This month we have a guest blog about hypermobility. It is a topic that I am passionate about because, being hypermobile, I understand the implications of being too flexible. The guest blog is by a colleague, Philippa Brebner, who has a special interest in ballet. Many ballet dancers have to be overly flexible in order to perform their sport properly. At our practice, we see many athletes that struggle with hypermobility, so this topic is of great importance. Perhaps you have been struggling with pain as described in this blog and hopefully this will give you a greater understanding.
Can I really blame all of this on hypermobile joints?
I sat recently with an extremely frustrated patient, as she asked me this question. ‘Is this really the only reason I am experiencing so much pain?’ With an impressively comprehensive medical history ranging from headaches and neck pain, costochondritis, and chronic shoulder instability to patellofemoral and low back pain, her question demands answering.
What is wrong with me?
Many people with hypermobility wonder whether they are simply hypochondriacs with low pain thresholds. They are not! In this post I will briefly explain the mystery that is hypermobility, and provide some direction in the best way to manage it, specifically in the sporting and dancing population.
What is hypermobility?
Hypermobility is a condition where the joints of the body have a range of movement that is more than the expected range for that joint i.e too flexible. It is measured using a set of tests called the Beighton score. It is important to understand that the increase in range of motion will vary between individuals, and consequently so will the symptoms they feel. Some individuals may not experience any symptoms as a result of their hypermobility – these are usually the ones who score lower on the Beighton score.
Joint Hypermobility Syndrome (JHS)
Those who experience other symptoms along with their increased mobility are classified as having Joint Hypermobility Syndrome. The most common symptom is pain – this usually comes from the muscles and tendons around the joint rather than the joint itself. Other possible symptoms include recurrent bladder infections, easy bruising, resistance to anaesthetic, digestive problems and fatigue. This is because all of the connective tissue in the body is affected, internal and external. Another way to look at it is that the connective tissue has low tone, so even organs are slack.
Ehlers-Danlos Syndrome (EDS) is a clinically recognised connective tissue disorder which is associated with more of the severe systemic symptoms.
What causes all the pain?
Because the muscles and soft tissues supporting the ‘loose’ joint have to work extra hard to stabilise it, they are more prone to tightness and spasm. Soft tissue injuries are also common – this includes ligament tears within the joint as well as muscle or tendon overuse injuries.
For hypermobiles, any movement, even a simple one, requires more work and greater stability to support the very flexible skeletal system, so over time even simple activities such as sitting at a computer or desk can overload their musculoskeletal system and lead to pain.
Sportspeople with hypermobility are more at risk for injury because they are exposing their joints and muscles to greater loads. This does not mean that hypermobile people must not play sport. In fact some of the best sportspeople can be classified as hypermobile.
Dancers are a very special group within this population because flexibility is a requirement for their sport. For dancers, hypermobility is both a blessing and a curse – their lax joints allow them to kick higher and jump longer, but if their muscular stability does not match this increased range, they are very prone to injury. The hypermobile dancer as well as other hypermobile sportspeople, need to have good body awareness and know when she/he is working out of their ‘stable’ range.
So what can be done about it?
There is no ‘cure’ for hypermobility. The best solution is to provide the loose joints with as much muscular control as possible through specific exercises targeted at the stabilising muscles. Pilates is one of the ways to accomplish this. Training programmes with a movement specialist such as a physiotherapist or biokineticist are also recommended. Progressive strength, good body awareness, and learning to understand the limitations of your joints and muscles, needs to be trained. At the end of the day, a hypermobile patient is in charge of the care of his/her body.
Why should I care?
Not looking after hypermobile joints can lead to complications later in life. Over time, joints become stiffer as a normal part of the ageing process. This process can be accelerated in hypermobiles who are thus prone to early-onset arthritis. So, the earlier you can diagnose and start exercising correctly, the better the outcome long-term.
In summary
1) Hypermobility can be the root reason for your pain.
2) Like many other impairments, it can range in its severity and the effect on your body. So don’t think that all of the symptoms that can come with hypermobility will happen to you!
3) It cannot be cured – the best way to manage it, regardless of its severity, is with exercises aimed at muscle control.
4) If you are hypermobile you need to work extra hard at being aware of your body and understanding how it works.
5) Some sports activites may need to be modified or changed – consult a professional if you feel would like more guidance regarding this.