DR. JEN CRANE

A rest day isn’t the absence of training; it’s a continuation of your training, allowing your body to go through its recovery processes.

Dr. Jen Crane is known for her innovative approach to injury prevention and performance optimisation in circus arts. As a dual credentialed physiotherapist and athletic trainer, she’s spent her career working with athletes and artists of all levels—from recreational acrobats to Cirque du Soleil artists and Olympic gymnasts. Jen loves leveraging her knowledge of the human body to exceed her client's circus goals—from contortion head-sits to dynamic aerial work; Jen specialises in troubleshooting barriers to goals that you’d never find in textbooks.

Was helping others always the goal, or did a specific moment guide you to this path?

I grew up in dance and performing arts, but at first, I didn't plan on working with performing artists. My early training focused on sports like football and tennis, and I even spent time teaching in PT school and working in research. It wasn’t until I was training as an aerialist and heard my circus classmates talk about how traditional physical therapists didn’t understand circus demands that I realised a gap existed. That’s when I decided to bring my physio knowledge into the circus world, and I’ve loved the unique problem-solving it involves.

Do you work primarily with circus performers, and what’s a typical patient like?

Yes, I do! I have an in-person practice here in Portland, Oregon at an aerial studio and also work virtually with patients worldwide, so I see a wide range. Many are recreational aerialists and circus artists, but I have a handful of professional artists—some on tour who may not have access to physio or injury rehab. Occasionally, I take short-term contracts with Cirque du Soleil or fill in when one of their physios is unavailable, so my patients range from beginners to lifelong professionals.

What are the most common injuries you see among aerialists, pole dancers, and those involved in extreme contortion?

Definitely shoulder injuries are the most common, particularly rotator cuff injuries or labral tears among aerialists and pole dancers. After that, low back pain is prevalent, especially in contortionists who rely heavily on their lower backs for back-bending. Hamstring injuries also rank highly, making those the top three injuries I typically see.

Do you help your clients decide whether to go through surgery for issues like a labral tear or torn rotator cuff tendon?

Yeah, that's definitely something I come across fairly regularly, and it’s always an individualised decision. Before I can start advising someone, we have a big conversation about whether this is their career and if they rely on income from performing. I consider whether they have the time, space, and resources to pursue surgery and all the recovery that comes with it.

It often comes down to how sustainable their current pain and limitations are. Can they manage it conservatively with their care team, or is it something they really can’t continue as it is? If they can’t see themselves doing what they’re currently doing for the next year or two, it might be time to consider other courses of treatment, including some pre-surgical interventions that are more invasive and time-consuming, but not yet surgery. There are many factors involved, and it’s highly dependent on the person and their situation.

How important is it for a PT to understand their clients on a psychological level, beyond just the physical aspects?

It's massively important! Typically, it takes a few sessions before I'm comfortable advising on their prognosis—whether they can manage their situation conservatively or if surgery is something they need to consider. This requires a lot of care for the whole person and understanding their entire situation, especially if surgery isn't feasible due to income or support issues.

The worst thing a rehab professional can do is give a blanket statement like: ‘You're not going to get better; go for surgery.’ I never want someone to feel alone in their decision-making. It's crucial to listen, empathise, and put yourself in their shoes, recognising how distressing it can be when they're limited in what they can do.

What signs can help circus artists tell injury pain from normal training discomfort?

The first thing I discuss with people is whether they can distinguish between normal training discomfort and pain that indicates an actual injury, productive versus non-productive discomfort. Productive discomfort is when you're stretching or conditioning and it feels tough, but you know it will improve with continued effort and perhaps make you stronger and more flexible. In contrast, non-productive discomfort is when you feel that if you keep going, it will make things worse.

I encourage them to think about whether they can sustain their current training. If the thought of continuing in their current state for another year makes them anxious, then it’s probably time to seek help for what they're experiencing. Recognising these differences is really important for their long-term health.

How can we help circus artists overcome the shame of being injured?

Many circus artists feel a sense of shame when it comes to admitting they’re injured, which can prevent them from seeking help. In my workshops, I often ask, ‘How many of you have a shoulder injury right now?’ Typically, only one or two people raise their hands. But when I ask, ‘How many of you don’t have an injury but feel something’s a little off in your shoulder?’ at least half the class responds. This illustrates how reluctant people are to admit their injuries.

A lot of them think that admitting they’re injured means they’ll have to step away from their training for a while, but that’s not the case most of the time. Usually, we talk about how to modify what they’re doing so they can keep training while recovering. It’s important for them to realise that they don’t always have to completely step away from circus or aerial work to heal.

What happens to a tendon when it doesn't fully recover?

In the circus, where training is year-round and at full intensity, pushing through tendon issues can lead to chronic inflammation and reduced elasticity. Without proper time and progressive loading to heal, tendons won’t improve on their own, potentially resulting in a thickened, inflamed tendon and sheath. Over time, this area becomes increasingly restricted and stops healing effectively. As the tendon and its connected muscle lose elasticity, the risk of rupture rises—a worst-case scenario, as surgical repair requires a long, challenging recovery process.

