Beyond the Backbend: Joint Hypermobility, Ehlers-Danlos Syndrome, and Safe Training in Circus

In circus, flexibility is a valuable asset—both artistically and physically. Extreme range of motion is often praised, but not all flexibility is created equal. For some artists, especially those with Ehlers-Danlos Syndrome (EDS) or Generalized Joint Hypermobility (GJH), that impressive flexibility comes with hidden risks and health challenges.

What Is EDS and Who Has It?

Not every bendy performer has EDS. Hypermobile EDS (hEDS) is a genetic connective tissue disorder that affects more than just joints — it can impact skin, blood vessels, and the nervous system.

Diagnosis is clinical and includes criteria such as:

• A first-degree relative with hEDS
• Systemic signs (stretchy skin, hernias, prolapses)
• Chronic musculoskeletal issues (dislocations, chronic pain)
• Exclusion of other conditions

A high Beighton score (a 9-point test for joint hypermobility) is a visual cue, but it’s only one part of diagnosis.

Studies confirm that hypermobility is common in circus performers, but EDS is not. For example, a 2011 study of ballet dancers showed 57% had generalized hypermobility, yet only 9% had symptomatic hypermobility syndromes. A 2014 study (Murray et al.) reinforced that many artists are hypermobile, but few meet the criteria for EDS.

Still, some circus artists do live with EDS, many undiagnosed. For them, awareness and recognition can be life-changing, leading to more appropriate training, support, and care.

When Hypermobility Hurts

Hypermobility can feel like a superpower… until pain, fatigue, or injury enters the picture. Those with symptomatic hypermobility or EDS may experience:

• Chronic pain and fatigue

• Frequent joint dislocations/subluxations

• Delayed healing

• Poor proprioception (difficulty sensing body/joint position)

• Dysautonomia (e.g., POTS, fainting)

• Fragile, stretchy skin

These issues are often invisible and misunderstood in high-performance settings.

Hypermobility and Neurodivergence

Research shows strong links between hypermobility and neurodivergent conditions like autism and ADHD.

A 2018 study (Baeza-Velasco et al.) found 44% of autistic individuals also met criteria for joint hypermobility. A 2020 study showed that 50% of adults with hEDS also had ADHD, and 28% had autism.

Coaches working with neurodivergent students should be especially mindful of proprioceptive challenges, injury risks, slower strength development, and fatigue.

Training Smarter: Modifications That Matter

1. Props Are Smart Tools

Blocks, straps, and bolsters aren’t just for beginners — they:

• Limit excessive passive range

• Encourage active control in flexibility work

• Reduce risk of joint strain or dislocation by loading different areas, so students can gain flexibility without increasing hypermobility

2. Strength Over Stretch

Traditional static stretching may not benefit hypermobile students. Instead, prioritise:

• Strengthening through controlled, full range of motion

• Joint stabilization exercises

• Core and glute activation

• Motor control and alignment drills

Take extreme care with correct technical and joint alignment during skills such as acrobatics. This builds body awareness, improves movement confidence, and helps prevent injury.

3. Collaborate with Professionals

If you suspect a student may have Ehlers-Danlos Syndrome (e.g., high Beighton score, chronic symptoms), encourage families to consult a geneticist. The 2017 hEDS diagnostic criteria is the current standard, though updates are coming.

If diagnosed, work with consent to connect the student with physios, myotherapists, or specialists. Many circus schools, including my own, already use a multidisciplinary approach, with excellent results.

Flexibility does not equal Ehlers-Danlos Syndrome. Avoid assuming a bendy performer has a disorder — only a qualified medical team can diagnose EDS. Your job as a coach is not to diagnose, but to observe, adapt, and educate.

Raising awareness of Ehlers-Danlos Syndrome and hypermobility ensures:

• Students who need support get it early

• All students train more safely

• Coaches create inclusive, informed environments

We don’t need to fear hypermobility — we need to respect it. The long-term health of performers depends on it.

Resources: The Ehlers-Danlos Society – www.ehlers-danlos.com / 2017 hEDS Diagnostic Criteria / Murray et al. (2014) – Performing Artists & GJH / Chan & Nichols (2011) – Ballet Dancers & Hypermobility / Baeza-Velasco et al. (2018) – Autism & Hypermobility / Casanova et al. (2020) – EDS and Autism Spectrum / Eccles et al. (2020) – Neurodevelopment & Autonomic Dysfunction

Jasmine Straga

Board Member, Fédération Mondiale du Cirque (under H.S.H. Princess Stéphanie of Monaco) Founder, Australian Circus Festival | Director, J.S. Creations -Australia

Jasmine Straga is an international performing arts professional and advocate for the circus industry. Trained in dance, theatre, and gymnastics, she toured globally as a contortionist, aerialist, and choreographer, directing shows such as Cirque Medrano and Cirque St Petersburg. She founded Gala Entertainment and contributed as an entertainment writer for Macau Closer magazine. Jasmine has produced events for circuses, casinos, and nightclubs across Asia and Oceania. As a director of the World Circus Federation, she works with UNESCO and governments to protect circus arts. Now based in Australia, she runs the Australian Circus Festival and mentors emerging artists. A passionate advocate for hypermobility awareness in circus, she promotes safer training practices informed by her experience with Ehlers-Danlos Syndrome.

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