Hypermobility: Understanding, Best Exercises, and What to Avoid

What is the Best Exercise for Hypermobility?

There is no single "best" exercise for hypermobility; rather, a strategic, individualized approach focusing on stability, strength, proprioception, and low-impact movements is paramount to manage symptoms and enhance joint integrity.

Understanding Hypermobility

Hypermobility refers to joints that move beyond a typical or expected range of motion. While some individuals have asymptomatic joint hypermobility (often termed "double-jointed"), for others, it can lead to chronic pain, recurrent injuries, fatigue, and other systemic issues. This symptomatic form is often diagnosed as Hypermobility Spectrum Disorder (HSD) or, in more complex cases, Ehlers-Danlos Syndromes (EDS).

The fundamental challenge with hypermobility is that joints lack the inherent passive stability provided by taut ligaments, making them more reliant on surrounding muscles for support and control. This increased reliance means that muscle imbalances, weakness, or poor neuromuscular control can easily lead to joint subluxations, dislocations, or chronic strain.

The Core Principles of Exercise for Hypermobility

For individuals with hypermobility, the traditional focus on stretching and flexibility is often counterproductive. Instead, exercise programming must shift towards enhancing joint stability and control.

• Prioritize Stability Over Mobility: The goal is not to increase range of motion, which is already excessive, but to train the muscles surrounding a joint to provide dynamic stability and prevent hyperextension or unwanted movement.
• Enhance Proprioception and Neuromuscular Control: Proprioception is the body's ability to sense its position and movement. Individuals with hypermobility often have impaired proprioception, making them less aware of their joint's position in space. Exercises that challenge balance and body awareness are crucial.
• Build Foundational Strength: Strengthening the muscles that cross and stabilize hypermobile joints is essential. This includes global muscle groups (e.g., quadriceps, hamstrings, glutes) but places particular emphasis on intrinsic stabilizers (e.g., rotator cuff, deep core muscles).
• Low-Impact and Controlled Movements: High-impact activities or ballistic movements can place undue stress on unstable joints. Controlled, deliberate movements with a focus on form are key to building strength safely.
• Gradual Progression and Listening to Your Body: Progress should be slow and deliberate. Pushing into pain or attempting to "stretch" further can exacerbate symptoms and lead to injury. Rest and recovery are as important as the exercises themselves.

Recommended Exercise Modalities and Types

Based on the principles above, the following exercise modalities are generally beneficial for individuals with hypermobility:

• Strength Training:
  • Focus: Building muscle mass and strength around joints to provide active support. Emphasize controlled movements, especially the eccentric (lowering) phase, to improve muscle endurance and stability.
  • Equipment: Resistance bands, light to moderate free weights, and selectorized machines can all be used effectively.
  • Examples:
    • Compound movements: Squats (often partial range, wall squats), deadlifts (e.g., Romanian deadlifts with light weight and focus on hamstring activation, avoiding spinal hyperextension), lunges (controlled depth).
    • Upper body: Rows (seated, bent-over), chest presses (dumbbell, machine), shoulder presses.
    • Key: Avoid locking out joints into hyperextension; maintain a slight bend.
• Core Stability Training:
  • Importance: A strong core provides a stable base for all limb movements, protecting the spine and reducing strain on peripheral joints.
  • Examples: Planks (forearm, side), bird-dog, dead bug, glute bridges, pelvic tilts. Focus on engaging the deep abdominal and pelvic floor muscles.
• Proprioceptive Training:
  • Importance: Retrains the nervous system to better sense joint position and activate stabilizing muscles reflexively.
  • Examples:
    • Balance exercises: Single-leg stance (progressing from firm ground to unstable surfaces like foam pads, with caution and support).
    • Tai Chi: Slow, deliberate movements that enhance body awareness and balance.
    • Modified Yoga: Focus on holding stable poses with correct alignment rather than pushing into deep stretches.
• Low-Impact Aerobic Exercise:
  • Benefits: Improves cardiovascular health without excessive joint stress.
  • Examples: Swimming (especially beneficial as buoyancy reduces joint load), cycling (stationary bikes are often preferred for stability), elliptical trainers, brisk walking.
• Pilates (Mat or Reformer):
  • Benefits: Excellent for developing core strength, body awareness, and controlled movement patterns. It emphasizes precise, deliberate movements and muscle activation.
  • Caveats: It is crucial to work with an instructor who understands hypermobility and can provide modifications to prevent hyperextension.
• Functional Movement Training:
  • Benefits: Focuses on movements that mimic daily activities, improving overall functional strength and coordination.
  • Focus: Training movement patterns (e.g., pushing, pulling, squatting, hinging, carrying) rather than isolated muscles.

Exercises to Approach with Caution (or Avoid)

Certain exercises can exacerbate hypermobility symptoms or increase injury risk:

• Deep Stretching or Extreme Flexibility Exercises: These are generally counterproductive as they can further destabilize already loose joints.
• High-Impact Activities: Running (especially on hard surfaces), jumping, plyometrics, and contact sports can place excessive stress on unstable joints and increase the risk of injury.
• Uncontrolled or Ballistic Movements: Fast, jerky movements or ballistic stretching can lead to joint subluxations or dislocations.
• Unmodified Yoga or Gymnastics: While beneficial with modifications, traditional yoga or gymnastics classes that emphasize extreme flexibility can be harmful if not tailored to hypermobile individuals.
• Heavy Lifting with Poor Form: While strength training is crucial, lifting weights that are too heavy for your stabilizing muscles can lead to injury. Always prioritize perfect form over load.

The Importance of Professional Guidance

Given the individualized nature of hypermobility and its varying presentations, consulting with healthcare professionals is paramount:

• Physician Consultation: Always begin by consulting with a doctor, especially one familiar with hypermobility conditions (e.g., rheumatologist, geneticist), to receive an accurate diagnosis and understand any specific limitations.
• Physical Therapist (Physiotherapist) or Exercise Physiologist: Working with a qualified professional experienced in hypermobility is highly recommended. They can:
  • Conduct a thorough assessment of your specific joint instability, muscle imbalances, and proprioceptive deficits.
  • Design a personalized exercise program tailored to your unique needs and goals.
  • Teach proper form and provide modifications to ensure safety and effectiveness.
  • Help you identify and avoid movements that might be harmful.

Key Takeaways for Safe and Effective Exercise

• Focus on Control, Not Range: The aim is to build muscular control within your existing, safe range of motion, not to increase flexibility.
• Listen to Your Body: Pay close attention to pain signals. Sharp pain, clicking, or grinding indicates that a movement is likely unsafe.
• Consistency is Vital: Regular, consistent exercise is more effective than sporadic intense sessions.
• Prioritize Form Over Weight/Intensity: Always ensure perfect technique before increasing the load or complexity of an exercise.
• Warm-Up and Cool-Down: Include a gentle warm-up before exercise and a cool-down with static holds (not deep stretches) afterward.