Hypermobility

Are you troubled by increased knee and elbow bend? Are you flexible more than other people, but you’re the one with recurring movement problems and pain in the musculoskeletal system? Then maybe you have problems with hypermobility. It is an unpleasant matter, but it can be solved. Movement habits and training should be, considering the difficulty, a little adjusted, and you should know what to avoid.

WHAT EXACTLY IS HYPERMOBILITY?

hypermobilni zenaGeneral definition describes enormous joint mobility in the sense of active but also passive movement in the joint. Which is related to the term hyperlaxity (increased mobility of the ligaments), which is also less resistant against the pressure. The reason why hypermobility forms is not entirely clear. There is assumption that there is a genetically given disposition (one of your parents suffers from it, thus it’s possible you will be affected as well), it can be discovered already in babies. Hormonal imbalance also has influence (women suffer more often from hypermobility than men), or improper physical load, which causes insufficiency in the gained joint ligaments and the intramuscular supportive ligament system (inappropriate sport, for example: gymnastics, injury, or serious illness).

That means that the joints have higher degree of mobility than is desired, and thus its more prone to damage/“blockage”. Simply said, if the hypermobile joint gets from natural position where it’s able of extreme movement, to a different position in which its not able to to move at all, it can lead to painful blockage, spasms in the neighboring muscles or directly to injury.

Hypermobility can be manifesting locally, when just some joints are more mobile than others. And overall hypermobility can be only temporary, affecting for example pregnant women as it’s caused by hormonal imbalance.

TEST WHETHER YOU ARE HYPERMOBILE

In order to find out whether person is hypermobile or not, you can use your own observation and simple tests. Here are some examples:

  • Bend as low as possible with your legs stretched: during normal mobility the tips of the fingers should touch the floor, hypermobile person will without problems place whole palms on the floor.
  • Stretching on neurological basis the knee and elbow joints: if we stretch during the neurophysiological basis to an unusual degree, it is considered hypermobility in certain joints.
  • “Scarf symptom”: when you are able to “hug” your own neck and touch your own spine with the tips of your fingers, which would be in norm. It becomes hypermobility when the fingers exceed through the center of the back with the whole hand.
  • Bending the thumb: if you can bend your thumb to your wrist with the help of your second hand, the joint is hypermobile.

HOW TO PREVENT THE PROBLEMS?

How much will hypermobility affect your life depends from a larger degree on you. Knowing and understanding the problem can often mean a start of the treatment.

Opinions on treatment and prevention of the problems caused by hypermobility are dividing. Next to clearly necessary strengthening of the muscles along the spine and surrounding muscles of the trunk and abdomen, by applying the stabilization exercises and minimizing the static, you won’t cause any harm by using joint nutrition supplements recommended by pharmacists, or by using pain killing drugs in acute cases. Some colleagues (even among doctors) do not recommend to sport as much, but rather exercising the joints evenly in a gym. We will try to give you small instruction with rational explanation of every single advice.

YT Plank on BOSUYT legs exerciseYT Rotating to the side

Regular movement

Exercising especially in a correct functional harmony helps to keep the joints in correct position. It improves blood supply of the muscles and movement of the synovial fluid, which improves the supply of nutrition and removal of waste substances during metabolic exchange. If the exercise has to be effective, it should be performed effectively, regularly and in a longer time span. We will gladly teach you which exercise would be ideal and how to correctly exercise. Everything else up to you.

Warming up and stretching

CLProtazeniIt is important to gradually and slowly warm up before the physical activity, and stretch after. It is a busted myth that hypermobile individual can’t stretch. Stretching is needed, but it’s important to know the limit and correct performance - not stretching out “from” the joint, and keep the joints centered during the stretching (the joints are in good contact with the joint capsule). This is worth asking and training with physiotherapist.

Correct movement stereotypes and habits

Hypermobile individuals usually have a hard time standing for a longer period of time or sitting in a stiff position. Therefore it is ideal to take short breaks to stretch your body. Children should use the school pauses for active movement. If you have to sit at your job, we recommend to use one of the unstable tools (gym ball, inflatable seat cushion), which will force your muscles to constant activity. If the muscles work correctly, the spine won’t collapse. The same rule applies for children who can exercise before going to school or exercise directly at school.

Certain degree of static pressure is unavoidable, therefore it is important to remember the principles about how to ease this pressure for our body. Having correctly high chair and table is important for a correct sitting posture. When we lay our forearms on the table, our shoulders should not be lifting up and your feet should be resting on the ground. During long term sitting you can use a balance tool, for example “overball” or a balance disc. It is also ideal if you practice a correct body posture, learning how to correctly lift up objects or carrying bags. If you have to lift up heavier objects, it is optional if you stand with your legs apart, grab the object in a squat and lifting it up and keeping it as close to your body as possible. Your back should be straight during the whole time. During activities which are performed in a slight bow, it is ideal to step forward with one leg and rest it on a slightly elevated surface.

YT Stabilizing trunkYT Gymball correctionYT corrected sitting position

Healthy sleeping

If it’s possible, try to get a mattress with a corresponding firmness (medium firm foam mattress is usually optional). Sleeping on your stomach is considered inappropriate. Height of the pillow is also important. The pillow should be high enough in order to keep the head in a straight line with the whole spine.

Ideal type of shoe

If you suffer from hypermobility we recommend to wear shoes that support transversal and longitudinal arches of your foot. High heels are inappropriate for longer wearing.

CLObezitaControlling the weight

Obesity significantly increases pressure in the joints which automatically worsens condition of the person.

Physiotherapy

University educated physiotherapist can immediately after solving the possible acute problems, work on functional activation of the muscles and their stabilizing function, considering the involvement of the muscle chains in the postural function, which is a process that is secured by a correct body posture. During the exercise, focus on activation and strengthening of the muscles, stabilizing function should also have an effect on the muscles, which is connected to the unstable movement section. This way the muscles are fixed (punctum fixum) on the unstable section. We use techniques with neurological basis, exercising on balance surfaces, or for example with TheraBands.

EXERCISE TUTORIALS:

  • Recommended exercises for treating Hypermobility



Author:
 Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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