Hypermobility: Understanding, Management, and Exercise Strategies

How to fix hypermobility?

Fixing hypermobility involves a comprehensive, long-term strategy focused on enhancing joint stability, building muscular strength, improving proprioception, and managing flexibility, rather than curing the underlying genetic predisposition. The goal is to reduce symptoms, prevent injury, and improve functional capacity through targeted exercise and mindful movement.

Understanding Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its typical range of motion. While some individuals experience "benign joint hypermobility" with no associated pain or problems, others may have Hypermobility Spectrum Disorder (HSD) or a more specific connective tissue disorder like Ehlers-Danlos Syndrome (EDS), which can lead to chronic pain, instability, dislocations, and other systemic issues. The term "fix" is therefore a misnomer; you cannot eliminate the anatomical predisposition to hypermobility. Instead, the focus is on managing and improving the body's functional response to it.

The Challenges of Hypermobility

While increased flexibility might seem advantageous, excessive joint laxity can lead to several challenges:

• Joint Instability: Ligaments, which normally limit joint movement, are more extensible, leading to reduced passive stability.
• Increased Injury Risk: Subluxations (partial dislocations) or full dislocations are more common.
• Chronic Pain: Overworked muscles trying to compensate for joint instability can lead to fatigue, spasms, and chronic pain.
• Proprioceptive Deficits: The body's sense of joint position and movement (proprioception) can be impaired, leading to poor motor control.
• Fatigue: The constant effort required by muscles to stabilize joints can be exhausting.
• Early Onset Osteoarthritis: Long-term instability and microtrauma can contribute to degenerative joint changes.

Principles of Hypermobility Management

Effective management of hypermobility centers on a holistic approach that prioritizes stability over extreme flexibility. The key principles include:

• Prioritize Stability and Strength: Build strong muscles around the joints to provide active support and compensate for lax ligaments.
• Enhance Proprioception: Improve the body's awareness of joint position to optimize movement control.
• Manage Flexibility: Avoid stretching into extreme end ranges; focus on maintaining functional, controlled mobility.
• Develop Efficient Movement Patterns: Learn to move within a stable, safe range of motion.
• Listen to Your Body: Recognize and respect pain signals, avoiding movements that provoke symptoms.

Key Strategies for Managing Hypermobility

Implementing these strategies consistently is crucial for long-term improvement:

• Targeted Strength Training:

  • Focus on Eccentric Control: Emphasize the lowering phase of movements (e.g., controlled descent in a squat) to build strength and control.
  • Compound Movements with Caution: Exercises like squats, deadlifts, and presses are beneficial but must be performed with impeccable form, often with a limited range of motion initially to maintain stability.
  • Isolation Exercises: Target specific muscle groups that support vulnerable joints (e.g., rotator cuff muscles for shoulders, glute medius for hips, vastus medialis obliquus for knees).
  • Progressive Overload: Gradually increase resistance, but never at the expense of form or stability.
  • Slow, Controlled Movements: Avoid momentum and jerky movements.

• Proprioceptive and Balance Training:

  • Unstable Surfaces: Incorporate exercises on balance boards, BOSU balls, or foam pads (start with stable surfaces and progress cautiously).
  • Single-Leg Stance: Practice standing on one leg, first with eyes open, then closed.
  • Mindful Movement: Pay close attention to how your body moves in space during daily activities and exercise.
  • Tai Chi or Yoga (Modified): These practices can enhance body awareness, but individuals with hypermobility must be highly selective and avoid positions that push joints into extreme ranges.

• Core Stability Training:

  • A strong core provides a stable base for all limb movements.
  • Planks, Bird-Dogs, Dead Bugs: Focus on maintaining a neutral spine and engaging deep abdominal muscles.
  • Anti-Rotation and Anti-Extension: Exercises that challenge the core's ability to resist movement are highly beneficial.

• Flexibility and Mobility Management:

  • Avoid Passive Stretching into End-Range: Do not hang passively into your maximal range of motion, as this can further stretch already lax ligaments.
  • Active Mobility: Focus on moving joints through their controlled active range of motion, where muscles are actively engaged to stabilize the joint.
  • Myofascial Release: Use foam rollers or massage balls to address muscle tightness that may be compensatory.
  • Dynamic Warm-ups: Prepare the body for movement with controlled, fluid motions.

• Movement Pattern Correction:

  • Work with a qualified professional to identify and correct compensatory movement patterns that may be contributing to pain or instability.
  • Learn to "lock" or "brace" joints appropriately, especially in weight-bearing activities, to prevent hyperextension.

Exercise Recommendations for Hypermobility

When selecting exercises, prioritize quality of movement over quantity or heavy loads.

• Strength Exercises:

  • Squats (Box Squats, Goblet Squats): Focus on controlled depth, ensuring knees track over feet and avoiding hyperextension at the top.
  • Deadlifts (Romanian Deadlifts, Sumo Deadlifts): Emphasize hip hinge mechanics, maintaining a neutral spine.
  • Overhead Press (Dumbbell or Kettlebell): Control the shoulder blade movement, avoiding shrugging or excessive arching of the lower back.
  • Rows (Dumbbell Rows, Cable Rows): Strengthen the upper back and scapular stabilizers.
  • Glute Bridges/Hip Thrusts: Excellent for glute strength and hip stability.
  • Lunges (Walking, Reverse): Focus on knee and hip stability.
  • Rotator Cuff Exercises: Internal/external rotations with light resistance bands.
  • Scapular Stability Exercises: Wall slides, Y-T-W exercises.

• Proprioceptive/Balance Exercises:

  • Single-leg Balance: Progress from stable ground to unstable surfaces.
  • Tandem Stance/Walk: Heel-to-toe walking.
  • Star Excursion Balance Test (modified): Reaching in various directions while maintaining balance on one leg.

• Core Exercises:

  • Planks (Forearm, Side): Maintain a straight line from head to heels.
  • Bird-Dog: Focus on controlled limb extension without spinal movement.
  • Dead Bug: Maintain lower back contact with the floor.
  • Pallof Press: Anti-rotation exercise using a cable machine or resistance band.

Important Considerations and Precautions

• Avoid Hyperextension: Consciously avoid "hanging out" in end-range positions, especially in joints like knees, elbows, and spine. Learn to engage muscles to maintain a slight bend or neutral position.
• Listen to Your Body: Pain is a warning sign. Differentiate between muscle fatigue and joint pain. Never push through joint pain.
• Gradual Progression: Start slowly with low resistance and high repetitions focusing on form. Gradually increase intensity, duration, or resistance.
• Warm-up and Cool-down: Always perform a dynamic warm-up before exercise and a gentle, active cool-down afterward.
• Hydration and Nutrition: Support overall connective tissue health with adequate hydration and a balanced diet rich in protein, Vitamin C, and other essential nutrients.
• Pacing: Individuals with hypermobility may experience delayed onset muscle soreness (DOMS) more intensely or for longer periods. Allow adequate rest and recovery.

When to Seek Professional Guidance

While self-management is key, professional guidance is often necessary, especially if you experience:

• Persistent or worsening pain.
• Frequent subluxations or dislocations.
• Significant limitations in daily activities.
• Uncertainty about exercise technique or progression.
• Suspected underlying connective tissue disorder.

Consult with a physical therapist, exercise physiologist, or kinesiologist experienced in hypermobility. They can conduct a thorough assessment, identify specific weaknesses or movement dysfunctions, and design a personalized exercise program tailored to your unique needs and goals. In some cases, a medical doctor specializing in rheumatology or genetics may be necessary for diagnosis and broader management.