What is hypermobility?
Joint mobility and muscle, tendon and ligament flexibility occur along a spectrum with everyone displaying individual levels of mobility/flexibility; hypermobility is an extreme form of connective tissue laxity which can cause structural dysfunction, pain and a multitude of long term problems. You can’t change your natural predisposition toward hypermobility but you can change how you control it.
Women have a higher pre-disposition towards symptoms of hypermobility, due to their individual levels of oestrogen, progesterone and relaxin produced within their bodies during the menstrual cycle and pregnancy. Men, due to their hormonal make up, display lower levels of individuals with hyper-mobility.
Hypermobile people feel tight; it’s most likely that muscles are fighting to hold joints together because tendons are lacking tension. At best, stretching is only going to feed into the dysfunction. Some individuals have more congenital laxity than others. This essentially means their tendons and ligaments have a bit more give to them. As a result, they can have substantially more flexibility because of the lack of passive stiffness. This means the muscles have to work harder to create stability at the hypermobile joints. This can often be accompanied by feelings of pain in end ranges of movement and general fatigue.(1)
To establish if you are truly Hypermobile, use the Beighton score which are a series of tests. Otherwise, if you suspect you are Hypermobile or just have unstable joints, follow these recommendations:
Training recommendations for hypermobility
These are some basic rules to adhere to when training clients with hypermobility:
- Create Self Awareness
- Remove Static Stretching
- Improve Muscular Control
- Target the Rotator Cuff before working the larger upper body muscles. These smaller muscles that support the joint are deep and let the brain know where the joints are located and how the arm is moving. For the Hip, these stabilisers include but are not limited to Glutes and Adductors.
- Utilise slow tempo and control time under tension.
- Use a variety of exercises over a period of time to challenge the stability of the joint.
- Vary the Stability of the joint and utilise this variable as a means of progression. For example, adding an external force to make an exercise more unstable such as hanging weights attached to bands on the end of a Barbell or having a partner try to push against you to create instability whilst attempting to hold a position. (3)
- Add Isometric holds to exercises as a way to increase time under tension and to bolster tendon and ligament strength. For example, holding different positions through the range of a Split Squat. It has also been shown that focussing on specific isometric exercises can reduce joint pain. (4)
- Using physical cues such as touching the area one wishes to focus on may help people who typically lack physical awareness. This method has also been shown to help reduce joint pain and improve balance and coordination. (5)(6)(7)
- Address Distraction and Approximation training balance. Distraction exercises pull the joints apart, for example a pull-up and approximation exercises push the joints together, such as a push up. Aim for balance between the two.
Shoulder/Elbow Specific Exercises
- Plank variations with emphasis on the press up position. Begin with simple, stable variations and progress through to more unstable Swiss ball variants and variants with Locomotion such as Bear Crawl or Lateral Hand Walks.
- Include Movements such as Press Ups and Supine Rows with an emphasis on not locking out the elbows or losing retraction and depression of shoulder blades.
- Utilise resistance bands for accommodating resistance including Isometric positions for Rotator Cuff such as Internal/External rotation, Swiss Ball Wall rolling, Trap 3 raise, WYT Variants and Perturbations for any of the previous exercises.
Hip Specific/Knee Specific
- Focus on single leg exercises.
- Arabesque (with Soft/Bent knee), Knee Drives against Wall, SL Stands with perturbations (such as med ball catches or eyes closed) and Planks/deadbugs/bird dogs/Abduction/Adduction with an emphasis on Pelvic control.
Once strength, stability and coordination has improved, no exercise should be avoided. Make sure you use appropriate loads for your level of competence in any given exercise.
- Jindal, P., Narayan, Am., Ganesan, S., & McDermid, J.C., (2016). Muscle strength differences in healthy young adults with and without generalized joint hyper mobility: a cross-sectional study. BMC Sports, Science, Medicine, & Rehabilitation. 8(12).
- Cattalini, M., Khubchandani, R., & Cimaz, R., (2015). When flexibility is not necessarily a virtue: a review of hyper mobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatric Rheumatology Online Journal, 13(40).
- Freyler, K., Krause, A., Gollhofer, A., & Ritz, A., (2016). Specific stimuli induce specific adaptations: sensorimotor training vs. reactive balance training. PLoS One, 11(2).
- Rio, E., van Arm, M., Docking, S., Moseley, G.L., Kidgell, D., Gaida, J.E., van den Akker-Scheek, I., Swerver, J., & Cook, J., (2017). Isometric contractions are more analgesic than isotonic contractions for patellar tendon pain: an in-season randomized clinical trial. Clinical Jounral of Sports Medicine, 27(3), 253-259.
- Wolf, J.M., Cameron, K.L., & Owens, B.D., (2011). Impact of joint laxity and hyper mobility on the musculoskeletal system. Journal of American Academy of Orthopedic Surgery, 19(8), 463-471.
- Sahin, N., Basket, A., Cakmak, A., Salli, A., Ugurlu, H., Berker, E., (2008). Rheumatology International, 28(10), 995-1000.
- Yong, M-S., & Lee, Y-S., (2017). Effect of ankle proprioceptive exercise on static and dynamic balance in normal adults. Journal of Physical Therapy Science, 29(2), 242-244.
Dan Clarke has been practising as a level 3 qualified Personal Trainer for over 8 years in a variety of different facilities and locations ranging from well-equipped commercial gyms through to sessions with minimal equipment outdoors. He enjoys working with small groups but finds the best results come from focussed 1:1 sessions, across all ranges of fitness, from introducing the basics of resistance training to beginners through to planning periodised programmes for performance athletes placing huge importance on posture and structural balance.