Some is good, but more isn’t always better.
Businesses know this with their pricing strategies. If you have too many options, people become paralyzed with decision making and are less likely to buy.
Eating some fruit is good for you. But, if your diet is just pounding grapes all day, then youâre going to run into some issues.
Even Charmin knows this and made âLess is moreâ the tagline of their campaign to show the quality of their toilet paper.
Hypermobility falls right into this bucket.
Hypermobili-wah? đ§
Simply put, hypermobility is having more mobility than most other people do.
This can be local to one specific joint, like a pitcher having a ton of shoulder external rotation and getting some insane layback.
What I want to talk about today, however, is athletes that can go full Mrs. Incredible and have general (or global) hypermobility. This is where theyâre super loose everywhere.
We can measure general hypermobility with a Beighton Score. Scoring at least 4/9 is considered positive for ligament laxity.
- Bending the thumb down to touch the forearm (1 point for R and 1 point for L)
- Bending the pinky backwards beyond 90° (1 point for R and 1 point for L)
- Hyperextension of the elbow beyond 10° (1 point for R and 1 point for L)
- Hyperextension of the knee beyond 10° (1 point for R and 1 point for L)
- Active forward flexion of the trunk with the knees fully extended so that the palms of the hands rest flat on the floor (1 point total)
Blessing and a curse
Our athletic society is obsessed with flexibility and mobility. Everyone swears tightness is their biggest limiting factor and theyâre constantly chasing more and more mobility.
Itâs true that there are some really cool benefits to being hypermobile.
- They can get into insane positions that others can only dream of.
Pitchers with a ton of layback may have an edge in generating more torque and throwing more heat.
- They can get away with being caught in awkward situations. They might come away unscathed by a movement that would break someone else in half.
But, there are also some major drawbacks of hypermobility.
- Theyâre able to get into positions that you canât control.
This leads to repeated microtrauma, which ends with issues like labral tears in a shoulder, OCD lesions in the knee and elbow, and repeated ankle sprains.
Every time they go to end range, the joint moves slightly out of place and chips away at structures that itâs not supposed to touch.
Little things can add up to big things, just like how wind and water slowly eroded rock to form the Grand Canyon.
This can also lead to more acute, traumatic injuries, like shoulder dislocations.
Interestingly, there are some more systemic issues that are highly associated with hypermobility.
- They’re predisposed to anxiety problems.
Research suggests that hypermobile individuals are up to 16x times more likely to have anxiety related disorders.
- There are often some underlying gut issues.
Hypermobile individuals commonly present with more than one GI symptom.
- They’re often hypersensitive to nociceptive (painful) stimuli, interoception, and fatigue.
Hypermobile people seem to experience a higher amount of pain for a given stimulus. This is not saying they’re not tough, in fact it can often be the opposite. It just means that their nervous system turns the volume of their pain up much higher than others.
They also have a heightened sense of interoception, which is the ability to sense internal bodily functions, like feeling your own heart beat.
These mechanisms are poorly understood, but there is a strong relationship between hypermobility, fibromyalgia, and chronic fatigue syndrome.
Whatâs going on here?
Thereâs a large genetic component to hypermobility. When I do an evaluation and find a positive Beighton, we can usually point to mom or dad and see where they got it from.
Collagen is a protein that is the primary building block of ligaments, tendons, and every other connective tissue structure in the body.
In hypermobile folks, the collagen structure is altered and significantly weaker.
Weaker collagen structure leads to loose ligaments.
A ligamentâs job is to anchor a joint together and prevent joints from dislocating all day. These weaker ligaments donât do as good of a job of keeping joints locked in place.
The weak collagen structure also results in issues in other areas of the body, including blood vessels. The weaker blood vessels are more pliable and are less efficient at pumping blood through the body. Thatâs why hypermobile people usually have chronically cold hands and low blood pressure.
What do we do about it?
Hypermobile athletes are able to get into crazy positions that they canât control. Their ligaments are weak and arenât adding any passive stiffness to the system.
