I tend to joke to my clients that I have unintentionally ended up treating a significant number of people who fall on the hypermobility spectrum because I am on this spectrum too. I personally understand what it is like to suffer from these issues and have spent the last couple of decades trying to better understand and serve my clients that do as well.
Sadly, the hypermobile population continues to be underserved, often misunderstood and poorly treated by our traditional healthcare model. Many individuals who fall on this spectrum find it hard to find practitioners (both physicians and therapists) who understand them or take their frequent (and often disabling) bouts of pain and disability seriously.
In simple terms, hypermobility can be defined as an increased or excessive amount of flexibility in joints and/or connective tissues of the body. It can exist by itself or be part of a more complex diagnosis.
There is a large spectrum to this condition ranging from increased flexibility of certain joints (such as the ankles or specific spinal segments) of the body to the more serious diagnosis of Ehlers Danlos Syndrome(EDS) – a genetic condition in which pathologic flexibility of the connective tissues can cause trauma at multiple joints, repetative dislocations, as well as potential complications with internal organs.
In this blog, I will discuss three signs that you may suggest you are on the hypermobility specturm, as well as outline three general recommendations I give on how to best manage hypermobility-related issues.
Three signs you may be hypermobile:
1. You feel tight most of the time.
“I can’t be hypermobile – you should see how tight my hamstrings are!”
This comment is very common from clients when I tell them I think they have an element hypermobility contributing to their issue or presentation.
Here’s the important thing we need to appreciate: the body is an extremely skillful compensator and adaptor.
If you have an increased amount of flexibility in your joints and lack stability, your body’s very intelligent nervous system may try to find ways to create some pseudo-stability and tightness that you don’t have. Tighter muscles may be it’s way of doing that for you. In fact, contrary to our culture’s general approach to “the more flexible the better” sometimes tighter muscles can be your friend, not your enemy.
2. Your joints can “go out” doing almost nothing.
For example, you are walking down the street and feel something slip in your lower back or rib cage.
Or, you bend slightly forward to brush your teeth or load your child into their car seat and feel a spasm in your lower back.
This is common in joints that have an element of instability and often happens when you are not consciously engaging your core or stability muscles. The hypermobile joint has less protecting it and is therefore able to shift. Positions of flexion (bending forward) and rotation (twisting) can be especially risky, especially if they are slight.
Not uncommonly, these slips in the joint will happen a few hours or a day AFTER an activity that left the joint/s more mobile or mildly to moderately sprained, such as an advanced yoga practice involving end-range poses, dead lifts at the gym, a deep tissue massage of some of the muscles your spine depends on for support, or a more aggressive joint thrust technique.
3. You have a history of participation in sports or activities that require increased range of motion of the joints in order to be able to do them.
This is one of the primary intake questions I ask new clients that are female and between 14-50 years of age and are complaining of spinal pain.
Examples of these activities can be: competitive dance, gymnastics, power and ashtanga yoga, acro-yoga, and many more.
These activities require a spine that can flex beyond the average ranges. You must have the genetics to have the bone structure and joint mobility that allow you to get into the extreme positions these sports require to perform well.
The pattern I have observed in the clinic through the years is that most individuals do pretty well during the years they are young and training a lot (ie. strong) and not sitting at a desk or standing for long hours, working or studying.
However, once they shift out of their vigorous training regimes and into a more “normal” lifestyle usually involving more sitting or standing for long periods and less training, issues can begin to arise.
The strength that kept these folks safe during their more active competitive years was needed in order to stabilize their joints for the outer ranges they were capable of and to provide some much-needed tightness to the system.
Add some aging in there (which sadly makes all of us begin to lose muscle mass – especially women), stress, and hormonal shifts and voila: You have the perfect storm for hypermobility issues to arise.
What can do we do to treat or manage hypermobility?
Hypermobility truly is a spectrum and no person or client is the same.
Therefore, it is essential to take an individualized approach to treatment planning.
However, there are some general guidelines for management of hypermobile joints that I tend to discuss with clients whom I believe fall on this spectrum:
1. Find your team.
Typically, people on the hypermobility spectrum have seen a lot of practitioners searching for explanations as to what is happening, relief of pain and management.
I recommend finding a Physiotherapist that understands hypermobility and can work with you with gentle joint mobilization and soft-tissue techniques to help manage pain as well as a progressive plan to get you stronger. Find a practitioner that makes you feel listened to – you deserve this.
Many of my clients on the hypermobility spectrum or with EDS also find treatment with a skilled and gentle osteopathic practitioner a benefit as well.
Other excellent practitioners to have on your team can be a kinesiologist, family doctor (if you can find one!), and/or Physiatrist (if you are dealing with more chronic pain or fall towards the EDS side of the spectrum).
2. Use caution with muscle release techniques, excessive stretching and joint manipulation.
Joint manipulation (techniques that make your joint crack) should be used sparingly, if at all.
I recommend staying away from practitioners, such as many Chiropractors and some Physiotherapists and Osteopaths, whose practice focuses on aggressive and repetitive joint thrust techniques. These techniques can be addictive for those with hypermobile joints and potentially contribute to the more frequent slipping of your joints over time, making you more dependent on your practitioner for pain relief and less able to manage flare-ups yourself.
Similarly, techniques that release your muscles, such as dry needling/IMS and massage techniques should be used very intentionally. Soft-tissue release techniques can be quite beneficial in helping to manage pain, but used alone will have the potential to contribute to flare-ups.
Discuss with your Physiotherapist or RMT what the goals are of your sessions are and adapt according to your response to treatment. Try to use care after your sessions. Personally, I love massage therapy, but try to exercise prior to my sessions and not to do much vigorous activity after sessions and instead rest or do gentle exercise only. Many of my hypermobile clients with whom we incorporate dry needling or manual therapy that loosens some of the joints with report making the same choice after Physiotherapy sessions as well.
3. Strengthening will be a very good friend, find a way to make it a part of your life for the longterm.
There is no “cure” for hypermobilie joints or body types, there is only management.
Unquestionably, the number one thing you can do for the management of hypermobile joints is to get stronger so that your muscles will better provide you with the stability and stiffness that your joints lack.
I recommend an intelligent gym program involving weight-bearing loads as well as core exercise designed either by your Physiotherapist or by a skilled Kinesiologist who can work in communication with your Physiotherapist to tailor a program to the findings of your Physiotherapy assessment and injury history.
Pilates can also be immensely helpful to incorporate into your life. If you are dealing with current injuries, I recommend starting with Clinical Pilates with a Physiotherapist with the goal of finding and integrating into an excellent Pilates studio over time for group equipment and/or mat classes and working with well-trained Pilates instructors who are able to work with to learn better control of your joints.
I hope these recommendations have been helpful.
Our Physiotherapists at Alaia would be happy to assess you in clinic and discuss more of the above.
You can book an initial assessment with one of our Physiotherapists HERE.
For more information on hypermobility spectrum disorders and EDS, please visit the WEBSITE for the Ehlers-Danlos Society.
Katrina Sovio, Registered Physiotherapist & Clinic Director
BHK, BScPT, MClSc, FCAMPT.