Hypermobility: Risks, Symptoms, and Management Strategies

Why is hypermobility bad?

While often perceived as beneficial, excessive joint hypermobility can be detrimental due to compromised joint stability, leading to an increased risk of injuries like dislocations, chronic pain, and accelerated joint degeneration, necessitating careful management and targeted strengthening.

Understanding Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range of motion. Unlike general flexibility, which is often a desirable trait achieved through muscle and soft tissue lengthening, hypermobility is primarily determined by the inherent laxity of ligaments and joint capsules. These structures, composed predominantly of collagen and elastin, provide passive stability to joints. In individuals with hypermobility, these connective tissues may be more extensible or less robust than average, allowing for greater joint play.

Hypermobility can be localized, affecting only a few joints (e.g., double-jointed fingers), or generalized, affecting multiple joints throughout the body. It's often genetic and can be identified using assessment tools like the Beighton Score, which evaluates the range of motion in specific joints.

The Spectrum of Hypermobility: From Benign to Symptomatic

It's crucial to understand that not all hypermobility is problematic. Many individuals possess a degree of hypermobility without experiencing any pain or functional limitations; this is often referred to as benign joint hypermobility. In some athletes, such as gymnasts or dancers, hypermobility can even be an asset, contributing to their performance.

However, when hypermobility leads to symptoms such as pain, instability, or recurrent injuries, it falls under the umbrella of Hypermobility Spectrum Disorder (HSD). In more severe cases, hypermobility can be a key feature of heritable disorders of connective tissue, most notably Ehlers-Danlos Syndrome (hEDS), which involves systemic manifestations beyond the musculoskeletal system. The "bad" aspects of hypermobility arise when this excessive joint laxity compromises joint integrity and overall body function.

Why Excessive Joint Mobility Can Be Detrimental

The inherent "badness" of hypermobility stems from its impact on joint stability and the compensatory mechanisms the body employs.

• Reduced Joint Stability: Ligaments and joint capsules act as passive restraints, preventing excessive movement. When these structures are overly lax, the joint lacks this crucial passive support, making it inherently less stable. This increased "play" within the joint can lead to sub-optimal joint mechanics.
• Increased Risk of Injury:
  • Dislocations and Subluxations: Without adequate ligamentous support, joints are more prone to fully dislocating (bones completely separate) or subluxating (bones partially separate and then realign). This is particularly common in highly mobile joints like the shoulder, patella, and fingers.
  • Sprains and Strains: Even minor movements can overstretch already lax ligaments (sprains) or cause muscles to work harder than they should, leading to strains.
  • Repetitive Stress Injuries: The constant micro-trauma from unstable joints can lead to inflammation of tendons (tendinitis) and bursae (bursitis).
• Proprioceptive Deficits: Proprioception is the body's sense of joint position and movement. Ligaments and joint capsules contain mechanoreceptors that feed this information to the brain. In hypermobile joints, the laxity of these tissues can lead to impaired proprioceptive feedback, meaning the brain receives less accurate information about where the joint is in space. This can result in:
  • Clumsiness and Poor Coordination: Increased likelihood of tripping, dropping things, or misjudging movements.
  • Delayed Protective Reflexes: Slower muscle activation to stabilize a joint during unexpected movements, increasing injury risk.
• Compensatory Muscle Overactivity and Fatigue: To compensate for the lack of passive stability, the muscles surrounding hypermobile joints are often forced to work harder and longer to provide active stabilization. This chronic muscular effort can lead to:
  • Muscle Fatigue and Weakness: Muscles become overworked and less efficient.
  • Chronic Muscle Pain and Spasms: Persistent tension and overuse can result in widespread or localized pain.
  • Imbalanced Muscle Development: Some muscles may become overly tight and dominant while others weaken, contributing to postural issues and further instability.
• Early Onset Osteoarthritis: Chronic joint instability and abnormal loading patterns due to hypermobility can accelerate the wear and tear on articular cartilage. This increased stress and friction within the joint can lead to premature degeneration and the development of osteoarthritis at an earlier age than typically expected.
• Chronic Pain: This is a common and debilitating symptom. It can stem from recurrent injuries, chronic muscle overactivity, nerve impingement due to instability, or the inflammatory processes associated with joint degeneration.
• Systemic Manifestations (in HSD/hEDS): While not purely musculoskeletal, individuals with HSD or hEDS may experience other issues that impact quality of life, such as autonomic dysfunction (POTS), gastrointestinal problems, skin fragility, chronic fatigue, and anxiety disorders, which collectively contribute to the "bad" experience of hypermobility.

Common Issues Associated with Hypermobility

Individuals with symptomatic hypermobility often present with a range of complaints, including:

• Recurrent joint dislocations or subluxations (e.g., shoulder, knee cap, jaw).
• Chronic musculoskeletal pain, especially in the back, neck, shoulders, and hips.
• Frequent sprains (ankles, wrists).
• Fatigue due to the constant muscular effort required for stabilization.
• Poor posture and difficulty maintaining upright positions.
• Proprioceptive challenges leading to clumsiness or falls.
• Increased susceptibility to tendonitis and bursitis.
• Digestive issues, headaches, or dizziness (especially in HSD/hEDS).

Management and Mitigation Strategies

While hypermobility itself cannot be "cured," its negative impacts can be significantly managed through targeted interventions:

• Strengthening and Stability Training: This is paramount. The focus should be on building robust muscular support around hypermobile joints. Examples include:
  • Core stability exercises to support the spine and pelvis.
  • Rotator cuff strengthening for shoulder stability.
  • Gluteal and hip abductor strengthening for hip and knee stability.
  • Foot and ankle intrinsic muscle work for lower limb support.
  • Emphasis on controlled, slow movements rather than heavy lifting or ballistic actions.
• Proprioceptive and Balance Training: Exercises that challenge balance and joint position sense are crucial to improve neural control and reduce injury risk. Examples include single-leg stands, balance board exercises, and unstable surface training.
• Low-Impact Exercise: Activities like swimming, cycling, elliptical training, and walking minimize stress on joints while promoting cardiovascular health and muscle endurance.
• Education and Body Awareness: Understanding one's own body and limits is key. Learning to avoid hyperextension (e.g., locking out knees or elbows) and maintaining a neutral joint position during daily activities and exercise is vital.
• Pain Management: This may involve physical therapy, manual therapy, anti-inflammatory medications, or other interventions as recommended by a healthcare professional.
• Appropriate Footwear and Support: Supportive shoes and, if necessary, orthotics can help stabilize the feet and ankles, which can have a positive cascading effect up the kinetic chain.

When to Seek Professional Guidance

If you experience persistent pain, recurrent joint dislocations, widespread symptoms, or suspect you might have Hypermobility Spectrum Disorder or Ehlers-Danlos Syndrome, it is crucial to consult with healthcare professionals. A multidisciplinary approach involving a physician, physical therapist, occupational therapist, and potentially other specialists (e.g., rheumatologist, geneticist) is often beneficial for diagnosis, comprehensive management, and improving quality of life.

Conclusion

While flexibility is often lauded, excessive, uncontrolled joint hypermobility can indeed be "bad" due to the significant risks it poses to joint stability, leading to increased vulnerability to injuries, chronic pain, and potential long-term joint degeneration. Understanding the underlying mechanisms and implementing a proactive management strategy focused on strengthening, proprioception, and mindful movement is essential for individuals with symptomatic hypermobility to mitigate these risks and maintain an active, healthy lifestyle.