What is hypermobility?
Hypermobility is when your joints are able to move beyond the normal range of motion. It can be mild and only affect a few joints (often the knees or elbows), but it can also affect multiple joints across your whole body.
If you have multiple ‘loose joints’ but they’re not causing pain or injury, then you might have heard the term generalised or benign hypermobility syndrome used to describe your condition. Being told that you have benign hypermobility syndrome is nothing to worry about. It’s not a disease process, it won’t get any worse, and it can actually be an advantage if you enjoy an activity which requires good joint mobility like yoga or gymnastics!
As a physiotherapist, my only concern for people who have benign hypermobility is the potential to overstretch and strain something more easily. So, if you’ve been told you have benign hypermobility, it’s absolutely crucial to build enough strength to control the extra range you have available, to ensure your soft tissues are well supported and your joints are protected. A physiotherapist could help you with a safe, effective prehabilitation plan and I’m a massive fan of Pilates because it’s so precise and well controlled.
At the higher end of this spectrum, I also see patients who are experiencing instability, joint dislocations, pain and fatigue associated with the degree of their hypermobility. The clinical term for this is hypermobility spectrum disorder and at the most severe end I might see patients with rare genetic conditions such as Ehlers Danlos Syndrome (EDS). Patients with EDS have such a degree of extensibility in their connective tissues that they often experience symptoms internally too, such as cardiovascular and gastrointestinal problems. They generally require a more complex treatment plan to help manage the range of symptoms they may experience but Pilates also can be a helpful part of their overall management strategy.
What is the difference between being flexible and being hypermobile?
Hypermobility is different from simply being flexible. Being hypermobile means that the supporting structures around your joints, like your ligaments, are more elastic and can stretch further than normal making your joint(s) excessively mobile. Whereas flexibility generally refers to the length of your muscles and their ability to stretch and lengthen.
So, although having good flexibility often goes hand in hand with good joint mobility, you can be flexible without being hypermobile. You can also be hypermobile but have some areas in your body that are stiff and tight and a common place I see this is clinic is in the hamstrings.
Hypermobility and flexibility both benefit from exercises but with different intentions. If I am working with someone and want to help them improve flexibility, their programme might focus on movements which encourage dynamic stretching and joint mobility. However, when I am working with someone who is hypermobile, exercises that emphasis control, strength and stability are more appropriate.
How do you know if you are hypermobile?
During a physiotherapy appointment a physiotherapist may use the Beighton Scale to assess if you have hypermobility. This is a series of 9 movements including:
- Can you touch your thumb to the inside of your forearm? (score one point for each side)
- Can you stretch your little finger backwards beyond 90 degrees? (score one point for each side)
- Can you straighten your elbows back beyond the normal straight position? (score one point for each side)
- Can you push your knee backwards – like a flamingo – beyond the normal straight position when standing? (score one point for each side)
- Can you touch the palms of your hands to the floor without bending your knees? (score one point)
The total score out of nine gives an indication of hypermobility. As an adult, a score of 5 or more suggests that you might have hypermobility.
Can you have areas which feel tight and stiff even if you have hypermobility?
Yes, you can still have tightness and stiffness even if you are hypermobile. The most common reason for this is muscle guarding. To protect against instability, the muscles around a joint might tighten to provide support causing stiffness or restriction.
Stabilising flexible joints can also be very tiring, so overworked, tired muscles might fatigue causing your body to maintain balance and compensate by making other parts of the body stiff.
How can Pilates help with hypermobility (what are the benefits)?
Building strength, control, stability and balance is really important if you have hypermobility and this is where Pilates really shines!
Although I do love a core exercise, Pilates offers far more than just core strength training … it can help you build body awareness and responsive muscular control around your shoulders, elbows, wrists, hips, knees, and ankles.
Gentle twists, holds and reaching are all part of the Clinical Pilates approach, which mimic the types of movements we do in everyday activity. Standing exercises also replicate everyday activity, so training in this position prepares your whole body for movements like lifting, bending and squatting. Building strength in this way means you’ll move with more ease and control day-to-day.
What type of Pilates exercises are best for hypermobility?
The type of exercises recommended really depends on your body and your goals, but I do find that many people I work with who have hypermobility struggle to know when they are moving well or not. This is when practising in front of a mirror can be a useful and I also use props like resistance bands to help my patients learn to stabilise movements and control their range of movement safely.
Gentle twists, holds and reaching movements are all build into Clinical Pilates repertoire which I recommend because they build strength and control and mimic the types of movements we do in every day. Standing exercises also replicate everyday activity, so training in this position prepares your whole body for movements like lifting, bending and squatting. Building strength in this way means you’ll move with more ease, confidence and control day-to-day.
Please reach out if you have any questions about Clinical Pilates. We’d be delighted to discuss options to train with one of our therapists … we offer online, 1:1 or group Pilates classes with clients of all ages and abilities!
Blog written by: Hannah O’Sullivan, our Sport rehabilitation specialist.