Understanding Hypermobility:

What It Is, How It’s Diagnosed, and How It’s Treated?

Hypermobility, often referred to as being “double-jointed,” is a condition where joints easily move beyond the normal range of motion. While it may seem like a cool party trick, hypermobility can lead to a variety of issues if not properly managed. There was a beautiful article in the Guardian about Simone Biles in Feb 24. The American Gymnast has helped reframe hypermobility and actually seeing it as a superpower. Let’s dive into what hypermobility is, how it’s diagnosed, and how we treat it.

What is Hypermobility?

Hypermobility occurs when the connective tissues that hold joints together, like ligaments and tendons, are more elastic than usual. This increased flexibility can affect one or multiple joints and is sometimes inherited. For many people, hypermobility doesn’t cause any issues. However, in some cases, it can lead to joint pain, instability, and an increased risk of injuries like sprains and dislocations. It can also be a part of more complex conditions like Ehlers-Danlos syndrome or Marfan syndrome.

How is Hypermobility Diagnosed?

Diagnosis of hypermobility typically involves a combination of physical examination and medical history. We use the Beighton score, a simple system that rates joint flexibility on a scale of 0 to 9, with higher scores indicating greater hypermobility. The Beighton score assesses the ability to perform specific movements, such as:

• Touching the floor with palms flat while keeping legs straight.
• Bending the thumb to touch the forearm.
• Hyperextending the elbows and knees more than 10 degrees.
• Hyperextending the little finger beyond 90 degrees.

In addition to the Beighton score, a thorough medical history can help determine if hypermobility is linked to a broader connective tissue disorder.

How is Hypermobility Treated?

Treatment for hypermobility focuses on managing symptoms and preventing injuries. Here are some common approaches:

1. Physical Therapy: Tailored exercises strengthen muscles around hypermobile joints, improving stability and reducing the risk of injury. Physical therapists can also teach proper movement techniques to avoid excessive joint strain.
2. Pain Management: Over-the-counter pain relievers like ibuprofen can help manage pain and inflammation. In some cases, GPs might prescribe stronger medications or look at other strategies to manage pain.
3. Lifestyle Adjustments: Avoiding activities that put excessive strain on hypermobile joints can prevent injuries. Ergonomic adjustments in daily activities, such as using supportive chairs or proper footwear, can also be beneficial.
4. Bracing and Support: Wearing braces or supports can provide additional stability to hypermobile joints during physical activities. Where possible the aim is to increase biofeedback so supports are less readily needed.
5. Education and Awareness: Learning about hypermobility and understanding one’s limits is crucial. Patients should be aware of the signs of overuse and avoid pushing their joints beyond a comfortable range.

Living with Hypermobility

Hypermobility doesn’t have to be a major hindrance. With the right approach to treatment and management, individuals with hypermobile joints can lead active and fulfilling lives. Watch the Video on Dafne Louzioti talking about her treatment and rehabilitation addressing her hypermobility and learn how she was empowered to transform her body from chronic pain to strength, poise and stability.

“As a hypermobile performance and martial artist, I spent most of my twenties tearing muscles and ligaments due to overuse and a limited understanding of my condition. Several physiotherapists tended to the isolated injury areas and never really helped me understand the cause of my injuries and how to avoid them”.

Often patients get told to avoid certain activities which put stress on the capsule and ligaments of the joint.  Whilst this is technically a sensible approach it often fails to address the benefits of loading and controlled movement, whilst also fails to acknowledge the myriad of benefits derived from exercise including mental and physical health.

It takes a long time, and there is lots of trial and error.  It’s very rare that you get a straight line of improvement as you need to test out the parameters of strength in a safe, controlled manner but also explore the boundaries of movement and pain. Pain is a wonderful teacher if you have the ability and space to listen.

“From the outset, working with Richard involved a holistic approach to the body and how it moves, while he has a deep and nuanced understanding of the body in motion that continually feeds into his work. As a result, beyond corrections and exercises, he has offered a wealth of knowledge towards understanding how to live with hypermobility. He supported me through gaining awareness of alignment, posture, and optimal muscle loading, always working towards stability and strength before range of motion, which almost single-handedly changed my movement practice”.

Treatment ideally should evolve from the treatment couch to what the individual hopes to do/achieve/perform in real life.  If it’s dancing, you need to watch them dance, if it’s singing, watch them sing, if they lift weights, then watch them weight lift.  The process is to then unpack various components of the desired movement and introduce segmental controlled movements that replicate or mimic the desired movement.  The skill is not over coaching, where the outcome is too obvious… The therapist wants to engage the nervous system and create small ‘aha!’ movements where a movement is ‘sparked’ and a neural pathway is created. The aim is that the patient can consciously reproduce a movement pattern as you shift from unconscious incompetence to unconscious competence (see diagram below capoeira video Dafne)

image adapted from https://www.innovationtraining.org/the-four-stages-of-competence-model/

“Effusive as this might sound, I trust Richard above anyone else to attend to whatever curve ball my body throws us both”.