Most people assume hypermobile just means “bendy,” “double jointed,” or just extra flexible, but in reality, there are many more complexities to it. Hypermobility is defined as joints that can bend beyond the typical range of motion. Some people can have just one joint in their body that is hypermobile compared to the others, but some people can have generalized hypermobility where multiple joints have increased laxity, and this is usually associated with a hypermobility syndrome. Hypermobility syndromes are estimated to affect about 20% of the population. Read on as today, we explain more about these syndromes and how they can be well-managed with a treatment team, including physical therapy.

What are hypermobility syndromes?

Beyond just increased joint motion, hypermobility syndromes are a disorder of the connective tissues of the body. The collagen and connective tissues surrounding the joints are looser which allows the joint to move beyond its normal range of motion. Some people can have hypermobility with an underlying disorder, such as Ehler-Danlos syndrome (EDS) or Marfan Syndrome, while others do not. Additionally, some people with hypermobility syndrome may have pain-related symptoms while others do not. Lesser known but common symptoms associated with hypermobility include digestive issues like constipation, bowel and bladder problems, poor proprioception or clumsiness, autonomic dysfunction like postural tachycardia and dizziness, headaches, thin stretchy skin, easy bruising, chronic fatigue, persistent pain, and the list goes on.

What can be very confusing for those suffering from hypermobility is that they often feel very tight. This can seem oxymoronic: why would someone feel so tight despite having loose joints? The explanation is that the muscles compensate and work overtime to stabilize the loose joint since the ligaments and connective tissue are unable to properly provide stabilization. This increased muscle firing to provide stability leads to overall increased muscle tone, hence the “tight” or “stiff” feeling.

Getting a diagnosis of hypermobility, especially one with an underlying disorder can be tricky, and require a battery of tests. Included in testing for hypermobility is a physical exam which will include the Beighton scoring system, which examines specific joints for extra motion. This physical exam can be performed by a trained physical therapist to see which of your joints may or may not be hypermobile. If you think you may suffer from hypermobility and it is impacting your function, consult with your medical provider.

What can I do to manage my hypermobility?

Hypermobility, especially those with an underlying disorder, should be managed by an interdisciplinary team which can include medical doctors, psychologists, nutritionists, occupational therapists and physical therapists, and other practitioners providing complementary therapies. Hypermobility can have an overwhelming effect on your daily life and having a support team is critical to help meet your specific needs.  Luckily, there are many tools and interventions to help manage symptoms that are associated with hypermobility. Things like external supports (e.g., braces or compression sleeves) can help support joints especially on days when pain is elevated. Although we cannot change the composition of our ligaments and connective tissues, there are other aspects in the body we can use to our advantage to better support hypermobile joints.

How can physical therapy help with hypermobility? 

A physical therapist trained in hypermobility can help you manage some of the physical symptoms mentioned just above through manual therapy, exercise, and education on self-care techniques. As stated previously, many people with hypermobility report having muscle soreness and pain. Many assume if a muscle is tight then stretching is the answer which is a good choice for someone who isn’t hypermobile. However, this is not the solution for someone with hypermobility and in some circumstances, stretching can make things worse. To address this restricted muscular sensation, a physical therapist can use hands-on soft tissue techniques, instruct you in appropriate self-release strategies, and teach you appropriate stretches. At Beacon Physical Therapy, we treat using the Functional Manual Therapy (FMT) paradigm which incorporates soft tissue techniques that are helpful in addressing increased muscle tone associated with hypermobility.

Additionally, it is imperative to strengthen the body’s stabilizing muscles to provide internal muscle support to looser joints. Everyone has a different starting level of strength; exercise programs must be tailored to an individual’s need. Specific to hypermobility, individualized exercise programs often begin with lower load resistance training, minimized weight bearing, and emphasis on targeting stabilizing postural muscles.

Proprioceptive training is another critical aspect of an exercise program for someone with hypermobility. Our body uses our proprioceptive system to understand the movement or position of our body and limbs in space without having to look at our body position with our eyes. To understand this system, think of being able to kick a soccer ball without having to look at it or being able to pedal a bicycle forward without looking at your feet, that is proprioception. An additional component of the FMT treatment approach is an emphasis on neuromuscular re-education using Proprioceptive Neuromuscular Facilitation (PNF). Put simply, PNF is a series of techniques to tap into and facilitate tonic (postural) muscles to improve stability in order to enhance movement and function. Many people can benefit from PNF, especially those with hypermobility who struggle with both proprioception and stability.

Additional Resources 

In sum, hypermobility can be accompanied by a wide array of symptoms beyond just loose joints. Consulting with your medical team and knowing the resources available to you is critical. An essential component to managing hypermobility is working with a trained physical therapist who can help you manage your symptoms, improve your function, and structure a plan to help you meet your specific goals.

For more information on hypermobility and treatment options, we have provided some references below.

            References:

1. Hypermobility Syndromes Association (HMSA). Hypermobility Syndromes Association (HMSA). https://www.hypermobility.org
2. Reuter PR, Fichthorn KR. Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students. PeerJ. 2019 Sep 11;7:e7625. doi: 10.7717/peerj.7625. PMID: 31565567; PMCID: PMC6744937.
3. Mathias CJ, Owens A, Iodice V, Hakim A. Dysautonomia in the Ehlers-Danlos syndromes and hypermobility spectrum disorders-With a focus on the postural tachycardia syndrome. Am J Med Genet C Semin Med Genet. 2021 Dec;187(4):510-519. doi: 10.1002/ajmg.c.31951. Epub 2021 Nov 12. PMID: 34766441.
4. Managing Ehlers-Danlos. EDSAwareness.com. https://www.chronicpainpartners.com/a-multidisciplinary-approach-to-managing-ehlers-danlos/. Published February 3, 2017. Accessed January 16, 2023.
5. Hypermobile Ehlers-Danlos Syndrome: An update on therapeutic approaches … (no date). Available at: https://www.practicalpainmanagement.com/pain/other/hypermobile-ehlers-danlos-syndrome-update-therapeutic-approaches-pain-management (Accessed: January 17, 2023).