Many artists lack access to healthcare professionals who understand their unique needs, leading to ineffective recovery strategies. Often, they think they just need to fully rest for a while before returning to training. This creates a cycle of total rest or full training, making it really hard to find an effective way to heal.

You worked with the Olympic teams in China in preparation for the Rio Olympics. How is the mindset towards pain and recovery different there?

The mindset in China regarding pain and recovery is very different. After spending a year working with various Olympic teams, I found that athletes are seen as replaceable; there are hundreds more who could be brought up to their level in a very short amount of time if they weren't already there. Everything for them revolved around the need to perform their best at every single meet and in every single moment. They needed their coaches to believe that they were the best as well.

A fascinating aspect of their culture is that female athletes were only allowed to take time off during their periods, which was often the only time they could rest. Most of these athletes were quite young, and while this intense training may help build skills, it comes at a significant cost to their long-term health. This often results in their careers ending incredibly early, with many athletes retiring in their early twenties.

How can circus artists use heart rate variability (HRV) to manage their training and recovery?

Heart rate variability (HRV) is a valuable tool for managing training and recovery, especially in fields like circus arts, where athletes typically maintain a ‘go, go, go’ mindset. HRV measures the time variation between heartbeats, providing insight into how well your body has recovered from previous stress. Using wearables like WHOOP, you can track your HRV overnight and receive a recovery score each morning. A high HRV indicates you're ready for intense training, while a low HRV suggests your body needs more rest. This helps performers balance their workload by listening to their physiological signals, ensuring they recover fully between sessions and avoid burnout.

When discussing rest days, do they mean complete rest or active recovery?

For those who struggle with staying still, I like to reframe rest days as recovery days. You’re not just resting; you’re training your recovery system. Think about activities that make you happy, like taking a hot bath, going for a walk, or enjoying a mild hike in nature.

Make a list of things that make you feel good and see how you can incorporate those into your day. Remember, a rest day isn’t the absence of training; it’s a continuation of your training, allowing your body to go through its recovery processes. Then, when you go back to training, you’ll have a lot more resources at your disposal to continue what you’ve been working on.

Could you clarify and help remove any fear surrounding recovery from a hip replacement for movement artists?

I’ve worked with numerous artists post-replacement, and while some may need to modify their flexibility practice, many return to training and performing successfully. Interestingly, some don’t even want their oversplits back; they’re satisfied with flat or near-flat splits. It’s crucial to focus on pre-hab and rehab for the best outcomes, helping them understand realistic goals and what they truly need from their bodies.

What are the main differences you see in recovery and injury prevention between a 25-year-old and a 45-year-old?

I think it's interesting because there’s a myth that older performers, especially aerialists, are more prone to injuries. However, I often see that older performers don’t get injured as much or catch issues earlier. With experience, they understand their bodies better and recognise the signals it sends. They've had injuries and know how much they suck, which motivates them to seek care sooner and take the necessary time to recover. They’ve experienced the consequences of pushing too hard when younger, leading them to have a better understanding of how incredible our bodies are and how to train smarter.

What are your favourite recovery practices?

I’m a huge fan of hot baths, hot tubs, and cold plunges. As I get older, I realise many recovery strategies lack strong evidence. However, there is solid evidence that down-regulating your nervous system activates the parasympathetic system for recovery. So, whatever feels good to you, do that! Personally, I love heat, especially hot baths.

Can you describe your work with the transgender community, especially those recovering from gender-affirming top surgery?

I focus on transgender athletes’ post-top surgery due to a clear need and knowledge gap. Friends who underwent surgery received minimal guidance from surgeons, often advised against lifting over 10 pounds or raising their arms for months, which caused panic among aerialists who rely on their bodies for a living.

Many hesitated to have surgery due to recovery concerns. Recognising this need for improvement, I collaborated with a leading surgeon to create a standardised post-operative protocol that provides clear recovery guidance. It's beneficial not only for circus artists but for anyone who has had top surgery.

Are there any myths or unconventional recovery techniques in the circus world that need debunking?

One of my favourite myths is that if you rip your hands on the trapeze or lira, you should pee on them in the shower to help them heal faster. I find this amusing, but there’s no research to support it!

What’s the most impressive recovery you’ve witnessed in your practice?

While I can’t share specific cases due to HIPAA, I can mention Paula Ayotte, a professional pole dancer in her 50s who had a knee replacement about a year ago. Knee replacements are notoriously painful and challenging to recover from—I've always said I'd prefer a hip replacement for its simpler recovery.

Paula documented her rehab on Instagram, and I was in awe of her determination. Despite the pain of regaining her range of motion, she diligently followed her physical therapy exercises and is now back to performing professionally, including drops onto her knees. Her incredible mental fortitude played a significant role in her recovery; it truly is a mental game.

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