Exercise and Hypermobility
When looking at the above picture, some people might say, “Wow, she’s really flexible. That’s incredible!” Others might cringe and simply say, “Ouch!”
Some people are impressed with this kind of flexibility and envious of it, and others think it simply looks painful and can’t be good for you. So who’s right? Is having that much flexibility a blessing, a curse, or some mix of both?
Today I’ll dive into some considerations when it comes to joint hypermobility and exercise. If you look like the person stretching above, then you definitely want to read on! But even if you don’t, you may still want to read on to find out more…
Stretching is one of the most important parts of an exercise routine…right? Well, like many other questions when it comes to the realm of fitness, the answer is: It depends!
Flexibility training is recommended by most trainers and online fitness articles for pretty much everybody. When they make this recommendation, they are usually assuming two things. The first assumption is that as you age you get stiffer and tighter, which is something that you need to counteract with a regular stretching routine. The second assumption is that if you don’t stretch, you’re more prone to injury, so stretching regularly will help prevent injuries.
While this thought process isn’t entirely untrue, it’s also not universally applicable. By that I mean that not everyone needs a dedicated flexibility training program, and for some people doing a regular stretching routine can actually lead to more problems.
The key is to consider how much inherent flexibility each person has. Some people start out rather inflexible and get even more so as they get older. For these people, stretching is not only a good idea, but also necessary for them to remain uninjured and able to move well throughout their life.
On the other hand, some people start out with more than enough flexibility, especially as relates to their joints. They are the people that we often refer to as “double-jointed.” While these people don’t really have two joints, what they do have is something known as congenital joint hypermobility. In other words, they were born with joints that are naturally more flexible than normal.
If you’re unsure whether or not you fall into this group, you can use something called the Beighton Score for Hypermobility to find out. This score was created to assess joint hypermobility in individuals, and it’s demonstrated in the video below:
While there’s no universal agreement on the classification of joint hypermobility based on the Beighton Score, it’s generally understood that a score of 0-3 indicates normal joint mobility or even hypomobility (abnormal joint stiffness), while a score of 4 or 5-9 indicates moderate to severe joint hypermobility.
Unfortunately, when we encounter individuals who have congenital joint hypermobility, we’re often wowed by these individual’s ability to move their bodies through crazy ranges of motion, but we don’t often consider the risks that are associated with this level of hypermobility.
What you must understand is that there’s a difference between good flexibility and bad flexibility. Many people mistake greater flexibility for greater health, but the more flexible you are, the more likely you are to have unstable joints, which makes you even more prone to injury.
This is especially important for those individuals who are into activities that demand high levels of flexibility, such as ballet, gymnastics, and yoga. While there’s a certain level of flexibility that’s required for these activities, that doesn’t necessarily mean that it’s a healthy flexibility. Having extreme flexibility may make you fit for these sports/activities, but fitness does not always equal health.
In fact, there’s quite often a tradeoff that must be made between high levels of fitness for a sport and high levels of health.
So, these individuals who are into ballet, gymnastics, yoga, or other high-flexibility activities, must understand that at some point, they’re making a tradeoff between fitness for their sport or activity and optimal health. While there’s a certain level of required flexibility for what they do, trying to push for too much flexibility can lead to even greater levels of instability at the joints.
In fact, according to Dr. Stuart McGill, who is a professor and researcher of spine biomechanics at the University of Waterloo, a more flexible spine predisposes you to injury rather than protecting you from it. When speaking about the low back, McGill says, “Statistically, those who have more range of motion in their back have a greater risk of back disorders in the future. So, having a flexible spine is not protective, in fact it’s quite the opposite.”
It’s unfortunate, but the idea that more flexibility is always better seems to be so ingrained in people’s minds. On numerous occasions, I’ve talked with people who have back pain and are looking for exercises they can do to decrease their pain. Seemingly across the board, they’ll say something like, “I heard about these yoga stretches that can decrease back pain, do you think I should do them?”
The problem is they think they’re in pain because of a lack of flexibility, but instead they’re in pain because they already have too much flexibility! Going through a series of stretches which bend, twist, and arch their back in all directions may feel good in the moment, but it’s really just adding fuel to the fire of joint instability. Often, if we can take away some of the stretches they’ve been doing to try to get rid of their back pain, and add some core stabilization exercises, they’ll instantly improve!
Now, I’m not saying that activities which demand high levels of flexibility are bad, just that you must be aware of the risks associated with them. Most people are aware of the risks of injury from playing football, but far fewer people are aware of the risks from over-stretching!
My point is that if you’re already someone who has greater than average joint mobility, even if it’s not an extreme level, then you need to understand how to take care of your body, and stretching is not the answer.
So, if you’re a flexible person who is pursuing activities like ballet, gymnastics, yoga, or other sports demanding high levels of flexibility, how can you maintain healthy joints? Learning how to train for greater joint stability is the answer.
Joint stability is really the key to maintaining healthy joints, not joint flexibility.
Let’s take the shoulder as an example. The shoulder joint is made up of a ball and a socket. The ball is the head of the humerus (the upper arm bone), and the socket is the glenoid fossa, which is a small cavity in the side of the scapula (the shoulder blade). The shoulder is stable when the ball is centered in the socket. It can rotate all around, but it must remain centered in the socket, like a golf ball on a tee.
