Hypermobility: Understanding Its Effects on Normal Movement and Management

How Does Hypermobility Affect Normal Movement?

Hypermobility, characterized by joints that move beyond their typical range, can affect normal movement by altering joint stability, proprioception, and muscular control, leading to both advantages and potential challenges in daily activities and exercise.

Understanding Joint Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range of motion. This increased laxity is primarily due to differences in the collagen structure of ligaments and joint capsules, which are the connective tissues responsible for passively stabilizing joints. While some individuals may experience "benign joint hypermobility" (BJH) with no associated pain or problems, others may fall within the spectrum of Hypermobility Spectrum Disorder (HSD) or, in more severe cases, Hypermobile Ehlers-Danlos Syndrome (hEDS), which involve systemic manifestations beyond just joint laxity.

The Biomechanics of Hypermobility

The biomechanical implications of hypermobility significantly influence how an individual moves:

• Reduced Passive Stability: Ligaments in hypermobile joints are more elastic or elongated, providing less passive restraint. This means the joints rely more heavily on active muscular contraction for stability, especially at end-ranges of motion.
• Impaired Proprioception: Proprioception, the body's sense of joint position and movement, can be diminished in hypermobile individuals. Mechanoreceptors within lax ligaments and joint capsules may provide less accurate feedback to the central nervous system, leading to a poorer sense of where the limb is in space.
• Increased Muscular Demand: To compensate for reduced passive stability and impaired proprioception, the muscles surrounding hypermobile joints must work harder and more constantly to maintain joint integrity. This increased muscular effort can lead to chronic fatigue and overuse injuries.
• Altered Motor Control: The brain adapts to the increased joint play by developing compensatory movement patterns. These patterns might involve 'locking out' joints into hyperextension to achieve stability or over-recruiting larger muscle groups, potentially leading to inefficient movement and muscle imbalances.

Impacts on Daily Movement and Activities

Hypermobility can manifest in various ways during everyday activities, often subtly altering movement patterns:

• Apparent Flexibility vs. Controlled Movement: While hypermobile individuals might appear very flexible, this flexibility is often uncontrolled. They may easily hyperextend joints (e.g., elbows, knees, fingers) without conscious effort, placing undue stress on the joint structures.
• Fatigue and Pain: The constant need for muscular stabilization can lead to chronic muscle fatigue. Overuse of stabilizing muscles and repetitive microtrauma from joint instability can also cause widespread musculoskeletal pain, often described as aching or stiffness.
• Risk of Injury: Hypermobile joints are more susceptible to sprains, strains, subluxations (partial dislocations), and even full dislocations due to the reduced passive and active stability. Simple movements like turning quickly or stepping off a curb can pose a risk.
• Coordination Challenges: Impaired proprioception can affect fine motor skills and gross motor coordination, making tasks requiring precision or rapid changes in direction more challenging.
• Postural Difficulties: Maintaining static postures (e.g., standing for long periods) can be taxing, as muscles must continuously work to counteract gravity and provide stability, leading to slouching or compensatory postures.

Challenges in Exercise and Training

For individuals with hypermobility, exercise and training require a nuanced approach to prevent injury and promote functional strength:

• Risk of Overstretching: Traditional stretching exercises can be counterproductive, further increasing joint laxity without improving controlled range of motion. The focus should shift from increasing flexibility to enhancing stability within the existing range.
• Difficulty with Form: Maintaining proper form during resistance training or complex movements can be challenging due to poor proprioception and the tendency to hyperextend. This increases the risk of injury and reduces exercise effectiveness.
• Compensatory Loading: Hypermobile individuals may unknowingly shift load to less stable joints or over-rely on certain muscle groups, creating imbalances and potential injury sites.
• Fatigue and Recovery: The higher muscular demand for stabilization means hypermobile individuals may experience fatigue more quickly and require longer recovery times.
• Proprioceptive Training: Exercises that challenge balance and joint position sense are crucial but must be introduced carefully to avoid instability.

Strategies for Managing Hypermobility

Effective management of hypermobility focuses on enhancing functional stability and control rather than increasing range of motion:

• Prioritize Strength and Stability:
  • Targeted Muscle Strengthening: Focus on strengthening the muscles surrounding hypermobile joints (e.g., rotator cuff for shoulders, vastus medialis obliquus for knees, core muscles for the spine).
  • Eccentric Training: Emphasize the controlled lowering phase of movements to improve muscular control and joint deceleration.
  • Closed-Chain Exercises: Exercises where the distal end of the limb is fixed (e.g., squats, push-ups) often provide greater stability and proprioceptive feedback.
• Enhance Proprioception and Neuromuscular Control:
  • Balance Training: Incorporate exercises on stable and progressively unstable surfaces (e.g., single-leg stands, wobble boards, but with caution).
  • Slow, Controlled Movements: Perform exercises with meticulous attention to form and speed, focusing on the quality of movement rather than quantity or weight.
  • Mind-Muscle Connection: Actively concentrate on feeling the muscles work and maintaining joint position throughout the range of motion.
• Mindful Movement:
  • Avoid Hyperextension: Consciously avoid "locking out" joints during daily activities and exercise. Maintain a slight bend in knees and elbows.
  • Body Awareness: Regularly check in with your body to identify and correct poor postural habits or compensatory movements.
• Low-Impact Activities:
  • Activities like swimming, cycling, and elliptical training are generally well-tolerated as they reduce impact stress on joints.
• Appropriate Footwear and Support:
  • Supportive shoes can help stabilize the feet and ankles. Bracing may be considered for specific joints under professional guidance, especially during high-risk activities.
• Gradual Progression:
  • Increase exercise intensity, duration, and complexity slowly, allowing the body ample time to adapt and strengthen.

When to Seek Professional Guidance

While self-management strategies are beneficial, it is crucial to seek professional guidance if:

• You experience persistent pain, frequent joint subluxations or dislocations.
• Hypermobility significantly impacts your daily life, work, or ability to exercise.
• You suspect an underlying connective tissue disorder.
• You need personalized exercise programming or pain management strategies.

Physical therapists, kinesiologists, sports medicine physicians, and occupational therapists can provide tailored assessments and interventions, focusing on pain management, strengthening, proprioceptive training, and safe movement strategies.

Conclusion

Hypermobility is a unique physiological characteristic that profoundly influences normal movement by altering joint stability, proprioception, and neuromuscular control. While it can offer advantages in certain activities requiring extreme flexibility, it also presents challenges related to joint instability, pain, and injury risk. By understanding the biomechanics of hypermobility and adopting a proactive approach centered on controlled movement, targeted strength training, and enhanced proprioception, individuals can optimize their function, manage symptoms, and participate safely in physical activity, transforming a potential vulnerability into a foundation for resilient movement.