Hypermobility

Being “double-jointed” can mean bending like Gumby or moving your neck and body like an Egyptian. But hypermobility, related to loose connective tissue, also has effects that range from clumsiness and difficulty standing for long periods of time to serious medical problems with heart valves, uterine prolapse, and diverticulitis.

Very hypermobile people can also feel stiffness, tension, and joint pain. And when bones aren’t held in place securely, joint instability can lead to injuries or pain that interferes with daily life.

Pain and fatigue are the most common symptoms of joint hypermobility syndrome (JHS)— linked to poor posture, ineffective movements, and “improper muscle recruitment” when performing simple tasks, according to a hypermobility blog. Alan Pocinki, who specializes in hypermobility at George Washington Hospital, explains that almost every JHS patient has chronic neck strain, because the neck ligaments are too loose to support the neck, which forces those muscles to work harder.

Share

About 30% of the population has some degree of hypermobility—most commonly in the elbows, wrists, fingers—and about 10% of these have medical symptoms, diagnosed as hypermobile Ehlers-Danlos syndrome (hEDS). Because genetic variants linked to other Ehlers-Danlos subtypes have not been found for hEDS, it remains categorized as a “syndrome” rather than as a “disease”—and is often overlooked by medical professionals.

Connective tissue knits the body together, explains Alissa Zingman, founder of the P.R.I.S.M. clinic in Silver Spring, Maryland, which assesses and treats complaints related to weak connective tissue. For example, an overactive immune system that can cause unexplained allergic reactions, such as swelling and difficulty breathing. POTS, or postural orthostatic tachycardia syndrome —causing lightheadedness, fainting, and rapid heartbeat when standing up—can also be a result of the weak connective tissues underlying hypermobility.

“Is EDS real?” queries a diagnostic algorithm, according to a STAT post. The frequent failure to diagnose EDS hypermobility in the absence of genetic proof keeps it stuck in “medicine’s grey area.” Zingman spent years seeking help for her own pain and frequently dislocated joints before she found doctors who took her complaints seriously and diagnosed EDS.

“Remarkably, this process [of tissue damage related to hypermobility] occurs so gradually that many people with JHS do not even notice… when in fact their necks are a mass of knotted soft tissue,” writes Pocinki. JHS affects three times as many women as men and tends to diminish with age.

Share

To assess a person’s degree of hypermobility, the Beighton score relies on movements such as bending your little finger backwards or your thumb forward to touch your forearm; hyperextending your elbows and/or knees; and putting your palms flat on the floor without bending your knees. A diagnosis of JHS combines that score with other criteria such as the number of joints affected, and many related to pain: duration of pain, back pain, and soft-tissue problems such as tendonitis.

“Emerging awareness” is how Certified Advanced Rolfer™ and movement therapist Rebecca Carli-Mills describes the current thinking about hypermobility—as descriptions and classifications change with new research. Also, Carli-Mills explains how reduced awareness of the location of their bodies in space, called proprioception, means “hypermobile people frequently bang into things and may have been told they were clumsy or awkward.”

Identifying joints as loose or hypermobile is crucial when choosing good exercises and activities—and avoiding those that can make problems worse. Isometric (or resistance) exercises keep the joints stable while working the muscles. Also, before any movement, engage the body’s stability. According to Pocinki, the worst exercises for hypermobile joints are free-flow stretching like ballet or gymnastics—and anything that involves grabbing a joint and pulling or pushing to “loosen it up.”

Core-strengthening Pilates exercises can decrease the load on susceptible joints—for example, the “bird-dog” pose: on all fours, stretch one arm out in front and the opposite leg in back, similar to a dog pointing toward its prey. The best exercises involve weightlifting and tension bands—increasing the number of repetitions while maintaining low weight or resistance. According to Pocinki, if you can’t do eight reps without straining, the weight is too heavy.

In high school I had a “tall-short” routine with a friend: standing side by side, we hyperextended our knees backwards until we looked an inch or two shorter — and then straightened them to grow taller. After years of injuries and surgeries, I’m grateful for the growing recognition of hypermobility and its risks, especially by exercise instructors who modify positions and routines.

And I have cut back on my hypermobility tricks—except for one: I flap one hand until the fingers slap against the palm, which creates something like the sound of one hand clapping. But I do this much less often since my kids started trying it, fearful for the future of their joints.