their splits and seeing those things  again makes them believers. It's just changing the information that's handed in that handed out and the  expectations that they have as a younger population.  

00:54:16 

Jennifer Milner 

Yep. Yep.  

00:54:17 

Lisa Howell 

If you think about it, the thing that's so exciting for me now is now the kids that I worked with 15 years ago, in  their late twenties, early thirties, and some of them are starting dance schools and their knowledge is so one of  them in particular, who I worked with a lot, she has a beautiful little dance school. Her students are immaculate  

and they do half the training of some of the other schools. They have way better technique and that she is  sculpting them so beautifully. I sat and watched one of her classes. I said, am I, God, your kids are gorgeous.  She said, I just do everything that you taught me. That for me is the most exciting thing is to see what happens  to the next generation. When we do have people who've been grown up with this, it's all they know is doing it  well.  

00:55:09 

Lisa Howell 

That's going to be an amazing generation to step into. That's why I say, I think either there were division or the  bell curve is getting bigger, amazing ones are getting more amazing. Ones who don't look at things it's getting  passed on with zero education, it's getting worse and there's a lot in the middle. I'm trying to focus on the people  who want to accelerate. I, you have to, you can lead a horse to water. You can't make it drink. If you have people who are wanting this information and passing on as much as humanly possible to this next generation,  they are going to be the dance teachers, the pause instructors, the physios, the health professionals, the doctors,  they're the architects of the next generation. I think the more that they have experienced it themselves, they are  going to be the ones to actually change the industry.  

00:55:58 

Lisa Howell 

Long-term.  

00:56:00 

Jennifer Milner 

Absolutely. Their, and their bodies will feel better in adulthood than the people who have been exposed to the  other end. As you said, I, I think that's so true. What advice would you give to young pre-professional  hypermobile dancers.  

00:56:19 

Lisa Howell 

Learn about your body? it's one thing to learn about the human body. Studying anatomy is great, but you have to  learn the nuances of yours. For instance, I had my appendix taken out when I was 16, that the pain that I ended  up getting on my back was due to one manned directly in line with my appendix scar and two levels of  multifidus and my back being totally wiped out after that surgery, everything else around was working totally  fine, but because I had hockey ligaments and I had this one band that wasn't firing, I had immense amounts of  pain. What was needed for me was very different than what my sister needs, what my best friend needs.  Learning that nuances of your own body, I think is the best thing. Working with somebody like Jennifer, where  they can come in and explore their body in. Long-term finding someone who you can work with closely, who is  going to be patient and work through at the pace that you need to unravel your own body.  

00:57:20 

Lisa Howell 

I feel if at all possible doing one-on-one or small group stuff is so important because if a teacher is trying to deal  with 25 people in a class, they cannot be that specific. I think we need to use the private lessons that people are  having to look at reeducating their basic classical technique, rather than just running their routine over and over  again. Seeking out people who understand hypermobility, whether or not they're hypermobile themselves. There  are some amazing clinicians who are not, who are great at dealing with hypermobility, but I find the ones who  are hyper mobile, usually have a bit of an in-depth view on just how intricate it is. The biggest thing to keep in  mind is if you have been in pain, do not think you're going to be in pain forever. You just need to learn more  because, this is the most devastating thing for me to hear that people have been told while you're hyper mobile,  you're going to be in pain.  

00:58:17 

Lisa Howell 

That is not correct. I am perfectly living proof of it from having years of extreme, chronic back pain to being totally fine. I think we need to be very careful with the messages, but if you are a young dancer and you are  hyper mobile, it's harder, you need to learn more, but you will get so much smarter, so much more intelligent as  a dancer be, have much longer career by understanding the nuances of your own body, the nuances between  your right hip and your left hip, they may be totally different hips. I think learning your own body inside out  upside down is the most empowering thing.  

00:58:56 

Linda Bluestein 

Excellent. That, and that's true for dancers nine dancers, everybody that work with the body that you have and  not the body that somebody else has.  

00:59:11 

Lisa Howell 

What are you that's in anatomy book, right? Different is a lot of people's anatomy than what is put on those little  plates in anatomy book. It is when I was a student, were doing anatomy. We'd often have different cadavers and  different dissections. I would make a point of going around and looking at the differences between them because  

they'd all had different histories that all have different lines, they're all different Heights and weights and races  and nationalities and everything. And it was fascinating. The differences, even in their muscle attachment points, someone were vastly different to others, right? To learn. We need to know that anatomy can be different.  The bit in the book is kind of an approximation and a summation of kind of what it is, but it can be so different.  Learning what works for you is the most important thing, rather than having one generic program that works for  everyone.  

01:00:01 

Lisa Howell 

Any program, I think must involve some assessment and training and reassessment to actually check that you're  working on the right things. Sure.  

01:00:10 

Linda Bluestein 

Sure. For older hypermobile dancers, who've been dancing for several years. What advice would you give them?  

