What is Hypermobility?
Hypermobility is when a joint moves beyond the normal range. Factors that influence joint range include:
- Joint Surface (some are more shallow)
- Muscle Tone
- Physical Activity/Training
- Connective Tissues (collagen)
Joint laxity is different from the term hypermobility as it denotes that the joint has excessive movement range in all directions but this may or may not be controlled.
The Beighton Score tests 5 areas of the body and a point is given to each of the manoeuvres you can do with a maximum score of 9. If you score 5/9 and you're between the ages 18-50 then you have hypermobility. It's quite limited so it's important to screen using the 5 - Part Hypermobility Questionnaire, which discovers if you have had a previous history of hypermobility too.
Hypermobility can be local (one or two joints), peripheral (fingers and toes), or generalised.
The Hypermobility Spectrum
New recognised terminology is as follows:
- Generalised Joint Hypermobility
- Peripheral Joint Hypermobility
- Localised Joint Hypermobility
- Historic Joint Hypermobility
- Hypermobile Ehlers Danlos Syndrome (hEDS)
- Hypermobility Spectrum Disorder (HSD)
hEDS is a connective tissue disorder whereas HSD doesn't quite meet the criteria for hEDS. HSD can be peripheral, local and/or historic.
It's not all about joints
Collagen is the subtance that holds us all together. It is found all over the body, from our bones, tendons, ligaments, muscles; to our skin, hair, nails, eyes; our viscera (organs) and blood vessels. This means that in some people with a true connective tissue disorder like hEDS they may have problems with lax skin, weaker blood vessels and problems with their organs too.
Hypermobility patients may also have associated symptoms of anxiety, dizziness, digestions problems, postural hypertension, fatigue. It goes without saying that many are in a lot of pain with clicky joints with some joints dislocating and subluxing.
Hypermobilty can be hereditary and genetic.
Unable to Feel
Hypermobility patients (or their individual joints if not generalised) lack proprioception meaning they are unable to sense themselves and the environment around them. This must contribute to anxiety levels, contributes to wobbly balance, poor coordintation and pain. Muscles have to work over time to support their joints. Extra tone/bracing may help them to feel i.e. improve their body awareness. This can lead to a deep fatigue in the muscles causing them to feel weak.
Hypermobile joints may be more prone to injury and or course, pain.
All of this leads to fear avoidance behaviours, which only creates more chronic pain.
An Asset or a Hindrance?
Hypermobility can be trained, as you'll see in gymnasts and dancers. Aesthetically in these instances it can be more 'beneficial' due to what is required from the performer. You can have a huge range of motion available in a joint but still be able to control it. It's when the latter is lacking the problems ensue.
Is it OK to move when you have hypermobility?
Absolutely, yes although I would heavily advise gaining professional advice to guide you safely back to movement. This of course depends on where on the spectrum of hypermobility you are, your history and if you have any of the other associated symptoms like fatigue. Getting a team of people around you to support you is key, from physiotherapists, manual therapists, osteopaths, Pilates teachers, movement professionals, perhaps you may also would benefit from CBT, talking therapy, rest, occupational therapy, orthotics, nutritionist..this list goes on.
How I can Help You
As an osteopath and Pilates/movement teacher I can help you to understand your pain and offer some relief with manual therapy. I'd give you loads of tools to strengthen your body and improve your proprioception which in turn helps with confidence so you can move more and be in less pain.
If you have any queries or would like to discuss further how I can help, please get in touch.
References to this blog all come from the fantastic workshop I attended through Body Control Pilates. Dr Jane Simmonds and Mark Parfitt created this course. They recommend the following charites if you want to delve deeper into learning more about hypermobility.