Naomi Glass, teacher at Pacific Northwest Ballet School, knows firsthand the advantages and challenges of hypermobility. As a young dancer, she was told to keep her hyperextended knees in a straight position far from her full range of motion. “It felt too bent to me,” she says. “But once I was able to access my inner thighs and rotators, I found strength and stability and could still use the line that I wanted.”

Hypermobility occurs when joints exceed the normal range of motion. Dancers can have hypermobility in specific joints, like their knees, or they can have generalized laxity throughout their bodies (which is often measured using the Beighton system—see below). While this condition may enable students to create beautiful aesthetic lines, it can also increase risk for injury. Help dancers gain the strength they need to stay healthy while making the most of their hypermobility.

Stand Strong

Students need correct body alignment to stand and move properly. “The pelvis should be neutral, so the dancer can engage the tops of the backs of the legs, access the inner thighs and externally rotate the femurs,” says Glass. “That allows them to find a solid position while still achieving a gorgeous leg line.” A strong core will create a trickle-down effect through the legs, so students are less likely to lock back in their knee joints. Keeping weight over the balls of their feet, rather than the heels, will also enable more stability and less gripping in the front of the thighs.

Don’t Overstretch

Dancers should avoid stretching to their end ranges: This practice will create even more hypermobility. Students should never feel so comfortable that they just sit in overextended positions. Active stretching with engaged muscles and resistance components will elongate muscles while developing strength at the same time.

“If dancers keep going to their end range, the ligaments get more and more stretched out,” says Julie Green of Performance Ready Physical Therapy, and physical therapist for Pennsylvania Ballet. “It’s hard for dancers to find a place that’s strong and stable, but not in their end range.” For hyperextended knees, students can sit with their legs stretched to the front and pull their patella up without letting their heels come off the floor. This exercise builds quad strength and muscle memory for when the dancer is weight-bearing.

Green also suggests that dancers roll out their muscles on a foam roller. “They feel like their muscles are tight and they want to stretch, but a lot of times it’s not the length of the tissue but the tight fascia that is giving them that sensation.”

Work the Feet

Beautifully arched feet tend to require extra support, since hypermobility in the ankles can cause instability and weakness. “Encourage dancers to stretch in their mid-ranges without their knees locked or pushing over their arches into their shoes,” says Green. “They have to pull up and out of their joints.”

Dancers can strengthen their ankles and the intrinsic muscles in their feet by doing TheraBand exercises, doming and doing a consistent series of gentle rises. “They should feel the weight evenly distributed through the metatarsals, so they develop the right alignment,” says Glass. “Hypermobility needs to be supported, and the strength needs to be there, especially before they start dancing on pointe.”

Build Upper-Body Strength

Don’t neglect the upper body when it comes to addressing hypermobility. Green recommends strengthening the scapula and rotator-cuff muscles by holding a TheraBand with the elbows at 90 degrees and opening the hands away from each other. Dancers can also lie on their stomachs or on a ball, and move their arms into a Y shape, T shape and I shape (down by their sides). “Exercises don’t make the hypermobility go away,” she says. “It’s maintenance and will be part of their life. Dancers blessed with this beautiful anatomy have to constantly concentrate on strengthening around their joints.”

How do I know if my students are hypermobile? Try using the Nine-Point Beighton System:

The nine-point Beighton system is commonly used as an indicator of generalized hypermobility. The higher the score, the higher the laxity (looseness). Julie Green, physical therapist for Pennsylvania Ballet, administers this test as part of each dancer’s screening. She uses it to gather information and help shape the dancer’s wellness plan.

• One point, if while standing forward bending, you can place palms on the ground with legs straight.
• One point for each elbow that bends backward.
• One point for each knee that bends backward.
• One point for each thumb that touches the forearm when bent backward.
• One point for each little finger that bends backward beyond 90 degrees.