“Hypermobility” just means a greater than normal range of movement. It’s not uncommon – by some accounts 20-30% of the population have some degree of hypermobility, either affecting an isolated joint, or generalised throughout the whole body. It’s found more often in young people, females, and certain ethnic groups (such as Asians and Afro-Carribeans). It can range from just being a bit more bendy than normal to being able to turn yourself into a piece of human origami.
Hypermobility doesn’t necessarily cause problems. In fact, having greater than average flexibility can provide definite advantages in sports such as gymnastics and dancing where high levels of mobility are required. Some people, however, experience pain or injury along with hypermobility in multiple joints of their body. This is referred to as “hypermobility syndrome” (or sometimes “symptomatic hypermobility”).
It’s commonly believed that having hypermobility increases a person’s risk of getting injured. People with this condition are sometimes warned to stay away from high intensity or contact sports. Is there evidence to support this, or is it a myth? And if you or a client has hypermobility, what’s the best way to manage it?
Not all hypermobility is the same
There are a number of factors that contribute to the range of motion at a joint, and any combination of these can be affected. Bone shape, lack of muscle strength, hormonal changes, training and previous injury can all be contributing factors in cases of hypermobility. If the increased range of motion is widespread throughout the body then it may be related to a genetic variation in the collagen that makes up the ligaments, joint capsules and other connective tissues. This group of connective tissue disorders is collectively known as Ehlers-Danlos Syndrome. Its symptoms can vary from relatively mild joint laxity, to serious and even life threatening health conditions affecting multiple organs and systems of the body. It can also be associated with an increased rate of anxiety and panic attacks – although the reasons for this aren’t completely understood.
Hypermobility syndrome is commonly diagnosed using the Beighton Score – a simple checklist that can be used as an indicator of generalised hypermobility. It’s useful as a broad guideline, or for conducting research, but it needs to be interpreted carefully when applied to individuals. A high Beighton Score doesn’t necessarily imply that you have hypermobility syndrome, and some people who struggle with pain relating to hypermobility may have a low score. And people with hypermobility mainly in areas not measured by the Beighton Score may not be picked up at all with this particular screening tool.
Hypermobility is not the same as joint instability
Hypermobility is often confused with joint instability, but the two are quite different things. Hypermobility simply refers to the amount of movement at a joint, but not the quality of that movement. Joint stability, on the other hand, refers to the ability to maintain and control joint movement or position. This involves both the passive structures of the joint – the shape of the bones, and the tension in the ligaments and joint capsule (which may be compromised in a hypermobile individual), but also the muscles and nervous system which can also actively stabilise a joint. Many hypermobile people also lack joint stability (the jury is still out on the precise relationship between the two conditions), but this is not necessarily the case. Most importantly, it is possible to improve stability with training.
What does the research say?
It’s important to remember that every person with hypermobility is different, and so we need to consider each case individually. Some studies have found it to be a risk factor for injury in some sports, but others found no difference in injury rates between hypermobile athletes and a control group. Advice from the medical profession has been similarly contradictory, with some authors recommending that people with hypermobility avoid strenuous or contact sports, while others have stated that pain-free hypermobility shouldn’t restrict a person from participating in physical activities of their choice. Most clinicians recommend that the guidance should be tailored for the individual, since there is so much variation in how this condition can present itself.
While the evidence is not conclusive, there is enough to suggest that joint hypermobility and hypermobility syndrome may be risk factors for sporting injury. It’s well worth seeking out a coach or PT who understands hypermobility and has experience of working with it. A good therapist will be able to give you exercises that will help to improve the stability and control of your joints and this may help to reduce your risk, alongside activity and technique modifications. Exercises that focus on building strength are likely to be helpful, but should be selected carefully to avoid stressing lax joints; focusing on correct technique is important for everyone, but may be even more so for the hypermobile athlete. Static stretching, and movements that stress the joints in the hypermobile range should generally be avoided.
Hypermobility may also be a factor to consider when choosing your sport in the first place: it’s thought to be more of a risk factor for contact sports, but may be advantageous for sports requiring a large range of motion. Don't necessarily rule out a sport or activity that you wish to do, but it’s worth discussing the implications with your doctor, physical therapist or sports coach and considering how to adapt your training and technique to reduce your risk further.
At Olton Osteopathy, our clients have all different degrees of flexibility, from the super-bendy to the stiff-as-a-board. Whether you think you are too flexible, or not flexible enough, we are happy to share our experience and help you to make the most of the body that you have.