Hypermobility: Understanding Its Disadvantages and How to Manage Them

What are the disadvantages of hypermobility?

While often associated with flexibility, hypermobility, or excessive joint range of motion, can predispose individuals to a range of musculoskeletal issues, including joint instability, increased injury risk, chronic pain, and compensatory movement patterns.

Understanding Hypermobility

Hypermobility refers to joints that move beyond the typical, healthy range of motion. It's crucial to distinguish it from general flexibility, which is the ability of muscles and connective tissues to elongate. Hypermobility, on the other hand, primarily relates to the laxity of ligaments, which are the primary stabilizers of joints.

Joint Laxity vs. Flexibility: Flexibility is desirable and trainable. Joint laxity, however, is often inherent and can mean the passive restraints (ligaments, joint capsules) are less effective at securing the joint. This laxity can be localized to a few joints or generalized throughout the body.

Benign vs. Syndromic Hypermobility: For many, hypermobility is benign, meaning it doesn't cause significant problems. However, for others, it can lead to chronic symptoms (Hypermobility Spectrum Disorder - HSD) or be part of a broader connective tissue disorder, such as Ehlers-Danlos Syndrome (hEDS), which has wider systemic implications. This article focuses on the general musculoskeletal disadvantages that can arise from excessive joint laxity.

Increased Risk of Injury

One of the most significant disadvantages of hypermobility is the heightened susceptibility to various musculoskeletal injuries.

• Joint Instability: Ligaments, designed to limit excessive joint movement, are overly lax in hypermobile individuals. This reduces the passive stability of the joint, making it more prone to abnormal motion.
• Dislocations and Subluxations: With reduced ligamentous support, joints can easily pop out of place (dislocation) or partially dislocate (subluxation). This is particularly common in shoulders, patellae, and fingers.
• Sprains and Strains: While muscles and tendons are generally stronger than ligaments, the increased range of motion can put undue stress on these tissues, leading to sprains (ligament overstretching/tears) and strains (muscle/tendon overstretching/tears) even during routine activities.

Chronic Pain and Fatigue

The constant effort required to stabilize overly mobile joints can lead to persistent discomfort and exhaustion.

• Muscular Overwork: Muscles surrounding hypermobile joints often have to work harder and more continuously to compensate for the lax ligaments. This chronic muscle tension can lead to widespread aches, stiffness, and pain.
• Inflammation: The increased movement and stress within the joint can lead to inflammation of the joint capsule, synovium, or surrounding soft tissues, contributing to chronic pain.
• Proprioceptive Deficits: The body's awareness of its position in space (proprioception) can be impaired in hypermobile individuals due to less feedback from lax ligaments. This can lead to inefficient movement patterns that further contribute to pain and fatigue.

Proprioception and Neuromuscular Control Issues

Effective movement relies on precise communication between the brain and body. Hypermobility can disrupt this.

• Reduced Sensory Input: Ligaments contain mechanoreceptors that provide crucial sensory information to the brain about joint position and movement. When ligaments are lax, this feedback is diminished, leading to a "fuzzy" proprioceptive map.
• Compensatory Movement Patterns: To maintain stability, the body may adopt inefficient or suboptimal movement patterns, often relying on larger, more superficial muscles instead of deeper stabilizing ones. This can lead to muscle imbalances and increased stress on other joints.
• Balance and Coordination Challenges: Difficulty in perceiving exact joint positions can impact balance, coordination, and the ability to perform precise, controlled movements, whether in daily life or athletic pursuits.

Muscle Imbalances and Compensatory Patterns

The body's natural response to joint instability is to rely more heavily on muscular effort for stabilization.

• Overactive Stabilizers: Muscles around hypermobile joints (e.g., rotator cuff muscles for the shoulder, deep core muscles for the spine) may become chronically overactive and tight in an attempt to provide stability. This can lead to pain and reduced range of motion in the muscles, despite the joint's underlying laxity.
• Underactive Prime Movers: Conversely, some muscles designed for large, powerful movements (prime movers) may become underutilized or inhibited if the body perceives the joint as unstable, leading to weakness and reduced functional capacity.
• Altered Biomechanics: The combination of laxity and compensatory muscle patterns can alter normal biomechanics, placing abnormal stresses on tendons, cartilage, and other joints, potentially accelerating wear and tear.

Increased Risk of Osteoarthritis

While often considered a condition of "wear and tear," hypermobility can paradoxically contribute to the development of osteoarthritis.

• Excessive Joint Play: The increased movement within the joint can lead to cartilage experiencing abnormal shear forces and uneven loading.
• Repetitive Microtrauma: Over time, this repetitive, abnormal stress can lead to the breakdown of articular cartilage, the smooth tissue that cushions the ends of bones, paving the way for degenerative joint changes characteristic of osteoarthritis.

Systemic Considerations

It's important to acknowledge that for some individuals, hypermobility is not an isolated musculoskeletal trait but a manifestation of a broader connective tissue disorder, such as Hypermobile Ehlers-Danlos Syndrome (hEDS) or other Hypermobility Spectrum Disorders (HSD). In these cases, disadvantages extend beyond the musculoskeletal system to include issues like:

• Autonomic dysfunction (e.g., Postural Orthostatic Tachycardia Syndrome - POTS)
• Gastrointestinal problems
• Skin fragility
• Easy bruising
• Chronic fatigue unrelated to musculoskeletal strain

While the focus here is on the musculoskeletal disadvantages, awareness of these broader possibilities is crucial for comprehensive care.

Challenges in Exercise and Training

For individuals with hypermobility, exercise, while essential, requires a modified approach.

• Difficulty with Controlled Movements: The inherent laxity can make it challenging to maintain tension and control throughout a full range of motion, increasing the risk of "hanging" on ligaments rather than engaging muscles.
• Risk of Overstretching: Hypermobile individuals can easily push past a healthy, stable range of motion during stretching, further exacerbating joint laxity and instability.
• Importance of Strength Training: While flexibility is often emphasized in fitness, for hypermobile individuals, the priority shifts dramatically to building strength and stability around the joints. This includes focusing on eccentric control, isometric holds, and movements within a stable, controlled range.

Managing Hypermobility: A Proactive Approach

While hypermobility has its disadvantages, proactive management can significantly mitigate risks and improve quality of life.

• Prioritize Stability and Strength: Focus on exercises that build muscular strength and endurance around the joints to provide active stability.
• Proprioceptive Training: Incorporate balance and coordination exercises (e.g., single-leg stands, unstable surface training) to improve body awareness and neuromuscular control.
• Controlled Range of Motion: Avoid passively stretching into extreme end-ranges. Instead, focus on active flexibility and strengthening within a safe, stable range.
• Professional Guidance: Working with a physical therapist or an experienced personal trainer knowledgeable about hypermobility is crucial. They can provide a personalized exercise program, teach proper movement mechanics, and help manage pain.

Understanding the unique challenges of hypermobility allows for a more informed and effective approach to fitness and overall health, emphasizing stability and strength over extreme flexibility.