Hypermobility: Exercises to Avoid, Risks, and Safe Strategies

What Exercises Should I Avoid with Hypermobility?

Individuals with hypermobility should primarily avoid exercises that push joints to their end range of motion without muscular control, emphasize passive stretching, or involve high-impact, uncontrolled movements, as these can exacerbate joint instability and increase the risk of injury.

Understanding Hypermobility: More Than Just "Flexibility"

Hypermobility, often referred to as "double-jointedness," is a condition where joints move beyond their normal physiological range of motion. Unlike beneficial flexibility, which is controlled and supported by strong muscles, hypermobility stems from laxity in the ligaments and joint capsules. While it might seem advantageous, this increased range of motion can predispose individuals to joint instability, subluxations (partial dislocations), dislocations, sprains, and chronic pain due to the lack of structural support. For those with hypermobility, the goal of exercise shifts from increasing flexibility to enhancing stability, strength, and proprioception (the body's awareness of its position in space).

The Core Principle: Prioritizing Stability Over Range of Motion

The fundamental principle for exercise with hypermobility is to prioritize stability over excessive range of motion. Your ligaments, which connect bone to bone and provide passive joint stability, are already overly elastic. Therefore, constantly stretching them further is counterproductive and potentially harmful. Instead, the focus should be on building strong muscles around the joints to provide active stability and control, ensuring movements occur within a safe, functional range.

Exercises to Approach with Caution or Avoid Entirely

While individual tolerance varies, certain exercise types and specific movements generally pose a higher risk for individuals with hypermobility.

• Ballistic Stretching and Bouncing:

  • These involve rapid, jerky movements to force a stretch, which can easily overstretch already lax ligaments and tendons beyond their safe limit, leading to injury.

• Extreme End-Range Passive Stretching:

  • Any stretch that pushes a joint to its absolute maximum, especially without active muscular control, should be avoided. Examples include:
    • Deep, prolonged static stretches: Holding stretches for extended periods that cause discomfort or push beyond a controlled range.
    • Certain yoga or Pilates poses: Poses like "wheel" (Urdhva Dhanurasana), "pigeon" (Eka Pada Rajakapotasana), or deep forward folds, if performed without conscious muscular engagement to limit the range or if they cause the joint to "hang" in its end range.
    • Overstretching in dance or gymnastics: Pushing for extreme splits or backbends without sufficient core and muscular control.

• Exercises Emphasizing Maximal Joint Extension/Flexion without Stability:

  • Movements that encourage hyperextension (going beyond a straight line) or hyperflexion (excessive bending) of joints are particularly risky.
    • Hyperextension of Knees and Elbows: Examples include locking out the knees during leg presses, squats, or leg extensions, or locking out elbows during triceps extensions, push-ups, or overhead presses. Always maintain a slight bend in the joint.
    • Deep Squats or Lunges into Extreme End-Range: If core and hip stability are compromised, going too deep can place excessive strain on knee and hip ligaments. Focus on controlled depth where muscles are actively engaged.
    • Overhead Presses with Excessive Lumbar Extension: If shoulder stability is poor, compensating with excessive arching of the lower back (lumbar hyperextension) can strain the spine and shoulder joint.
    • Certain Chest Stretches: Aggressively stretching the chest by pulling arms far behind the body, which can hyperextend the shoulder joint.

• High-Impact, Uncontrolled Movements:

  • Activities that involve sudden, uncontrolled forces on joints can be problematic, especially if foundational strength and proprioception are lacking.
    • Plyometrics and Jumping: While beneficial for some, uncontrolled or high-volume plyometrics can repeatedly stress joints. Start with low-impact, controlled variations if attempting.
    • Sports with Sudden Directional Changes: Activities like basketball, soccer, or tennis, if performed without adequate joint stabilization, can lead to sprains or subluxations.

• Resistance Training with Poor Form or Excessive Weight:

  • Regardless of the exercise, using too much weight or performing movements with poor technique can compromise joint stability and increase the risk of injury for anyone, but especially for those with hypermobility. Always prioritize perfect form over load.

Why These Exercises Pose a Risk

The risks associated with these exercises for hypermobile individuals stem from several biomechanical factors:

• Ligamentous Laxity: Already loose ligaments are further stretched, reducing their ability to provide passive joint stability and making the joint more vulnerable to injury.
• Reduced Proprioception: Hypermobile joints often have diminished proprioceptive feedback, meaning the brain receives less accurate information about joint position, making it harder to control movements and avoid unsafe ranges.
• Increased Joint Instability: Pushing joints to their end range without muscular control can lead to repetitive microtrauma, increasing the likelihood of subluxations or dislocations.
• Muscle Overcompensation and Fatigue: Muscles surrounding hypermobile joints may work harder to provide stability, leading to chronic tightness, fatigue, and pain in these muscles.
• Accelerated Degenerative Changes: Chronic instability and repeated micro-injuries can contribute to accelerated wear and tear on cartilage and joint structures, potentially leading to early onset osteoarthritis.

Safe Exercise Strategies for Hypermobility

Instead of avoiding exercise, individuals with hypermobility should embrace a strategic approach focused on building stability and strength:

• Focus on Strength Training: Prioritize exercises that build strong muscles around your joints. This includes compound movements (squats, deadlifts, presses) performed with controlled form and isolation exercises that target specific stabilizing muscles (e.g., rotator cuff, glute medius).
• Proprioceptive Training: Incorporate balance exercises (e.g., single-leg stands, wobble board exercises) to improve joint awareness and control. Start with stable surfaces and progress cautiously.
• Core Stability: A strong core (abdominal and back muscles) is crucial for providing a stable base for all limb movements, protecting the spine and peripheral joints.
• Controlled, Mindful Movements: Perform exercises slowly and deliberately, focusing on muscular engagement rather than momentum. Stay within a pain-free, controlled range of motion.
• Low-Impact Activities: Activities like swimming, cycling, elliptical training, and walking are excellent choices as they provide cardiovascular benefits without excessive joint impact.
• Pilates and Modified Yoga: When practiced with an emphasis on core engagement, controlled movement, and avoiding end-range stretches, these can be highly beneficial for building stability and body awareness. Always inform your instructor about your hypermobility.
• Qualified Professional Guidance: The most important strategy is to seek guidance from a physical therapist, exercise physiologist, or certified personal trainer experienced with hypermobility. They can assess your specific needs, identify weak links, and design a safe, effective, and individualized exercise program.

When to Seek Professional Guidance

If you suspect you have hypermobility, experience joint pain, instability, or frequent sprains, it is crucial to consult with a healthcare professional. A doctor, physical therapist, or exercise physiologist can properly diagnose your condition, rule out underlying disorders (like Ehlers-Danlos Syndrome), and provide tailored advice for safe and effective exercise. They can teach you proper form, identify specific muscle imbalances, and help you navigate your fitness journey safely.