01:00:21 

Lisa Howell 

Keep learning. Because it's been one way for the last 20 years. Doesn't mean it's going to be that way. Also don't  let your ego get in the way of no, I've reached this point of training. I must not go back. Going back to the  drawing board is one of the most important things I think for everyone. Especially if you're one of those people  who every month you get practice zero, or if you have gut issues, they may be affecting things way more than  you think. I think again, just learn your own body, seek out people who can help you learn your own body  because doing it on your own, it is possible, but it's way slower and way more painful. Finding somebody who's  been doing it for years and we'll have, 10 different techniques for facilitating each thing that you're missing and  be very good at working out exactly what is missing.  

01:01:12 

Lisa Howell 

Hunting down somebody to work with, and expecting yourself to continue to improve your body is in a constant  state of reef formation, give it different instructions, you get a different result. The thing that will just warms my  heart so much is the number of teachers after the level one training course who contact me three, six, nine  months later gone, Oh my goodness. Thank you so much. I am so much better because I've been doing these two  simple little things and it's different things for everyone, but I've actually been doing these. I feel like I did 10  years ago, or I haven't had back pain and I've had back pain for 12 years. For me, it's just that constant state of  learning, exploring more understanding as much as we humanly can and just being gentle on yourself, not to  achieve a certain level, everyday during the month be aware that it will wax and wane.  

01:02:07 

Linda Bluestein 

Very good. Very good. In terms of, switching gears just to future research, what kind of research do you, there's  obviously lots that we still yet, would like to know, but is there any particular research that you're hoping to see  happen in the next few years? Yeah.  

01:02:25 

Lisa Howell 

I think the great research that has been done and there's been a huge amount of work on diagnosing different  connective tissue disorders, which I think is absolutely fabulous. However, I think I would love to see more  work on these practical strategies that we do. I find that there are a lot of very good clinicians in the world who  are doing amazing things with retraining, but it's very hard to research that. The problem is the way most  research is structured, is taking a big group of people, giving them a technique and expecting to see a positive  response. I think the hardest part is that most good clinicians will look at the individual go, what does this  individual need structure their retraining around exactly what that person needs and adjust it real time if they're  coping or not coping. I think it's very hard to do great research around this topic.  

01:03:16 

Lisa Howell 

If you gave Jennifer five girls came into you all extremely hyper mobile, do you do the same thing with all of  them? Not at all. It's so customized. And I brought this up at university. We were looking at research and I was  getting frustrated and my tutor asked if there were any questions I said, so hang on, you're taking 200 people  with chronic, non-specific low back pain. You're giving them the same program and you expect a positive  response. And he said, well, yes. I said, even if they are 76 year old women, you could have one, who's an Olympic athlete. One who's had six children, one who had Harrington rods put in when she was 12. One who is  morbidly obese and one who is, on the spectrum and cannot concentrate on the task at hand, how are you going  to give them all the same program? Give me those six individuals.  

01:04:11 

Lisa Howell 

I will give you six better ones, but you cannot give them the same program. He looked at me and said, Lisa, You  want to make a great clinician. Don't do research.  

01:64:22 

Lisa Howell 

The thing is that we need to learn how to research what the clinicians are doing. There is so much richness in  what the clinicians are doing, but unfortunately the research is often being done by people who are just coming  out of their degree and they're doing their masters and they're studying something. They have no practical  experience and they're not looking at the things that we know works. The, the research is not necessarily  reflective of what experienced clinicians are doing in the studio, or in the clinic. I also would love to see more  research on the relationship between gut biome, dietary support, and hypermobility and connective tissue  disorders. I think there's a massive area that is about to be, covered hopefully. I do think that's going to have a  massive impact on how we perceive fascia. Also on the effect of our internal organs, because most type of  mobile people have their little lazy eye and they have occasional heart flutters and they have a sluggish digestive  system.  

01:05:22 

Lisa Howell 

There's so many other things that happen when your connective tissue system is a bit insufficient, not quite as  effective as it should be. The other side of that is going okay, so we know that your fascia sucks. It's not very  well, but looking at the research on the most optimal ways of training fascia for resilience rather than  unraveling. So I had a chat tom Myers. I went and did one of his courses. It was great, had a chat to him. I said,  look, so all of the course was on unsticking things. I said, what are your strategies for training at when it's  insufficient? And he just looked at me and went, Lisa, that's your area comment, put your light Mr. Fascia.  

01:06:06 

Lisa Howell 

And he said, Well, the clients that I deal with are all a step forward. He said, so all of my work I've been  working on unraveling them. Whereas those of us who work with dancers, we're often dealing with the complete  opposite end of the spectrum. Sometimes yes, they may need facial emoting, but a huge amount of the time.  They actually need to be training their fascia to be more resilient. This is something that I haven't seen much  research on. It's something that I think would be very powerful. I think we need to focus the research on things  that are going to change how people are treated, rather than changing things that will sit in a textbook. Well  absolutely.  

01:06:47 

Jennifer Milner 

That's really fabulous because of course now fascia is we're understanding a lot more about it, but it wasn't that  long ago that we thought Dasha was very unimportant. Now we know that fascia is so important when it comes  to chronic pain. That's such a, a huge area that, a hundred percent this work. What is going to be next for you  then Lisa, are you going to, where are you going to go with your work? Because wherever you go, I will go  there with you.  

