Stiffness with Hyper-mobility: What does this mean?

Have you ever been told by a manual therapist that you are hyper-mobile, really flexible or maybe even too flexible? Most people are surprised to hear that there is such a thing as being TOO flexible. A misconception is that the more flexible you are, the better it is for you, or the “fitter” it makes you.

Of course, having some degree of flexibility is very important. This will help with ease of movement, balance and longevity with quality of life. However, if the movement allowed passes normal “text book” ranges of motion or does not have the strength of the muscles around to support it, it can lead to injury or pain.

So what is hyper-mobility I hear you say?

The word ‘hyper’ means over, above or beyond. Mobility refers to movement range within joints. So essentially it means your joints move too much. Now this can be due to many reasons, including environment influences and genetic causes. Environmental factors that can create hyper-mobile joints are sports such as gymnastics, ballet/dance and yoga. This is particularly the case if done intensely to a competitive level before reaching full puberty.

The “problem” or pain should I say, tends to occur later in life. When the individual no longer takes part in the activity which leads to them not having the strength they once did to support these very flexible joints. Genetic causes are linked to a structural change in the collagen of ligaments and tendons. This is often passed down through families and can be associated with other conditions, such as Ehlers Danlos Syndrome.

Common misconceptions

Now to discuss the complex symptom of stiffness. This is often felt by people with hyper-mobility. General advice that you will hear from doctors, GPs, PTs, online exercise videos, manual therapists and maybe Pat your next door neighbour, is to stretch if you are in pain, feeling stiff or after exercise as a cool down. This is where a one size fits all approach REALLY doesn’t work for people with hyper-mobility.

By stretching joints that are already moving too much you are feeding into the problem. It may give you relief short term, but it certainly is reinforcing and continuing to create the imbalance of being too flexible. Often patients report that even though they have been stretching that they still feel very stiff.

What does hypermobility FEEL like?

The interesting thing is when you test their range of motion it is more than perfect! So they aren’t stiff in the conventional sense. For example, if I take myself as an example. I do not suffer with this bio-mechanical condition and when trying to touch my toes I am miles away. I have to work very hard at keeping my range of motion. If I’m not careful I would end up with the movement of a brick wall, especially with all the impact activities I like to partake in. Now the interesting thing is, I don’t FEEL stiff. Hyper-mobile people tend to really FEEL stiff, but they aren’t… I’ll explain why.

When the joint moves too much, the stability of the joint, or lack of should I say, provides a neurological response back to the brain. This can also have a physical outcome with sprains, strains or dislocations. Something called proprioception is the bodies ability to know where it is in space without you having to look at your limbs or body part.

When someone suffers with a joint sprain or they naturally have joints that move too much. This subconscious innate ability is compromised, which leads to the body compensating in order to protect the joint. The joint will end up constantly ‘searching’ for feedback to give it the stability it so needs and craves. This often leads to very tight (hypertonic) muscles and creates a feeling of stiffness for the person. This can potentially lead to chronic (long-term) pain.

Hopefully this already explains how and why stretching will only aggravate and amplify the feeling of stiffness, as it only creates more flexibility and therefore more instability, which creates a reaction of tighter muscles, leading to more stiffness. It’s a vicious cycle!

So, what’s the solution then?

STRENGTH! By providing the joints with extra stability in strengthening the surrounding muscles, it will reduce and eliminate the stiff sensation because you are giving the joints what they want and need, so they no longer need to ‘search’ for feedback from the brain. This results in symptom relief and a longer term solution in addressing the underlying issue in the first place. The muscles won’t have to tighten up, as they will be strong enough to protect the joint and this will help decrease the muscle pain.

Fancy seeing if you are hyper-mobile?

We use a test named the Beighton Scale to grade if someone is hyper-mobile and to what severity. This test is not clear cut though, as we combine the results along with previous medical history to determine if someone is hyper-mobile. It is commonly diagnosed this way, rather than through testing, as there isn’t a blood test or imaging scan that can ‘show it’.

Genetic testing can be done to determine if there is an underlying genetic disorder that hyper-mobility is just one symptom of, but this comes with other health symptoms that your practitioner will make the necessary links to make sure you are guided correctly. A positive Beighton score for adults is a 5/9 possible and for children it is at least 6/9.

As we get older, our joint mobility naturally decreases. Sometimes as a practitioner we ask questions more related to the past. Such as if you ever had a party trick that you would show your friends? This could include performing the splits, popping your thumb in and out of the joint or excessive back bending. Just because you may not be able to do these things anymore as a 70 year old, doesn’t mean that you were not once hyper-mobile and have pain attributed to this mechanical change. There is a criteria check-list that practitioners use to assess how likely it is a patient has hyper-mobility tendencies.

How do we treat Hyper-mobility?

Unfortunately there is not a magic cure, surgery or medicine that reverses this condition. Conservative treatment is used to help manage symptoms relating to it. This usually comes in the form of a less is more approach when it comes to hands on treatment. Treatment is used to create more movement, which you can probably understand after reading this blog is not the ideal affect. Exercise is also paramount in improving stability and decreasing laxity within the joint, therefore decreasing pain. I usually steer patients away from yoga due to the nature of stretching, but strongly encourage pilates to work on those intrinsic muscles.

If you would like more information on hyper-mobility, please contact Nadene.

You can also visit the Hyper-mobility Syndromes Association

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