EVER FEEL like Gumby? Do double-jointed tricks with your thumbs, remember dropping into splits easily in your youth? Have such difficulty standing for long periods that an hour at a museum is more tiring than one spent climbing the Billy Goat Trail? Also, tired and achy? Have cold hands and feet?
You might have hypermobile joints, which are too loose, move too easily and/or move too far. “You can’t control your joints the way you need to,” according to Mike Robertson. One indicator of hypermobility is difficulty standing on one leg.
Loose joints create strain on soft connective tissues — muscles, ligaments and tendons that are designed to stabilize joints — in turn, making the connective tissue too lax to stabilize the joints and more vulnerable to tearing and pain. While the most common sign is too much flexibility, hypermobile people can also feel stiffness and tension in the joints.
With reduced awareness of the location of their bodies in space, called proprioception,” hypermobile people frequently bang into things and may have been told they were clumsy or awkward — a klutz,” notes local Certified Advanced Rolfer™ and movement therapist Rebecca Carli Mills.
Suffering chronic joint pain and other symptoms related to hypermobility can lead to a diagnosis of Joint Hypermobility Syndrome (JHS), writes Alan Pocinki, hypermobility expert at George Washington Hospital, in a packet requested by his patients “to help educate others about their condition.” JHS affects three times as many women as men, occurs in as much as 10% of the population, and tends to diminish with age.
“Emerging awareness” is how Carli-Mills describes the current thinking about hypermobility, as descriptions and classifications change with new research. People with lax joints fall along a broad spectrum, from those with hypermobility but only mild or no related symptoms — to those more severely affected, some of whom have variations of a rare connective tissue disorder called Ehlers-Danlos Syndrome.
“Remarkably, this process [of tissue damage related to hypermobility] occurs so gradually than many people with JHS do not even notice…when in fact their necks are a mass of knotted soft tissue,” Pocinki writes.
Identifying joints as loose or hypermobile is crucial when choosing good exercises and activities — and avoiding those that can make problems worse. Resistance exercises, called isometric, keep the joints stable while working the muscles. Imagine pushing against a building “as hard as you can as if trying to move it,” writes Kerrie Reed, on Livestrong.com.
The best exercises involve weight lifting and tension bands — increasing repetitions while maintaining low weight or resistance, according to Pocinki: if you can’t do eight repetitions without straining, the weight is too heavy; and, don’t increase weight or resistance until you can do two sets of 15 reps without straining.
Bicep curls should be done with controlled resistance, that is, not relaxing the arm or releasing the weight at any point; and focusing on whole-body alignment to avoid straining a different part of the body, like the lower back, says Carli-Mills.
What’s very important for hypermobility is strengthening the core to decrease the load on susceptible joints, for example, by doing modified Pilates on the mat or ball. Also recommended are quadruped exercises, the most familiar being “bird-dog” — on all fours, stretch one arm out in front and the opposite leg in back, like a dog pointing toward its prey.
For all exercises, engage the body’s stability prior to the movement. Iyengar Yoga poses can provide good stretching, because muscles are engaged in isometric contractions and kept in controlled alignment — what some call “hugging in.”
The worst exercises for hypermobile joints are free-flow stretching like ballet or gymnastics. Anything that involves grabbing a joint and pulling or pushing to “loosen it up,” Pocinki writes. While hypermobile people often feel the need to stretch, in some cases their joints are already stretched as far as they will go — like a rubber band with no more elasticity. Once overstretched, a ligament can’t be corrected, “but you can turn on [activate] muscles surrounding the joint,” explains Robertson.
Among activities, the best for hypermobility are low-impact and improve muscle endurance: swimming, cycling, cross-country skiing, walking and Pilates. The worst: high-impact exercises that involve running, jumping or physical contact, according to Pocinki.
Fatigue and pain are the most common symptoms that accompany hypermobility — caused by poor posture, ineffective movements and “improper muscle recruitment” when performing simple tasks, according to a hypermobility blog. Some hypermobile people use physical or occupational therapy to learn correct movements.
Almost every JHS patient has chronic neck strain because the neck ligaments are too loose to support the neck, which forces the neck muscles to work harder, Pocinki explains. Also the shoulders are so loose and weak that activities using the arm pull on the neck. Other affected joints can cause knee, hip and back pain, tennis elbow, ankle sprains and bunions.
Other JHS-related symptoms: lightheadedness on standing quickly, low blood pressure, headaches, digestive issues, anxiety, nearsightedness or drooping eyelids, unexplained bruises and abnormal scarring, and constant thirst. Pocinki emphasizes that “Many people with loose joints will have no related medical problems at all.”
To assess the degree of hypermobility, the Beighton score uses these movements: bending your little finger backwards; bending your thumb forward to touch your forearm; hyperextending your elbows and/or knees; putting your palms flat on the floor without bending your knees. To diagnose JHS, that score is combined with other criteria, many related to pain such as the number of joints affected, the duration of pain, back pain and soft-tissue problems such as tendonitis.
While increasing muscle tone and stability can be a slow process, “people improve more quickly if they give up things that are bad for them, like running and stretchy hot yoga, while following a consistent program in good isometric exercise,” says Carli-Mills. And whenever possible, she suggests: engage the glutes and abs.
Another suggestion: when standing in line, spread weight evenly over the feet — think “leaving big foot prints” — then increase pressure through the feet into the ground — creating deeper and bigger foot prints; then allow this pressure to spread upwards through legs and hips, without locking the knees, through the top of the head. As she puts it, “Reach towards sky, connect the sky to the ground.”
Do something every day, even when tired, says Pocinki: a minimum of five minutes of light weights for shoulder strengthening and five minutes of isometrics for core strengthening. With another five minutes, add the bird-dog.
From the British Hypermobility Syndrome Association, the advice is Fidget! And avoid staying in any one position for more than half an hour.
Be aware of surfaces, says Carli-Mills. In movie chairs that slant backwards, for example, stuff your jacket into the back. And “soft lumpy sofas are bad news” because a JHS person’s alignment slides easily out of place.”
Finally, she advises, “Bring more mindfulness to movement and action to activate the nervous system in a different way.”
— Mary Carpenter
Mary Carpenter is the well-being editor of MyLittleBird. See more of her posts here.