Additionally, hypermobile individuals have reduced proprioception. Proprioception is the ability to sense movement and location of a joint. If you close your eyes and someone moves your arm around, proprioception is what allows you to know where your body is in space.
Our primary objective is to add stability. We need the athlete to have better control over the crazy positions they can get into.
We can increase this protective tightness by: 1) adding muscular strength, 2) improving proprioception, and 3) reducing stimuli that exacerbate looseness.
1. Increasing muscular strength adds active stiffness to the system to make up for the lack of passive stiffness provided by the ligaments.
Passive stiffness refers to restraints that occur without any energy being used, while active stiffness refers to restraints by muscles that use energy.
In other words, having really strong muscles can help fill the void left by weak ligaments.
2. Proprioception is something that can be trained. Repeated exposure to eyes closed training and rhythmic stabilization exercises can help recalibrate proprioception.
3. Hypermobile athletes do not need to add more mobility, theyâre already set. But, thereâs a paradoxical issue here.
The Hypermobility Paradox
Hypermobile athletes already have too much mobility, but they constantly feel tight.
Theyâre constantly cracking their backs, stretching, and complaining about how tight they feel. Clearly, every objective test shows that their muscles are not tight when they can split in half like a contortionist.
So, why do the loosest people on earth always report feeling tight?
There are a few theories and the answer is probably a mix of all of them.
1. Reduced proprioceptive feedback
Our brain wants to constantly know whatâs going on with our body, so it can make the best decisions to navigate our environment.
Hypermobile athletesâ reduced proprioception means that the brain isnât getting the feedback that it would like. So, it tells them to stretch and go to end range, so they can get some neural feedback.
2. Fatigue and reduced strength
The muscles of a hypermobile athlete are pulling double time to make up for the lack of ligament stiffness.
Theyâre always on.
This can lead to tired, weak muscles. Tired, weak muscles are often perceived as being tight.
3. Trigger points
In order to increase stiffness and give some control, trigger points might develop in loose muscles.
Donât pick the scab
Hypermobile athletes constantly stretching isnât just not helpful, itâs harmful to the long-term game plan.
Our objective is to lay down protective tightness. Stretching removes that protective tightness.
Itâs like picking a scab as a wound is trying to heal. You remove all the protective tissue and start bleeding all over again.
Hypermobile athletes should do purposeful dynamic warm-ups, but they should not spend time static stretching and constantly cracking their back.
Instead, we want to focus on increasing proprioception and strength.
Anytime you feel the need to stretch, find a way to contract that muscle instead. That should scratch the itch and feed beneficial adaptations.
A final thought…
There’s something really special about taking a dream and turning it into reality.
It sounds obvious, but really take a second to think about it. You imagine something, you create a vision for it, and then you take that vision directly out of your head and will it into existence in the real world.
The best part? It’s a game you never have to stop playing.
You can keep dreaming and keep creating.
Vera Wang didn’t design her first dress until she was 40. Bernie Marcus founded Home Depot when he was 50. Arianna Huffington was 55 when she founded the Huffington Post.
How can you join in on the infinite game?
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Best,
Zach
Dr. Zach Guiser, PT, DPT, CSCS
References:
- Smith TO, Poland F, Macgregor AJ, et al. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatology International. January 2013:1-8-8. doi:10.1007/s00296-013-2790-4
- Thwaites PA, Gibson PR, Burgell RE. Hypermobile Ehlers-Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know. J Gastroenterol Hepatol. 2022;37(9):1693-1709. doi:10.1111/jgh.15927
- Eccles JA, Thompson B, Themelis K, et al. Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study. Clin Med (Lond). 2021;21(1):53-58. doi:10.7861/clinmed.2020-0743
- Syx D, De Wandele I, Rombaut L, Malfait F. Hypermobility, the Ehlers-Danlos syndromes and chronic pain. Clin Exp Rheumatol. 2017;35 Suppl 107(5):116-122.
- MallorquĂ-BaguĂ© N, Garfinkel SN, Engels M, et al. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Front Psychol. 2014;5:1162. Published 2014 Oct 14. doi:10.3389/fpsyg.2014.01162