When I speak to other healthcare professionals about circus artists (once they figure out the difference between a trapeze and a trampoline) they always want to know what kinds of injuries circus artist have. They also assume that injury rates are much higher in circus arts than they are. To answer their questions I conducted a survey on injury rates back in 2013 and 263 of you graciously responded. (See below for some of the information from that survey)
However, as I am preparing for a workshop on the Evaluation and Treatment of Circus Artists for healthcare professionals in Boston next month, I am realizing how much the community has grown and would love to get a more updated view of what injuries are occurring in the community.
Please take this 7 question survey below to help the knowledge in our community grow.
Thanks for your help! I look forward to reporting back with results!
(And if you know any healthcare professionals who would benefit from knowing a bit more about what you do have them come join me in Boston!)
Here you can find both archives of the Pure Motion Physical Therapy Blog as well as updated posts.
I look forward to your questions and comments. Let me know what you'd like to learn about or your views on previously covered topics via the contact page or here in the comments.
Thank you for joining me on this journey.
Dr. Emily Scherb, PT, DPT
A conversation over on Facebook about warming up had me reviewing my post from waaaay back in February on warm ups. It reminded me that I was remiss in not emphasizing my love of working oppositional muscles to improve the balance of muscle pull on a joint. That means more pushing for all aerialists! Anyone who does that much pulling / hanging really should be doing some overhead pushing to balance out the muscles of the shoulder and surprise the stabilizers with forces in new directions. Acro / handbalancing / tumbler folks I recommend the exact opposite for you. How about giving hanging a try (with good form, please)? Overhead pulling is the answer for you.
How should an aerialist get pushing? I'm a fan of training functional movements. So, how about a handstand (with good form, please)! Too hard? Try a downward dog. Somewhere between? Put your feet up on a increasingly higher supports, as you can maintain your shoulder control, until you are stacked and in an upside-down L shape with your hips over your hands.
Don't forget! This is all about pushing, for you (wonderful) body nerds this is coming primarily from the serratus anterior. Keep your shoulder blades actively reaching away from your hips and your elbows feeling like they are rotating towards each other (as if you were trying to turn you thumbs to point forward from the shoulder).
If you are a handbalancer working on pulling, hanging is all about proper form and getting the shoulder blades and humerus in the proper position. Your shoulder blade needs to rotate upward a full 60 degrees. Your serratus anterior is already super strong from all of your pushing. You'll be relying more on your lower trapezius to keep your scapula down on your back while helping with your scapula's upward rotation.
Note the distinctions that these things should be done overhead. Our shoulder is a complex joint and the intricacies of the motion and stabilization of full shoulder flexion deserve and need extra love.
For you body nerds check out this video,, with a more full description of the movement and the movers at play coming soon.
This month the International Olympic Committee (IOC) put out a consensus statement about "load management" and its relationship to major risk factors for injury in elite athletes. In my mind, performers are the ultimate athletes able to combine strength, grace, control, flexibility, artistic prowess, and explosive power all while managing performances, training, and the stresses (and joys) that come from creating art.
What is this load that the IOC is concerned about? Load, in summary of the IOC, is the combination of all sources of pressure on you comprised of those directly from your sport and those from outside your sport, including physiological, psychological, or mechanical stressors (ie lack of sleep, a busy schedule, preparing for a show, or going for a hard hike). These factors are considered over the short term (one training session or performance) and long term (months or years) and the variable magnitude of the factors (ie duration, frequency, and intensity)
If when you grab your aerial silks, trapeze, or rope and the inside of your elbow shouts with sharp pain, you could be suffering from “climber's elbow” otherwise known as medial epicondylosis. But, what exactly is going on and what can you do about it?
That super tender spot on the inside of your elbow is the medial epicondyle. This knobby bump on the ulnar (pinky side) of the elbow where the common flexor tendon attaches the wrist and finger flexor muscles, and the pronantor teres to the bone. These are the muscles that you use to flex your fingers and grasp your apparatus, to turn your palms facing outward, like to grip a trapeze, and to bend your wrist toward the pinky side of the hand, as with vertical apparatus. So, basically, all the muscles we hang our entire body weight from.
Often injury to this tendon is due to overuse, either from over training with too little rest, or from muscle imbalances in the body that make these muscles work overtime. Overuse and muscular imbalance is incredibly common due to how our lives revolve around finger flexion. These are the same muscles we use to type and use those '”wonderful” track pads on our laptops. Considering that not only are we aerialists, but also participants in the digital age, this gets tricky.
