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Wednesday, August 10, 2011

Ouch! Do They Even Have Bones?

       Contortionists, those select group of people who twist and bend their bodies like a paper clip, are quite a sight to behold.  Folding themselves into tiny boxes, bending backwards into a perfect circle, weaving their legs behind their head and ears…  While some people may cringe at the extreme poses that contortionists can do, most people enjoy being spectators to these unbelievable acts, even willing to spend a lot of money to see them.  

Personally, I love watching them... from the music, to the costumes and props, and of course, the performance itself.  But most importantly, as a person of science, and an orthopedic surgeon, they make me wonder at the anatomical conditions that make their acts humanly possible.  Do they utilize technical tricks in their performances or are their bodies built differently from the average joe? 


What is contortionism?

Contortionism is defined as a discipline of movement that involves dramatic bending and flexing of the human body, beyond the usual human postures.  It is an art form that has existed and was recorded since ancient times.  Just like other disciplines, such as yoga or wushu, contortionism requires extensive training and personal discipline.  (Hmmm. I wonder if kama sutra is considered part of contortionism.)

Sorting out the Myths

Many fallacies and misconceptions abound about contortionism.  Some of which were probably perpetuated by the performers themselves or their promoters, to create hype or an air of mystery.  After all, the strange and unexpected are what sells with the public.  (Just look at our tabloids!)  

A number of these myths persist due to general lack of knowledge on human anatomy and the biomechanics of the human bones.  Let’s sort out fact from fiction:
         
 Myth #1: Contortionists have soft bones.
 
Some people assume that contortionists are able to bend their bodies into extraordinary shapes because they have soft bones that flex like muscles do.  From the countless bones I’ve mended or replaced, I have yet to see a pliable or bendable one.  Even fracture-prone people, often referred to as having brittle bones, don’t have bones that bend. (They may crumble to pieces, though). Physiologically, soft bones are not possible because bones are made of substances that make them hard and unyielding.  Bones function as a scaffolding or shield for the vital parts of our body. So if bones were soft, it would go against the very essence of its function. 
   
Myth #2: Contortionists are “double-jointed”.

Normal human beings have exactly the same number of joints.  The rare exception would be some of those who have extra or missing bones.  "Double-jointedness" is but a slang expression for hyperflexible people.  

Myth #3: All contortionists have to dislocate their joints when they perform.

We often hear of people who can intentionally pop one or two bones out of their socket without feeling pain (or perhaps just a little).  We may even actually know one.  The condition, also called loose joint, is actually due to the laxity of the ligaments that stabilize the joint.  Much like a loose fan belt in a car.

The spine bones, the bones involved when we bend backwards, would actually be very dangerous if dislocated as these may cause impinging of the spinal cord, intense pain, and paralysis. (By the way, you know GMA underwent spinal surgery of the neck, right? This is because of the impingement of the nerves on her neck, which may be due to too much craning of her neck muscles to get a glimpse of people taller than her, or from too much shaking of her neck side to side while denying the allegations against her.  Ok, just kidding. Goodluck on the emergency re-operation, Madame).

 In general, habitual or frequent bone dislocations must be avoided since they make the joint more unstable and prone to injury.  Another thing to consider, a dislocated limb can rarely lift itself or support any weight.

Myth #4: Most contortionists have a medical condition that makes them prone to joint dislocation.

I used to think that this was the main reason why contortionists can do these seemingly impossible acts.  Examples of these conditions are Ehlers-Danlos syndrome (EDS) or miscellaneous joint laxity syndromes (ex. Marfans syndrome).  These are genetic disorders that predispose a person to laxity and hypermobility of the joints. 

However, I realized that people with genetic predisposition for loose joints don’t necessarily have the strength required to perform backbends while balancing on their fingertips, or teeth, as seen earlier on the youtube video!  It is easier for a strong person to gain extreme flexibility, than for an extremely flexible person to gain strength. 
                             
Ok now. So what’s really going on?

Recently, I was interviewed in the GMA-7 show "Aha".  In that interview, I discussed the normal range of motion of the spine and my explanation on why contortionists can do their act.  

video

My apologies, the sound quality was not that good. My point there was that there are several factors that affect human flexibility.  These include internal resistance within a joint, the elasticity of muscle tissue, ligaments and tendons, age, gender, and training. Generally, young people are more flexible than older people, and women are more flexible than men.  

Contortionists just have more stretchable ligaments than normal people, which make them more flexible than average persons. You're not supposed to be able to pop your shoulder out of its socket, or make your spinal vertebrae go out of alignment.  That is not good, orthopedic-wise.

 In 2003, Prof Richard Wiseman studied a contortionist named Delia Du Sol at The Dana Center (London). He explored the remarkable anatomy of Delia Du Sol, one of the UK’s top contortionists, as she performed live, demonstrating seemingly impossible body bends and squeezing into a tiny cube. This project involved carrying out the world's first MRI (magnetic resonance imaging) scan of a contortionist in an extreme back bend in the presence of medical specialists.


A similar study in 2006, at the Center for Spinal Surgery, University of Zurich, Switzerland was done.  The kinematic MRI of the presented case as well as that of Delia Du Sol stated above did not reveal any evidence for abnormal dislocation or subluxation (partial dislocation) in extreme body contortions.  They also found no evidence of deformed bone structures that might contribute. These studies indicate that this excessive motion results from extreme spinal flexibility due to flexible ligaments and not due to bony abnormality.

 
Take home mesage

Obviously, not anyone can become a contortionist. Most are born with unusually flexible spines and other joints. Although often scoffed off as natural freaks, contortionists train constantly to perfect their craft. Part of their ability is genetic, and part of it is a result of extensive and continuous training.   

So friends, don't try anything that's out of your league or that you're inexperienced with. The contortionists may look amazing and flexible but they obviously did this after a lot of practice. 

Common sense tells as that if you want to try it out, consult a person that is very experienced with contortionism first and make sure to run through the risks that are involved.

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