Hypermobility: Understanding Normal Flexibility, Concerns, and Management

Can hypermobility be normal?

Yes, hypermobility can indeed be a normal and entirely asymptomatic characteristic for many individuals, existing on a broad spectrum of joint flexibility; however, it can also be indicative of underlying conditions when accompanied by pain, instability, or systemic symptoms.

Introduction to Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its typical, expected range of motion. This increased laxity in the ligaments and connective tissues surrounding a joint allows for greater flexibility. While often perceived as an unusual trait, hypermobility is surprisingly common, affecting a significant portion of the population to varying degrees. Understanding the nuances of hypermobility is crucial for fitness professionals and individuals alike, as its implications range from benign to potentially problematic.

The Spectrum of Joint Mobility

Human joint mobility exists on a wide continuum. At one end, we have individuals with limited flexibility, often described as "stiff." In the middle lies the average range of motion. At the other end of this spectrum are those with hypermobility – joints capable of extending or moving further than what is considered typical. This spectrum highlights that "normal" is not a single point but rather a range, and hypermobility simply represents an extreme on that range.

When is Hypermobility "Normal" or Benign?

For many, hypermobility is a benign characteristic, often referred to as Benign Joint Hypermobility (BJH). In these cases, individuals possess highly flexible joints without experiencing pain, instability, or other associated symptoms. Key characteristics of normal or benign hypermobility include:

• Asymptomatic: The most defining feature is the absence of chronic pain, recurrent dislocations, or significant functional limitations related to the joint laxity.
• Genetic Predisposition: It often runs in families, suggesting a genetic component influencing the elasticity of connective tissues.
• Advantageous in Certain Activities: For athletes in sports requiring extreme flexibility, such as gymnastics, dance, ballet, or even some martial arts, hypermobility can be a distinct advantage, allowing for greater range of motion and intricate movements.
• Common in Childhood: Children tend to be more flexible than adults, and hypermobility often lessens with age as connective tissues naturally stiffen.

It's important to distinguish between having flexible joints and experiencing problems because of that flexibility. If there are no adverse effects, the hypermobility is simply a physiological variant.

When Does Hypermobility Become a Concern? (Pathological Hypermobility)

While benign hypermobility is common, excessive joint laxity can sometimes lead to significant issues, classifying it as pathological hypermobility. This typically falls under the umbrella of Hypermobility Spectrum Disorder (HSD) or, in more severe cases, Ehlers-Danlos Syndromes (EDS) and other connective tissue disorders. When hypermobility becomes problematic, individuals may experience:

• Chronic Pain: Persistent musculoskeletal pain, often widespread and disproportionate to activity levels.
• Joint Instability and Subluxations/Dislocations: Joints may frequently "give way" or partially (subluxation) or fully (dislocation) come out of their sockets, even with minimal trauma.
• Fatigue: Chronic fatigue is a common co-occurring symptom, often debilitating.
• Proprioception Deficits: A reduced sense of body position and movement, increasing the risk of falls and injuries.
• Autonomic Dysfunction: Conditions like Postural Orthostatic Tachycardia Syndrome (POTS), affecting heart rate, blood pressure, and digestion.
• Skin and Tissue Fragility: In some connective tissue disorders like EDS, skin may be unusually soft, stretchy, or prone to bruising and scarring.
• Other Systemic Manifestations: A wide range of non-musculoskeletal symptoms can occur, affecting various body systems (e.g., gastrointestinal, cardiovascular, neurological).

When these symptoms are present, hypermobility is no longer considered "normal" but rather a clinical condition requiring medical diagnosis and management.

Assessing Joint Hypermobility

Clinicians often use standardized tools to assess the degree of joint hypermobility. The most widely recognized is the Beighton Score, a simple 9-point system that evaluates the passive range of motion in five specific joints/movements:

1. Passive dorsiflexion of the 5th metacarpophalangeal joint beyond 90 degrees (bilateral).
2. Passive apposition of the thumb to the forearm (bilateral).
3. Hyperextension of the elbows beyond 10 degrees (bilateral).
4. Hyperextension of the knees beyond 10 degrees (bilateral).
5. Ability to place palms flat on the floor with knees straight (forward flexion of the trunk).

A higher score indicates greater generalized joint hypermobility. While useful for screening, the Beighton Score alone does not diagnose HSD or EDS; it merely quantifies the degree of laxity. A comprehensive clinical assessment by a specialist is necessary for diagnosis of a hypermobility disorder.

Managing Hypermobility: A Fitness Educator's Perspective

For individuals with benign hypermobility, or those with HSD/EDS who are cleared for exercise, the focus shifts from increasing flexibility to enhancing stability and strength. As an Expert Fitness Educator, the core principles for training those with hypermobility include:

• Prioritize Stability Over Flexibility: Unlike average individuals who might benefit from stretching to increase range of motion, hypermobile individuals already possess excessive range. The goal is to control this range.
• Strength Training: Emphasize building strong muscles around the joints to provide active support and stability. Focus on compound movements with controlled execution.
• Proprioception and Balance Training: Improve the body's awareness of its position in space. Exercises like single-leg stands, balance board work, and unstable surface training can be highly beneficial.
• Avoid End-Range Hyperextension: Consciously train to stop just short of full hyperextension during movements. For example, in a push-up, avoid locking out the elbows completely.
• Core Stability: A strong core provides a stable base for all limb movements, crucial for overall joint protection.
• Slow, Controlled Movements: Minimize ballistic or uncontrolled movements that can stress lax joints.
• Low-Impact Activities: Activities like swimming, cycling, and elliptical training are often well-tolerated as they reduce impact on joints.
• Pain Management and Professional Guidance: If pain or instability is present, exercise should always be guided by a physical therapist or healthcare professional who understands hypermobility. Collaboration between medical and fitness professionals is paramount.

Conclusion

Hypermobility is a fascinating aspect of human variability. While it can be a perfectly normal, asymptomatic trait for many, it also exists on a spectrum that can lead to significant health challenges for others. The distinction lies not in the degree of flexibility itself, but in the presence or absence of associated symptoms like pain, instability, and systemic involvement. For fitness enthusiasts and professionals, understanding this distinction is vital for designing safe, effective, and empowering exercise programs that support joint health and overall well-being, whether hypermobility is a benign advantage or a condition requiring careful management.