Hypermobility

By Tegan Hailey

For many of us, the restrictions due to covid-19 have stiffened us up a bit, and whilst we are all keen to get back into doing the activities we love, what happens when the opposite occurs, and we are naturally too flexible?

Flexibility Vs. Hypermobility 

The terms flexibility and hypermobility are often used interchangeably, and whilst they look very similar, they are two very different adaptations within the body. Flexibility is a broad term referring to the available range of movement in the body, which does not go beyond normal range of motion. Hypermobility on the other hand, refers to when some or all of a person’s joints have an unusually large range of motion, in which people are usually able to move their joints painlessly and effortlessly into positions that others find simply impossible! It is often referred to as having “loose joints” or being “double-jointed” and often masquerades as good flexibility. 

Spotting the difference:

Example: Bending forward to touch your toes 

If your hamstrings are flexible enough, they will lengthen allowing you to reach the floor. However with hypermobility, the muscles are likely to be very tight, so the movement must be adjusted from somewhere else. In this case it is most likely that as you bend forward, the laxity of the ligaments at the knee will enable the knee to go into hyperextension, thus allowing you to reach the floor. Creating the illusion of flexibility. 

Hypermobility is often hereditary, with one of the main causes thought to be genetically determined by changes in a type of protein called collagen. Whilst everyone is born with a certain amount of laxity in their joints. If collagen is weaker than normal, the tissues in the body can become fragile, which can cause ligaments and joints to become loose and stretchy. The result gives the joint a range of motion beyond what is normally expected. Whilst people with hypermobility often lead normal lives, and although it can be beneficial in certain professions to have increased flexibility, ie dancers and gymnasts. There is a small subgroup of the population who experience symptoms, such as … 

• Pain and stiffness in the joints and muscles

• Clicking joints

• Joints that easily dislocate

• Fatigue

• Recurrent injuries - ie sprains 

• Digestive problems 

• Dizziness and fainting

• Thin of stretchy skin 

Those who suffer from symptoms like these are more likely to suffer from a connective tissue disorder. Benign Joint Hypermobility Syndrome (BJHS) is the occurrence of hypermobility in which musculoskeletal symptoms occur, predominantly pain in joints. Ehlers-Danlos Syndrome (EDS) on the other hand is a rare inherited disorder characterized by thin, fragile and loose skin and extreme joint laxity.

Assessing joint hypermobility - THE BEIGHTON SCORING SYSTEM

The level of hypermobility in an individual is determined through the Beighton Scoring system; it is a 9 point scale that requires 5 maneuvers for the assessment of various joints in the body. 

Note: Although it can be seen as a good party trick, the one thing to remember is not to overextend your joints just because you can. 

Exercise with hypermobility:

There is no reason why people with hypermobility shouldn’t exercise. But, due to the ability to take a joint past its normal range of motion easily, hypermobility needs to be taken into consideration when choosing the appropriate type of exercise. People with hypermobility usually benefit from a combination of controlled exercise and education about normal ranges of motion and how to avoid hyperextension. 

Great forms of exercise include …. 

• Swimming

• Cycling

• Pilates

• Strength training

The main focus when exercising with hypermobility is to improve muscle strength and fitness, without causing increased mobility. Ligaments do not have the same elastic properties as muscles, meaning they are unable to return to their original starting length once stretched. Building good muscle tone is vital as it increases stability and support around joints, further reducing the demand on hypermobile joints. It is also important to focus on the correct engagement of muscles and initiating good movement patterns, to further help protect vulnerable joints. 

Tips & Tricks - Exercising with hypermobility:

Wherever you fall on the scale of hypermobility, the key to injury prevention is achieving a good balance between movement and stability. Any movement regardless of flexibility or strength should be performed accurately with control and awareness. For more information about what exercise is suitable for you, please contact your osteopath.