As soon as the ball glides forward, backward, up, or down, it moves off its centered position in the socket and puts strain on the structures surrounding it. An extreme amount of sliding in any direction, to the point where the ball separates from the socket, is called a joint dislocation. However, even a minor amount of sliding back and forth or up and down is enough to be unstable and cause some shoulder pain.
There are two ways that the shoulder maintains this stability of being centered in the socket, and that is by passive and active joint stabilizers.
Passive stabilizers are structures such as the bony structure of the joint, the ligaments surrounding the joint, and the labrum, which adds depth and stability to the socket. These structures don’t have the ability to contract and relax like muscle, so they’re really just like guy wires on a bridge or other free-standing structure that add passive support and stability to the joint.
Collagen is the main structural protein found in these connective tissues in the body, and thus it’s what provides stability to these passive stabilizers. Most often, people who are naturally flexible to the point of having some level of joint hypermobility are in this situation because they naturally don’t develop collagen as well as other people.
There are varying degrees of this lack of collagen production seen in people, sometimes being inherited genetically – in conditions such as Osteogenesis Imperfecta and Ehlers-Danlos Syndrome – and other times acquired with age – as in Osteoporosis.
Without adequate production of collagen, you simply don’t have the same inherent stability in the joints of your body, and that’s a blessing and a curse at the same time. It’s a blessing because it allows you to succeed in sports or activities that require abnormal levels of flexibility. But it’s a curse because it predisposes you to injuries created by unstable joints, such as dislocations and sprains.
So, what do you do if you’re one of those people who naturally doesn’t develop collagen as well as others? In the absence of passive stability, you must have pristine active stability around the joint. What do I mean by active stability, and how do you get more of that?
Well, active stability comes from the muscular system surrounding every joint. Muscles and tendons course over and around every joint in the body. These structures are what allow us to move because we can actively contract and relax them to result in movement.
What is less understood about the muscular system is that it doesn’t just allow us to move our body, it also allows us to prevent unwanted movement. The same muscles that provide movement to a joint also have the capacity to provide active stability to prevent a joint from becoming injured. This is an ability that everyone possesses to varying degrees, but it’s also something that we can train in people to improve their joint stability.
This is done by training muscles around a joint to contract as a balanced, cohesive unit to help keep the joint centered. Going back to our example of the shoulder, there are many muscles around the shoulder which provide movement and stability to the joint, but one of the biggest shoulder stabilizers is the rotator cuff.
The rotator cuff is comprised of four separate muscles which work as a balanced, cohesive unit to contract simultaneously and stabilize the ball of the humerus in the socket.
Training these muscles to stabilize means more than just training them to be strong. While being strong is a precursor to having good active stability from the muscular system, being reactive is the key to stability.
Being reactive means that those rotator cuff muscles can kick into stabilizing mode the instant an outside force tries to push the head of the humerus out of the socket. Without this reactive stabilization, the head of the humerus is free to move around as far as those passive stabilizers allow it to. But with reactive stability from the muscles, the head of the humerus remains centered in the socket despite random outside forces trying to move it.
So, how do you train the muscles to stabilize like that? You do something like this:
In addition to adding perturbations like in the video above, adding in loaded carries that demand stability at the shoulder are a great way to promote stability while outside forces try to create instability. Bottom’s-Up Kettlebell Carries are a great tool when it comes to this kind of training for the shoulders:
In addition to adding in perturbations and kettlebell carries, training with single limb exercises, like a 1-Arm Cable Press, or a 1-Leg RDL, recruits the smaller stabilizing muscles around the joint, and not just the big prime movers.
Another key when selecting exercises for someone with joint hypermobility is to choose exercises which give them a greater chance at creating and maintaining stability throughout the movement. To do this, closed chain exercises are the best.
Closed chain exercises are those in which the hands (for upper body movements) or feet (for lower body movements) are in constant contact with the ground, or another stable surface. A great example of this is a push-up, in which the hands remain stable on the ground throughout the whole movement. This provides great stability for the shoulder joints because they don’t have to stabilize a moving extremity as far away as the hand. Instead, the hands remain stable while the shoulder blade itself is free to move and maintain alignment at the shoulder.
Incorporating the above tips to train joint stability and not just strength can go a long way in helping you stay injury free, even if you have hypermobile joints.
So with all of that being said, remember that while there are benefits to being extremely flexible, there are also huge risks. Being aware of those risks and learning how to train your body to maintain joint health goes a long way in preventing injuries and unwanted wear and tear on the joints.
Overall, the key to exercise with joint hypermobility is to understand that strength alone won’t make you more stable. While strength will help, you must prioritize exercises that promote joint stability.
You also must be aware of the dangers associated with attempting to stretch and increase flexibility. This is not a good idea for those with joint hypermobility, unless it is absolutely necessary for a sport, and it’s done in a controlled manner which stretches the muscle, and not just the passive structures of the joint.
Although we all like to do more of what we’re good at (and for flexible people, that’s stretching!), that’s not always good for us. The key is ensuring that you have a balance between flexibility and stability. Mobility is a great thing, but not without stability to control it.
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