The dictionary definition of hypermobility is:
“An increased range of movement of joints and joint laxity, occurring normally in children and adolescents or as a result of disease, for example Marfan or Ehlers-Danlos Syndrome.”
Fast facts about hypermobility:
- Many children are naturally hypermobile – this will wane with age.
- If someone is hypermobile, it does not mean that they have a connective tissue disorder such as Ehlers-Danlos Syndrome or Hypermobility Spectrum Disorder.
- Some people are hypermobile – in fact it can benefit dancers, athletes and sports people.
- Hypermobility can be ‘acquired’ in some cases where people are forced into positions required for dance or gymnastics.
We know therefore that some people are more flexible than others and maybe they need it for their profession. These people know how to move well, control their range of motion and do not experience any other symptoms with their hypermobility, such as chronic pain or injury.
But what happens when you have a client who is hypermobile and has other symptoms? Maybe the client does have chronic pain and is experiencing subluxations in the joint. (A subluxation is a partial dislocation, where the two bones that form the joint are still partially in contact with each other. A dislocation is where the two bones fully separate from each other). They may also present with other issues like delicate, stretchy skin, be prone to bruises, have chronic fatigue and be intolerant to intense exercise. They may complain of regular injuries and muscular strains for no apparent reason. In this case, the client could have a connective tissue disorder such as Ehlers-Danlos Syndrome (EDS).
Ehlers-Danlos syndromes are a group of connective tissue disorders that can be inherited and varied both in how they affect the body and in their genetic causes.
Aside from the physical symptoms of EDS, it is known that people with this syndrome also lack motor control skills, lack coordination and have a lesser sense of proprioception (our ability to sense where our body is in space). There tends to be a lack of body awareness, which goes with control and stability. A modified and individually adapted Pilates programme is often an excellent way forward to build these much needed skills.
Be aware of the following when programming for hypermobility:
- Lack of awareness can mean that the client will not be aware when joints are locked or posture is out of alignment.
- The unconscious act of locking joints can set up a spiral of pain and dysfunctional movement.
- The client may be more accident prone – make sure your studio or workspace is clear of objects that can be tripped over.
- Think carefully about studio based exercises that require balance or lack of support. These will not be your starting point.
- Due to lack of proprioception and control, the hypermobile client can potentially move into ranges of movement that are considered beyond ‘normal range’.
- Moving into these bigger ranges of movement do not tend to hurt – it is normal when the client has been used to allowing these ranges. But as I say to my clients – “just because we can, doesn’t mean we should”.
We need to help our clients reign in their movement – until they understand what it feels like to stabilise their joints and control movement. Repeated over-stretching will simply exacerbate laxity and increase the chance of subluxation. We need to train muscle tone and strength to support the joints.
So whilst hypermobility can be a benefit for some, most of our clients are going to be seeking ways to improve their strength and coordination. Keep ranges small, with little or low loads. And remember, not every exercise in the manual is going to be suitable or appropriate for the hypermobile client. Adapt according to the individual situation.
I will be writing next about cueing, and why we need to mind our language in my next blog. For a more practical approach, join my workshop for Polestar Pilates teachers Wed 6th November at Moss Pilates’ King’s Cross: