Understanding and Managing Joint Hypermobilityby Jen Sinkler
I always joke that some people are made out of rubber and some are made of lead. Personally, I’m lead, meaning I’m not very flexible, but others — many women, especially — are over at the far other end of the spectrum. Hypermobile joints can be a major concern in the context of fitness, and I asked world-renowned trainer Eric Cressey (author of the truly excellent High Performance Handbook) to chime in on the topic with information about how you can both identify if you’re hypermobile (AKA rubber), and provide some drills for developing greater stability. Here’s what he had to say.
One of the biggest mistakes people make in fitness is assuming everyone should train exactly the same way. Obviously, this line of thinking is incorrect for a variety of psychological, physiological, and biomechanical reasons, but perhaps none stands out as more important to appreciate as joint hypermobility.
You see, some individuals have more congenital laxity than others. This essentially means their ligaments (which connect bone to bone) have a bit more give to them. As a result, they can have substantially more flexibility because of the lack of passive stiffness. As a result, the active restraints — muscles and tendons — have to work harder to create stability at the hypermobile joints.
Unfortunately, we’re naturally drawn to doing what we’re good at doing, and that’s why you see a lot of really loose-jointed folks at yoga and Pilates classes when a well-designed strength training program (to create good stiffness) probably would offer quicker benefits. That’s not to say that yoga and Pilates aren’t fantastic; I’m just saying that these initiatives ought to be biased toward drills that promote building stability within the joint range of motion that’s already present (as opposed to trying to become even more flexible).
In certain situations, joint hypermobility can be an advantage; swimmers and gymnasts are great examples in the world of athletics. This hypermobility predisposes these individuals up to a host of other musculoskeletal issues, however, ranging from ankle sprains to shoulder subluxations to stress fractures to hernias to early osteoarthritis. Also, the underlying cause (collagen deficiency) affects not just skeletal muscles, tendons, and ligaments, but also visceral organs (smooth muscle), skin, blood vessels, and the tissues of the eye. As a result, hypermobile individuals are more likely to have detached retinas and gastrointestinal reflux disorder, and a host of other issues.
Of course, it’s important to actually be able to identify if you’re hypermobile. How do you know if you are?
First, think about your handshake. There will typically be a lot of give in hypermobile individuals’ handshakes (pliability in the fingers and wrist), and the hands will often be cold – even when it’s really warm in the environment at hand. Your knuckles might even pop a bit.
Second, try a Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9; a higher score is indicative of greater hypermobility:
- Elbow hyperextension > 10° (left and right sides).
- Knee hyperextension > 10° (left and right sides).
- Flex the thumb to contact with the forearm (left and right sides).
- Extend the pinky to >90° angle with the rest of the hand (left and right sides).
- Place both palms flat on the floor without flexing the knees.
Now, considering a sedentary population, many trainers assume all individuals are incredibly tight and need to stretch until the cows come home. With that in mind, here’s a great example of an athlete who — at 6-foot-4-inches and 240 pounds — wouldn’t appear to be hypermobile to the naked eye (especially since hypermobility is more common in females). However, when you run a Beighton test, you quickly see that he’s actually got a lot of laxity, and his programs need to focus on building stability first and foremost.
Stretch him, and he’ll get worse. Build stability, and he’ll thrive — all because you ran some simple tests ahead of time.
You can’t change your natural predisposition toward hypermobility, but you can change how you control it. Most importantly, you have to constantly remind yourself not to keep stretching an already excessive loose joint. In other words, it’s more about what you don’t do than what you do actually do.
Truthfully, with training hypermobile folks, most exercises are fair game, but you just need to make sure that they aren’t exaggerating the range of motion (ROM) on exercises; they need to stop short of where their end-range is. A great example is elbow hyperextension on pushups — this is not something you want to see!
Building on this, though, incorporating good stability training can help you overcome these common musculoskeletal ramifications. Here are a few of my favorite movements. You’ll notice that they’re all about creating stability within the range of motion that’s already present:
Identifying joint hypermobility is a quick process that can yield game-changing information to dramatically improve program design and training techniques.
The Beighton Hypermobility Test is one of the screens we use in my resource, The High Performance Handbook, which is on sale for $50 off this week only. For more information, head over here.