Hypermobility and Chronic Hip and Back Pain

Chronic hip and back pain are increasingly common among us women, especially as we age, and can, unfortunately, become exacerbated through our dancing. There also seems to be a direct correlation between chronic back pain and dancers with Generalized Joint Hypermobility (GJH). A recent study revealed that dancers with GJH seem more vulnerable to musculoskeletal and psychological complaints. In addition, GJH was also associated with lower physical fitness, despite training (this is why caregivers for professional dancers should monitor closely the physical capabilities and the amount of psychological strain).

Although many dancers can sometimes wish to be as flexible as our hypermobile counterparts, hypermobility can become a problem. Frequently, there are no long-term consequences of joint hypermobility syndrome, but hypermobile joints can lead to joint pain. Over time, joint hypermobility can lead to degenerative cartilage and arthritis. Certain hypermobile joints can be at risk for injury, such as sprained ligaments. It can also become a problem if you – now an adult – haven’t built the strength to develop the needed stability. This is especially important for especially the small deep back muscle, pelvic floor, and deep abdominals, as well as the muscles needed to achieve true turnout in ballet. The inability to control this increased movement effectively, they will often result in problems, and as dancers, we want to pay special attention and be kind to our joints. If the deep muscles are not effectively engaging to control the spine correctly, then the bigger back muscles will grip on, trying to substitute for the deeper ones. This will cause massive pain in your lower back and hips if we don’t attention during training.

Unfortunately, we are addressing two muscle groups that are vastly different physiologically. The deep back muscles are designed for endurance (or in other words, to work at a low intensity for long periods of time), while the larger muscles in the back are more phasic muscles, designed for more agile movement. The faster twitch muscle fibers are best used for short bursts of activity.  If the big back muscles (Erector Spinae) are on constantly this results in stiffness and pain in the low back, as the muscles are being used for a job that they are not physiologically designed to do. This then usually leads to chronic hip and back pain.

If you suffer from this on your rest days, you’ll probably feel like you need a massage, you’ll feel tight and probably find yourself constantly stretching and cracking your back to relieve the pressure. Although this may give us some temporary relief, we should train our minds and bodies for a more sustainable solution for our bodies, by specifically retraining the deepest muscles. While most dancers spend a lot of time trying to strengthen their abdominals, let’s resort to one of our favorite workouts, Pilates, to help aid in the retraining and rediscovery of our back. Lets we forget that other conditions – such as arthritis and degenerative spinal conditions – are also threats, so we must create awareness to fix these problems before they impede us from even stepping up to the barre.

Many dancers with these issues also have numerous issues with abdominal pain and digestive issues, which can also result in it being very hard to isolate and activate the right muscles. It is essential to work on improving this side of things to enable you to find these deep stabilizers. It is also very important that you are getting adequate nutrition for optimal healing, rather than simply cutting out food groups that may irritate a sensitive stomach.

The best way to accurately isolate these deep stabilizing muscles is to have a ‘real-time’ visual ultrasound to actually view the muscles on a screen, while consciously contracting and releasing them. I find that this is really helpful for anyone but essential for those that have had issues with back pain and instability. Even in dancers who have had no issue with pain, I find it a very helpful process that can help them ‘find their center’ much more effectively than normal retraining. Much like how a foundation stabilizes a house, your stabilizer muscles help to keep you balanced and upright when moving. Your stabilizer muscles are not directly involved in the lifting of the weight, but help keep your body steady, through isometric muscle contractions.

Students with chronic low back pain often also have issues with pain in their hip flexors, which is closely tied in with the instability on her low back. When the low back is unstable, the Psoas Major muscle will contract at the top end (where it attaches to the front of the spine) in an attempt to stabilize the low back. This means that it is not available to be used to hold the leg devant or a la second and often results in irritation in the front of the hips. If this is your case, you will feel that you need to stretch out your hip flexors, but this will actually often make it worse, as the hips are most likely already inflamed. The real solution is in learning how to stabilize the back effectively and retrain the muscles of the hip so that each is doing what it is meant to do, resulting in much more mobility and strength in all ranges.

To truly relieve this issue with chronic hip and back pain it is essential to address all of the above issues and move gently back into classwork. There are magnificent Pilates back-strengthening exercises that can help target very specific areas of your back (if you don’t feel that your problem area was targeted specifically, enough, you are more than welcome to book a Private Class). You will need to avoid extending the low back and sustained extensions at full height while you work on re-patterning the motor control around the hips, however, this should result in far less pain and an improvement in your technique overall.  In class, you must focus on maintaining subtle deep abdominal control and true turnout isolation, while keeping the legs low, before you progress back to a full class. Talk to your teacher and – to the best of her abilities during a virtual meeting – you can discuss what’s hurting and when so that she can provide some guidance (which may include directing you to the appropriate healthcare provider).