It is hopefully becoming clearer why the tendons attaching to the medial epicondyle are constantly subjected to sustained stress and are vulnerable to microtauma. Microtauma is normal and given adequate rest the body can repair the tendons to a higher level of capability to endure the stresses we put on it. However, without that rest the strong repeated muscle contractions can result in injury.
If you find yourself rubbing your elbows while training or having lingering pain there is hope. Find yourself a great physical therapist and get guidance on the rehab pathyway to pain free aerial practice. Tendons respond best when you load them properly and give them rest to rebuild.
If your pain is due to muscle imbalance and poor function, then your movement patterns are what need to change first. To quote a leading researcher in the field, Dr. Jill Cook, “With poor function you will never be out of pain. To get out of pain, improve function.” Having someone take a look at how the whole body, shoulder, and wrist are working can be the key to being pain-free and will get you prepared to rehab the tendon itself. For more info and links to relevant articles click here.
There are four phases to tendon treatment: isometrics to reduce pain, isotonics for strengthening, fast eccentrics to improve energy storage, and sport specific training and loading.
Phase 1: Isometrics to Reduce Pain
The first step in healing is stopping the cycle of pain and teaching the brain that though the muscles are firing, your elbow does NOT have to hurt. In isometric contractions, the muscle length and joint angle do not change. To do this, hold a heavy load (~75% max) for 45 seconds with the wrist and/ or fingers (depending on which tissues are most irritated) in a mid range position with the forearm supported on a table 5 times. By the second or third repetition this should be pain free, and without pain your strength will already be about 19% increased!
Phase 2: Isotonics for Strengthening
Once you are pain free, the next step is to strengthen the muscles and load the tendons slowly and avoiding fatigue. Begining with eccentric (lengthening) and moving toward concentric (shortening) contractions with an even amount of weight throughout the movement. As you are loading the tissue it is important that you have no pain for a full 24 hours after each session before you increase weight or resistance.
Phase 3: Energy Storage
Tendons are the springs in our system and need to be able store energy without pain. At this phase you will begin to perform fast eccentric contractions to mimic the loads that your tendons go through in daily life with about 48 hours of rest to allow for remodeling.
Phase 4: Sport Specific
Congratulations!!! You are back to (less modified) training and feeling pretty great. Now is the time to work on your grip endurance and your ability to absorb the force of doing smaller to larger release moves and re-grips.
Tendons may take a while to heal, but they will heal. The earlier you recognize your symptoms and get help, the sooner you will be back in the air and feeling great.
Some final thoughts:
I know we all love to stretch, but please AVOID stretching your flexor tendons. I know, everyone tells you to stretch, but here's why you shouldn't. The mechanism of injury to the tendon is excessive load that increases the tensive and compressive forces on the tendon. So, when you think about what stretching does, it INCREASES the tension and therefore the load on the tendon pressing it against the epicondyle and irritating the tissue further.
As far as technology goes, track pads can be killer on the flexor tendons. GET a MOUSE. It can be a cheap and very effective way to decrease your daily symptoms and help you feel more comfortable throughout your day and in the air. Also, try to limit phone time in general. Just holding those little buggers and swiping can get irritating after a while.
Modify your TRAINING, but DON'T STOP fully. Give your elbows a bit of a rest, you may need to take a small break. In the meantime, work on your form, general strength, conditioning, and anything else you can do without increasing your symptoms. Your body and mind will thank you. :)
This blog post is for information only and is not meant to replace proper medical care and diagnosis. If you have any new pains or concerns about your body and its function please set up an appointment with a provider you trust.
Let's investigate the reasons behind why the hollow body is so important, when it is most useful, and how it is not always needed, and when to look out for injurious movements.
Who: Most aerial teachers start teaching their beginning students how to hang with “engaged” shoulders and a hollow body in their very first class.
What: A (correct) hollow body position is identified by a slightly flexed (flattened) lower back with the rib cage drawn down which is stabilized with all four of the abdominal muscles.
How to do proper shoulder external rotation with a resistance band.
Have you ever been unsure about how to warm up? When to strengthen? When to stretch? Read on for how to structure your training to prevent injuries.
The first thing you need when you start training is to get more blood flow to move into your muscles to prepare them to move, work, and stretch. To do this, begin your practice with 10 minutes of gentle aerobic activities. A gentle jog, a bike ride to the studio, even light jumping in place all fit the bill.
Once your muscles are warm, you are ready for dynamic stretching, moving through a full range of motion instead of holding a static position. Static stretching at this point in your training can decrease your muscular performance.
Next, it is time to get the body ready to do sport or circus specific activities. So, we begin progressive loading of the joints and muscles with increasing strength and muscular demands. For aerialists, I like something similar to the progression below.