Hypermobility Part Two

So you might be Hypermobile....now what?

So you’ve done the Beighton score and found out that you might be hypermobile – what does this mean for you? 

First of all, the Beighton score is not the only score for hypermobility, nor is it 100% accurate. If you feel like you have symptoms of hypermobility but don’t test positive on the Beighton, talk to your physiotherapist or GP for further scoring. Some people experience stiffness as they age, and lots of people with hypermobility can develop stiffness, which may confuse your scores. 

For lots of people, you may not find that you don’t have any symptoms while others might have widespread pain from recurrent joint subluxations/dislocations. Treatment and management is completely depending on the person so it’s impossible to generalise for the whole hypermobility spectrum. However, exercise is really important for all hypermobile people and I will explain why further down in this post. 

Genetic testing is required to diagnose Ehlers-Danlos but there are many other tests to diagnose different types of hypermobility which include a detailed family and medical history as well as physical assessment. If you are looking for further assessment, speak to your physiotherapist or GP about what kinds of testing can be done. 

Why is exercise important for those with hypermobility? Why do they feel stiff when they are so flexible?

Those who are hypermobile tend to be more flexible than others but paradoxically also feel very stiff and tight. Our joint stability is made up of static stabilisers such as ligaments and bone which are non-contractile. We also have dynamic stabilisers such as muscles which control our movements and joints. Those who are hypermobile often have less support through their static stabilisers – our body is able to compensate for this with our dynamic stabilisers, which is great! However, this means that the muscles around the joints are constantly working at a low level which can lead to them feeling tight and stiff. Luckily, we are able to strengthen these muscles to help prevent them becoming tight and stiff. 

Those who are hypermobile often describe themselves as clumsy and un-coordinated. Because there is more flexibility in the joint, the cells in our muscles and tendons which usually tell our brains where our limbs are in space don’t give as much feedback as they would in non-hypermobile people. This can, however, be trained with exercises called proprioceptive exercises which help our body awareness. 

Finally, there are a few barriers for those who are hypermobile. It is dependent on the type of hypermobility, but generally those who are hypermobile decondition faster when they pause exercise and take longer to build muscle compared to your average Joe. While this may not be a problem to some, others may experience worse joint pain and fatigue with deconditioning so it is important to maintain strength in our stabilising muscles. 

Common areas for hypermobile people to experience pain are around the neck, upper back and lower back. You may experience lots of stiffness in the upper back and pain around the shoulders, or experience tightness in the base of the head with accompanying headaches.  Good places to start for conditions like this are closed chain exercises – these are exercises where you stay in contact with the floor/ground/wall. In particular, these are good because they help you with proprioception (learning where you are in space) as well as stabilising around your joints by giving you more feedback through the extra point of contact.

If you are hypermobile and experiencing symptoms from it, we highly recommend speaking to a physiotherapist to build a tailored program for you that will improve and manage your symptoms before progressing to more vigorous exercise. If you are hypermobile and asymptomatic, generally speaking, pilates is great for your stabilising muscles. While yoga can be great for relaxing and strengthening, be aware that passive stretching does not build strength and that those with hypermobility are more prone to injury via stretching than others. Please listen to your body and be careful not to overstretch. 

Below we will go through a few beginner exercises to start to improve mobility in the upper back and strengthen through our neck, shoulder and back stabilisers. 

  1. Thoracic windmill stretch 
  1. Thoracic extension – cat cow variation 
  1. Prone scapula retraction

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