Introduction


The Hypermobility and Concussion in Circus Arts Masterclass, taught by Stephanie Greenspan and Dr David Munro provides a complete overview of Circus Arts Injuries. This Executive Summary provides clinically relevant, actionable information that may be useful to health professionals.

Part 1 - Introduction to Circus Arts


Circus arts comprise a wide age range and diverse backgrounds, from dance and gymnastics to minimal prior fitness. Artists can be classified by physical demands or discipline, with significant crossover. Injuries may be acute or load related, depending on the act. Understanding performance demands, landing mechanics and repetitive tasks is essential for effective rehabilitation.

  • Ask performers to share video footage to better understand movement demands.
  • Assess landing mechanics and foot alignment, particularly in impact based acts.
  • Balance flexibility with strength and control, especially in flexibility dominant artists.

Part 2 - Hypermobility-Related Conditions in Circus Arts


Hypermobility in circus artists can be localised or generalised and does not automatically mean hyperflexibility. Screening tools such as the Beighton score and lower limb hypermobility score can help identify this. While some are asymptomatic, hypermobility can contribute to injury risk, shoulder instability and extension-based low back pain. Awareness of systemic issues and training load is essential for safe performance.

  • Screen for hypermobility using Beighton score, 5-point questionnaire or lower limb assessments.
  • Address shoulder instability with motor control, positional awareness and rotator cuff strengthening.
  • Manage extension based low back pain by initially reducing extension load and gradually reintroducing skill specific movements.

Masterclass Preview

Enjoy this free preview of Stephanie and David talking about shoulder injuries in the circus arts and hypermobile athletes.

Part 3 - Concussion Management


Concussion management in circus arts follows an eight-stage, criteria-driven return to performance guide, beginning with relative rest. Younger performers may have delayed symptoms, and both cognitive and physical loads must be carefully managed. Gradual reintroduction of sport specific activity, dual tasking and monitoring heart rate are key, alongside collaboration with coaches, parents and the performer to ensure safe recovery. Noisy performance environments can affect symptom progression and should be considered during rehabilitation.

  • Reintroduce cognitive tasks gradually, including school, work or dual tasking exercises.
  • Use heart rate monitoring and sport specific exercises when returning to moderate intensity activity.
  • Educate and collaborate with coaches, parents and performers to support safe recovery.

Part 4 - Holistic Health Management in Circus Arts


Holistic care in circus arts requires understanding the performer’s identity, commitment level and the aesthetic or cultural expectations within their discipline. Circus can be central to someone’s sense of self, influencing injury response and rehab engagement. Financial constraints and mistrust of clinicians are common, so collaborative, respectful care is essential to maintain participation and wellbeing.

  • Explore the artist’s identity, goals and aesthetic pressures to guide realistic rehabilitation planning.
  • Consider financial limitations when structuring management and follow up.
  • Build trust by collaborating and modifying activity rather than simply advising complete cessation.