What Should Ballet Dancers Know About Ehlers-Danlos Syndromes?

With potentially more than 13 different EDS subtypes, these highly complex syndromes can affect muscles, joints, and even organs. Definitions surrounding EDS—as well as their diagnostic criteria—continue to spark debate among researchers. In fact, according to Dr. Aiko Callahan, a Boston-based physical therapist who specializes in hypermobility disorders, a revised version of the EDS classification system is expected at the end of 2026.

Ballet’s aesthetic tends to favor the swooping lines that extra flexibility allows—bendy feet and knees, especially—and it’s no coincidence that people with hypermobility may be drawn to dance. But those perks come with a unique set of challenges, especially in individuals with EDS. So what should ballet dancers know about these elusive disorders? From symptoms to prevalence and treatment, here are some pointers to start.

What Are Ehlers-Danlos Syndromes?

EDS are hereditary disorders of connective tissue, with different subtypes that affect everything from the skin to the vascular system, pelvic organs, muscles, and gums. Generalized joint hypermobility presents in only about 10 to 30 percent of the general population, and a small portion of those people present with EDS. Hypermobile EDS is the most common subtype—according to Callahan, about 85 to 90 percent of individuals diagnosed with EDS fall into the hypermobile category. These people experience instability in some or all of their joints, along with other symptoms like skin laxity and abnormal scarring. (Wagenveld describes her symptoms as “classic” for hEDS: hypermobility, stretchy skin, easy bruising and scarring, joint subluxation or dislocation, and chronic fatigue.)

Callahan adds that these syndromes are commonly associated with other disorders, like postural orthostatic tachycardia syndrome (POTS) and mast cell activation syndrome (MCAS). They also often accompany phenomena like gastrointestinal issues, neurodivergence, and anxiety.

How Common Are Ehlers-Danlos Syndromes in Ballet?

Dr. Linda Bluestein, a former dancer and now a hypermobility specialist with hEDS, explains that there has not been significant research on the prevalence of the syndromes among ballet dancers. But she suspects that many dancers may have hEDS without realizing it. “We desperately need that data,” she says.

Because ballet lends itself toward hyperextended lines and extreme joint mobility, Bluestein believes most professionals likely exhibit generalized hypermobility or related symptoms. But many hypermobile dancers do not have EDS, and others without obvious hypermobility can present with an EDS subtype. EDS are spectrum disorders, Bluestein continues, and they can manifest differently between individuals—and within the same person over time. Some people with EDS need mobility aids, wheelchairs, braces, or splints. Others have no assistive-device needs. Bluestein’s own symptoms changed after she stopped dancing; activity demands, injuries, hormones, and other factors can all influence symptom patterns. “The spectrum is massive,” she says.

How Might EDS Affect Dancing?

Since her diagnosis, Wagenveld’s symptoms have remained generally stable. She describes her hEDS as a double-edged sword: “It gives you something that can be beneficial for the art form: You can do things physically and make shapes that other people cannot. But on the flip side, you are that much more susceptible to injury and prone to fatigue.”

Many people incorrectly believe that having hEDS makes ballet easier. Instead, Wagenveld’s muscles work constantly to counteract the extra mobility in her hips, knees, elbows, and shoulders. “Even when I’m just standing,” she says. Because of that, her muscles often feel chronically tight, and the instability within her joints increases injury risk. That’s why it’s crucial for hypermobile dancers to work on whole-body strength and stabilization, says Callahan, adding that people with EDS tend to have a baseline strength that is much weaker than that of the general population. People with EDS can take longer to heal and build muscle mass if they do not reach and maintain a comparable baseline strength. “If an artist doesn’t have control over their range of motion, that’s when they run into musculoskeletal problems,” says Callahan.

How Can Ballet Help?

Bluestein says that ballet’s structured movement can benefit people with hEDS, especially. Dancers have keen bodily awareness, which can help with tracking and managing symptoms. Wagenveld checks in with her body during each company class and remains mindful throughout the workday. “If the dull ache of a fatigued joint turns into something sharper, I know I have to step back.”

Wagenveld has noticed that her needs differ at Charlotte Ballet, which has more contemporary repertoire, than at Grand Rapids Ballet, where she previously danced. “With classical ballet, you’re trying to remain stacked,” she explains, “so it’s easier to stay correctly engaged; you’re not constantly going in and out of engagement like you do with contemporary.” To relax into the deeper, more extreme movement that contemporary requires, Wagenveld pays extra attention to how her muscles and joints feel. “Sometimes hearing the words ‘Milk it’ is scary, because if I’m in a really low, open lunge, my kneecap could slip out if I go too far,” she says. “It’s a tricky balance.”

What Are Diagnosis and Treatment Like?

Diagnosis for EDS can be a long and frustrating process, says Bluestein. Sometimes, people with EDS are accused of “crying wolf” because of fluctuating symptoms. No matter what, she says, stay vigilant and self-advocate: “Dancers push through pain all the time. That can get in the way of getting the treatment you need.” She suggests starting by reading about EDS and their affiliated disorders. (The Ehlers-Danlos Society website offers more resources and information.)

Both Bluestein and Callahan strongly recommend working with a specialist or physical therapist who can help build an individualized treatment program. Depending on their subtype, a person may require more intense medical monitoring. For Wagenveld, regular visits to Charlotte Ballet’s physical therapy team have helped her manage pain and prevent injury. There, she primarily works on stabilization exercises. “They almost seem ridiculous, because the movements are so small,” she comments. “They’re so hard for me because I’m essentially retraining my body’s baseline. But they make a world of difference.”