Hypermobility and Physiotherapy- Here’s how we could help you

Many of us wish we were more flexible. For some, however, having “floppy joints” comes naturally. While being extra ‘bendy’ might be great in a yoga class this “hypermobility” comes with its own complications.

Arthritis Australia estimates that up to 10% of Australians experience hypermobility.

There are different degrees of hypermobility. For some, it’s quite subtle, for others it’s extreme! 

Our ligaments and tendons are designed to hold our joints in position and support a standard range of movement. Hypermobility is when those ligaments and tendons are looser, allowing joints to move outside of the normal range expected.

Do you think you may be hypermobile? 

Are you wondering how physiotherapy could help? 

Then you’re in the right place.

Here we will cover hypermobility, how we test for it and how physiotherapy may help improve strength and stability in your joints, manage your pain and reduce your risk of injury. We will also highlight the best exercises for hypermobility and what exercises to avoid.

What is hypermobility and how does it impact your life?

As mentioned above, hypermobility describes excessive flexibility or range of movement in one or more joints. 

Interestingly, many hypermobile people don’t experience problems. In fact, many leading Australian dancers and gymnasts are hypermobile. 

Unfortunately, not everyone who has hypermobile joints can use it to their advantage. For some, this excessive range of movement causes musculoskeletal problems, including stiffness and pain in joints and muscles and an increased risk of recurrent injury.

Other symptoms of hypermobility include:

• Clicking joints
• Extreme tiredness
• Back and neck pain
• Poor Co-ordination
• Easy bruising
• Stretchy skin

People with joint hypermobility can be predisposed to joint subluxations (joints slipping out of alignment), soft tissue injuries, or even full dislocations. Spinal consultants also see greater susceptibility to typical sprains and strains resulting in sporting-related injuries.

Adolescents and children with joint hypermobility may have increased instances of panic attacks, anxiety, and depression. This may be addressed with a combination of psychological and physiotherapy-based treatments.

A small number of adolescents and children displaying hypermobility report instances of gastro-oesophageal reflux, chronic constipation, irritable bowel syndrome, chronic abdominal pain, and urinary tract symptoms.

This is because the gut mainly comprises of connective tissue, and researchers believe gastrointestinal issues surface due to the patient’s connective tissue being more flexible. This makes physical digestion more difficult. Gut problems appear to improve with enhanced hydration, a high-fibre whole-food diet, and physical activity.

How do we test for Hypermobility?

A standard test for hypermobility is the “Beighton Score”. Simple tests can identify if you have hypermobility such as “bending your thumb back to touch your forearm” and ‘touching your hands flat on the floor with legs straight”.

Another diagnostic test, ‘the Brighton Criteria’, assesses other features connected to hypermobility, such as chronic joint pain for longer than 3 months and increased skin stretchiness.

What Causes Hypermobility?

Many people exhibiting hypermobility have family members who are ‘flexible.’ The condition commonly runs in families. 

Interestingly, joint hypermobility occurs three times more frequently in women than men. 

Some other factors that can contribute to hypermobile joints are:

• Strength/muscle tone- weaker, or more relaxed muscles allow for a greater range of movement.

• Bone shape/Joint socket depth- shallow joint sockets, allow a greater range of movement than is considered normal.

• Poor proprioception (ability to sense movement)- you may struggle to sense how far you stretch your body, leading to hyperflexion.

Less commonly, hypermobility may be caused by an underlying condition such as:

• Down syndrome– a developmental disability, often characterised by low muscle tone and high joint flexibility.
• Ehlers-Danlos syndrome– syndrome affecting elasticity in joints, skin, and blood vessels
• Marfan syndrome– a connective tissue disorder

What are the best exercises for hypermobility and what exercises should you avoid?

If you have hypermobility, choosing the best exercises, and avoiding the wrong ones, is crucial to managing your symptoms and avoiding injury.  

Joint instability may be reduced through exercise with a physiotherapist. 

The best exercises for hypermobility aim to strengthen the muscles around the joint. Often, certain exercises can reduce joint pain and lower the instance of recurring injuries. 

Low-impact strengthening and stability exercises, such as clinical Pilates, can be helpful for many hypermobile patients via improved:

• Posture, correct muscle activation, and movement techniques that reduce joint stress
• Breathing techniques that help with relaxation and the pain associated with spasms in muscles working overtime to stabilise ‘floppy joints’
• Body awareness, control, and coordination, helping to reduce the risk of recurring injuries
• Endurance and muscle strength to provide an enhanced level of support for hypermobile joints.

Unfortunately, people with hypermobility are at a higher risk of dislocation during exercise. This is why it’s so important to work with a physiotherapist to ensure you are using the correct technique. 

To decrease the risk of injury, in hypermobility, exercises to avoid include:

• Full extension exercises- doing a squat or a push-up is fine, however, fully extending your joint at the top end of this motion could result in over-extension and injury. To avoid this, keep a slight bend in your elbows or knees at the top end of the exercise.

• Over-exertion- the more tired your muscles become the less they’re able to provide strength and stability to your joints. It’s better to focus on quality rather than quality in exercise. Pushing beyond your limits can increase your risk of injury.

• Stretching- hypermobile joints can become over-stressed by stretching. It may be better to use a foam roller instead.

• Contact/high-impact sports- The risk of injury in these sports is already high however for someone with hypermobility this risk is magnified. 

If you suspect, you are hypermobile The Brisbane Spine Clinic in Eight Mile Plains can assess which joints are hypermobile and can often identify if this is impacting other joint structures. We’ll work with you to release or mobilise problem areas via manual therapy, and we can tailor an exercise plan to your individual needs.

Come in and see us at The Brisbane Spine Clinic for helpful advice and exercises.

 *Please note, the content within this article is for educational purposes only, and the treatment and advice mentioned may not be suited for everyone. Please consult a team member at the Brisbane Spine Clinic or your General Practitioner for specific advice.