01:07:20 

Lisa Howell 

I think the coolest thing I closed my clinic last year, July last year. For me that has now opened up a whole lot  more potential. I have been hands-on people for 20 years and I had always structured the clinic as a R&D  facility. I had one hour one-on-one or an hour and a half or two hours, one-on-one appointments. I used it to  research as much as humanly possible about what dancers needed. Now the focus is on getting that condensed  into ways that people can understand. Something that I'm working on a lot is a series of injury management  guides, which basically takes a lot of each common injury, say plantar, fascia pain, posterior impingement, I'll  just ladders, spinal stress fractures, and looks at what it actually is, why it usually happens and enough details.  That can understand the nuances between it because it's never the same. 

01:08:17 

Lisa Howell 

There is no one program, but looking at how we need to assess somebody who has that thing going on and  possible rollouts taping the strategies, offloading techniques, and retraining, so that it doesn't happen again.  Especially with the hyper mobility. I have a YouTube, playlist, which has hypermobility hacks. I do want to do  a stack more on those, and they are practical hacks that I have learned myself to get around, not having great  ligaments. I am putting a huge amount of effort into the teacher training. Running the teacher training  workshops all around the world, everywhere from Norway to the US to Asia, to you name it, Germany,  wherever. Even more than that from running those over the last five years, I've worked out. It's one thing,  getting that information. It's another integrating it into the classroom. We've now filmed every element of that,  the original teacher training workshop, and I'm also creating class plans to help integrate that work at lots of  different ages.  

01:09:23 

Lisa Howell 

How do you start to teach ten-year-olds about the China? How was this different to how you approach a class of  16 year olds? If you have a student who's rolled over on their ankle, how do you deal with this in class? and so  teaching people how to use the content in the exact situation that they're coming up with, you've got a bunch of  eight year olds who are coming up with servers disease. What things can we pull from the program that I  completely appropriate for them? What information does the parent need? So really trying to unpack it and  make it easy for teachers to use every day without them having to go and do a physio degree to understand it.  Kind of digesting it, pre digesting it down and packaging it up. So that it's much easier to understand. That's  kind of my big push over the next 12 to 18 months.  

01:10:12 

Jennifer Milner 

That is going to revolutionize dance training. Absolutely. I think that is going to be such a huge help on such a  widespread level. So I'm really looking forward to that. There anything else that you wanted to say or add that  we haven't covered?  

01:10:27 

Lisa Howell 

No. I just, first of all, thanks for inviting me to be on here and thank you for the work that both of you are doing  to raise the awareness of this, because it is such a massive issue globally. I think the more of us who are out  there, educating and empowering and being in contact with different people, Linda, the work that you're doing  with health professionals to even expose them to the challenges that come when you're dealing with this. I think  there's a huge number of medicos who do not understand hypermobility at all. That's why we're struggling with  what some people are getting told when they go and see the health professional. The work that you're doing to  try and educate that sphere, I thank you so much for, and I think, we're all trying to do as much as we can to  raise awareness, to help people live better, whatever field they're in.  

01:11:21 

Lisa Howell 

I just want to thank you guys for everything you do.  

01:11:26 

Jennifer Milner 

Well. Where now I know where I can find all of you, but for our listeners, where can we read your blog and buy  your books and sign up for your workshops? Where can we find it, all of that?  

01:11:37 

Lisa Howell 

Theballetblog.com is my main website and all of the workshops are on there. Thousands of free articles, the  video courses for any of the paid programs. We also have now the hard copies you can buy through Amazon so  you can order them and get them in a couple of days. Rather than us holding stock in Australia and having to  send it across the world. I had the, my YouTube channel, and we're actually going through and trying to  reorganize that at the moment and make it a whole lot easier to find absolutely everything, but just trying to get  as much content out into the world. We also have Facebook and Instagram, so whatever channel you like to  operate on, we have one of those and they don't do Snapchat. Sorry never got TikTok just yet. Whatever our favorite social media is just like for the ballet blog, social media, and we'll find it. YouTube it's actually their  Isabella blog channel, but we're actually migrating it all to be under Lisa, how I'm managing three YouTube  channels. It's a little bit time consuming. All of the YouTube stuff is going to be under Lisa, how, but everything  else just looks at the ballet. Pinterest, we also have, so whatever you like,  

01:12:52 

Jennifer Milner 

Wow. Yeah. With the ballet blog.  

01:12:56 

Lisa Howell 

Yeah. It's discovered it's actually, a huge amount of people were sharing things themselves. We decided to make  a core channel to make that easy for people to find.  

01:13:06 

Jennifer Milner 

Super smart. That's really good. Well we are so grateful for you being here. You have been listening to Bendy  bodies with hypermobility MD today. Our guest has been Lisa Howell, physio therapist, and that is it for today,  but we have lots of great guests coming up. So stay tuned.