Have you ever felt awed or admired the way a gymnast, dancer, or figure skater can bend and move their body?

What you may have been observing is hypermobility, which is an above average range of motion in one or more joints. I wanted to address this topic because joint hypermobility affects many people (about 20%), is largely unrecognized, and can have a big impact on a person’s life.Hypermobility can occur with a joint injury, skeletal differences or genetic mutation that affects the connective tissue (e.g., Ehlers-Danlos syndrome (hEDS), Marfan Syndrome, Down syndrome). Not everyone with hypermobility has symptoms. Hypermobility Spectrum Disorder (HSD) is an umbrella term which includes people who have no genetic marker for hypermobility but are symptomatic.

Common symptoms include:

• pain/stiffness in joints and muscles
• frequent joint/muscle injuries (e.g., full or partial dislocations, muscle sprains)
• fatigue
• digestive issues
• mast cell activation syndrome (MCAS)
• pelvic health and bladder issues

Regardless of the cause, knowledge, support, and lifestyle modifications can make a positive difference in symptoms and quality of life for people with HSD.

The 5-Point Hypermobility Questionnaire for adults (2013)

1. Can you now (or could you ever) place your hands flat on the floor without bending your knees?

2. Can you now (or could you ever) bend your thumb to touch your forearm?

3. As a child did you amuse your friends by contorting your body into strange shapes or could you do the splits?

4. As a child or teenager did your shoulder or kneecap dislocate on more than one occasion?

5. Do you consider yourself double-jointed?

Two or more ‘yes’ responses suggests joint hypermobility

Joint hypermobility is linked with structural differences in the brain and nervous system.

Psychiatrist and researcher Dr. Jessica Eccles found that the amygdala is larger and more reactive in people with hypermobility. The implication is that people with HSD are more prone to ‘fight or flight’ reactions and hypervigilance. Because they have a more sensitive nervous system, they are much more likely to experience anxiety, depression, and health conditions that are sensitive to physical and emotional stress, such as irritable bowel syndrome (IBS), chronic fatigue, fibromyalgia, and postural orthostatic tachycardia syndrome. POTS is a form of dysautonomia that causes increased heart rate with positional changes or extreme heat.

As well, a smaller parietal cortex in people with hypermobility results in decreased proprioception – the ability for your body to sense its movement, action, and location. Decreased proprioception can result in problems with motor control and coordination. For this reason, gym class and team sports can be difficult in grade school for children and youth with HSD. They may be labelled or perceive themselves as 'clumsy'. People with hypermobility can also be prone to injury because they lack a sense of when they’ve pushed their body too far.

Neurodifferences such as autism, ADHD, and Tourette syndrome are overrepresented in people with HSD.

Interoception is the ability to sense signals inside your body, such as hunger, thirst, and heartbeat. Heightened interoceptive sensitivity can result in overwhelming inner sensations as well as difficulty interpreting physical states. Interestingly, hypermobility has been linked to eating disorders, particularly anorexia nervosa.

"Hypermobile people [including] ourselves are often not initially able to identify the full range of difficulties we are facing, because we're so used to dealing with them, because they are often minimised are attributed to psychological issues by others and because we lack the information to assemble all the pieces of the jigsaw puzzle". 

~ Jess Glenny, Yoga therapist, author of Hypermobility on the Yoga Mat

Early identification of hypermobility in children is important to assess for the possibility of developmental disorders, medical concerns, and manage symptoms as they arise. Physiotherapist Pam Versfeld has an interesting page on her website for recognizing signs of hypermobility in infants. Children with hypermobility can learn how to participate in physical activity they enjoy and avoid injury.

Although people with HSD may appear to excel at activities such as yoga, they typically feel tight, stiff, and restricted. 

The reason is that their muscles are overworking to provide stability and keep them upright. Yoga can be an excellent practice for hypermobility. Mindful movement increases proprioception, coordination, and body awareness. However, not all yoga practices are appropriate for people with hypermobility, including those that are too hot, fast, or encourage people to push their limits. Experts recommend a trauma informed approach. Rather than passive stretching, people with HSD need a practice that engages muscles for stabilizing and strengthening to help with bone density and tendon stiffness. A practice that offers a slower tempo, use of props, rest and recovery helps counteract fatigue and soreness from exercise. Individuals with POTS may also find yogic breathing practices problematic because the tendency to overbreathe causes a lack of carbon dioxide in the blood stream; triggering more symptoms of dysautonomia. Hypermobile-aware yoga instructors take an individualized approach and provide feedback to their clients/students. People with hypermobility can enjoy yoga and other physical activities with knowledge about their condition and a practice that supports their unique abilities and needs. 

Do you know someone who might benefit from this information? Please share this article with them!

References and Resources

Glenny, J. (2021). Hypermobility on the yoga mat: A guide to hypermobility-aware yoga teaching and practice. London: Singing Dragon.

Hypermobility, pelvic organ prolapse and pelvic health with Libby Hinsley, DPT. Pelvic Health Professionals Guest Expert call, November 7, 2022.

https://www.hypermobility.org/

This article was published in my Fall 2023 newsletter. Sign up for my newsletter here!