All About Hypermobility & How to Care for Extra Flexible Joints

The medical term for having extra bendy joints is ‘hypermobility.’ It can apply to you if you have just a few highly flexible joints or several throughout your body. Some people are born with hypermobility, while others — like gymnasts, dancers, and contortionists — train their joints to become extra flexible.

To your average person who struggles to touch their toes, the extra range of motion may sound like a bonus, but it can have its downsides. Joint pain and dysfunction are unfortunately common for people with hypermobility. If hypermobility is caused by a connective tissue condition such as Ehlers-Danlos Syndrome (EDS), it typically affects more than just your joints, impacting everything from your fertility and menstrual cycle, to your gastrointestinal health, and pelvic floor muscle function.

Read on to learn more about hypermobility, what can cause it, and how to support your joints so that all that awesome flexibility doesn’t lead to aches, pains, and other life-disrupting symptoms.

What does it mean to have hypermobility?

To understand hypermobility, it helps to know a little about joint anatomy. Your joints are the points where two or more bones come together. Each joint is stabilized with various combinations of connective tissue (such as ligaments, cartilage, and joint capsules) and the tendons from the muscles that help with movement. 'Joint mobility' refers to the joint's ability to move within its normal range of motion. If you have a frozen shoulder, for example, and can't reach your arm above your head, you have limited joint mobility in your shoulder.

When a joint has more motion than average, it’s known as joint hypermobility. Some hypermobility is common and benign — you're extra bendy in certain places, but it doesn't bother you or interfere with your life. If joint hypermobility is leading to symptoms like pain or joint/muscle dysfunction, it's broadly referred to as Hypermobility Spectrum Disorder (HSD).

In more serious cases, hypermobility can be a sign of a connective tissue condition. Connective tissue conditions affect the health of the tissue and how well the connective tissue can perform its many functions, which range from transporting nutrients throughout your body and brain to storing fat and fighting off pathogens.

Some connective tissue conditions that contribute to joint hypermobility include:

• Ehlers Danlos Syndrome - a group of hereditary connective tissue conditions
• Marfan’s Syndrome - a genetic condition that impacts the fibrillin and elastic fibers in your connective tissue, contributing to joint laxity
• Down Syndrome - a genetic condition commonly associated with ligament laxity and joint hypermobility

Because connective tissue conditions can impact connective tissue throughout the body, they're associated with a broader range of symptoms and conditions. Individuals with hypermobility caused by these conditions may be more likely to experience:

• Chronic fatigue
• Vasomotor symptoms such as fainting and dizziness
• Thin and stretchy skin

They’re also more likely to have irritable bowel syndrome (IBS) and higher rates of pelvic floor issues, like bladder and bowel leaks, pain with sex, and pelvic organ prolapse.

How does hypermobility impact the way you move & exercise?

Because people with hypermobility can do things like bend their thumb back toward their wrist, you might think that movement is easier for them. However, the body relies on the strength and stability of the joints to provide pain-free and coordinated movements. Having extra stretch in connective tissues can compromise joint mechanics and muscle performance during exercise in a variety of ways.

Joint hypermobility is associated with:

• Abnormal balance and coordination which may increase the risk of falls
• Compromised joint control and poor joint proprioception (awareness of the position and movement of your body)
• Increased risk of joint dislocation
• Muscle pain & spasm, either due to injury or because the muscle has to work overtime to create stability in a joint
• General fatigue

Even though hypermobility can increase the risk of injury during exercise, staying active is still beneficial for hypermobile people, as long as they can do so safely.

Beyond boosting overall health and wellness, exercise can help improve:

• Joint proprioception and stability
• Muscle strength & endurance
• Bone health
• Reduction in chronic pain

How do you exercise safely with hypermobility?

Because ligaments and joints are stretchier and weaker with hypermobility, it's important to strengthen the muscles around them to provide extra support. For people with mild hypermobility, this may be fairly easy — they can engage in regular exercises and sports as long as they listen to their bodies and avoid movements that strain their joints.

For others with more pronounced hypermobility, it can be hard to know which exercises are safe. That's why it is important to seek support from a PT. Physical therapists familiar with hypermobility can design exercise routines specific to your body, challenges, and goals.

Generally speaking, slower and more mindful movements are a good place to start.

Some forms of exercise to consider if you’re hypermobile:

• Weight lifting with slow movements, starting with just your body weight and aiming for a smaller range of motion and just a few reps at a time
• Yoga and Pilates classes that emphasize proper positioning, slower movements, and balance postures
• Tai Chi, Qi Qong, and other exercise classes that emphasize balance and slow, flowing movement

Adding stabilizing elements to your workout can also help you move in a more controlled and safe way, for example:

• Squatting while leaning against a large ball that's placed against a wall may be an easier starting point than a regular air squat
• Stationary bikes or elliptical machines are often more comfortable than treadmills because your hands and feet are in contact with the machine at all times
• Exercising in water, which provides tactile feedback and reduces gravity’s pull on joints

Even your everyday activities such as cooking, cleaning, or walking can be a source of exercise. Be mindful of your movement patterns and engage your muscles in a supportive way to get the most benefit and reduce your risk of injury.

High-Intensity Interval Training (HIIT) or kickboxing classes are not necessarily off the table if you have hypermobility, it’s just that the quicker you move, the harder it can be to control your body and move safely. If you are doing these exercises already without a problem, you don’t need to stop unless you’re running into pain or injuries. Want to get started? Check-in with a physical therapist so that you can get proper guidance on body mechanics, safety cues, and joint protection. They’ll even be able to provide you assistance with proper bracing recommendations for vulnerable joints.

Is it safe to stretch if you have hypermobility?

With hypermobility, your muscles may feel very tight, so it's tempting to do a lot of stretching to help loosen them up. While this may be helpful in some cases, you need to be careful when stretching to make sure that you're targeting the ‘belly’ of the muscle and not aggravating tissues that are already weakened or overstretched.

If you are trying to determine if a stretch is effective, ask yourself a couple of questions:

1. Do you notice that the stretch has a lasting impact, i.e. stretching reduces pain or stiffness over time and helps you move more comfortably?
2. If you have pain, does taking a break from the stretch causes your pain to return?

When in doubt, book a visit with a PT to learn how to properly stretch your muscles.

How can a pelvic floor PT help with hypermobility?

Just like other areas of the body, having stretchier tissues in the pelvic floor can cause problems – for example, if the colon stretches out farther than it is supposed to, it can become tougher for folks to effectively push out their poop. The cause of the connection between hypermobility and bladder urgency and painful penetration is less clear, but it may be related to muscles tensing because of pain or because other tissues are overstretched.

A pelvic floor physical therapist can help with all of these issues by helping to retrain the pelvic floor muscles and other related structures of the body. They can also guide you in how to properly use a pessary (a device inserted into the vagina), which can help support the bladder or uterus if it's bulging into the vagina in an uncomfortable way.

What are some other treatments for hypermobility?

While there is no treatment for the genetic causes of hypermobility, there are many different treatments and supports that can help you manage symptoms. Aside from strengthening and physical therapy, sometimes braces can help manage specific hypermobile joints (such as knees, ankles, wrists, and fingers) to prevent overstretching and reduce pain and swelling in those areas. Braces, along with compression garments, can also assist with proprioception for injury prevention.

For pain management, traditional pain medications can sometimes offer some relief, as well as muscle relaxants for those experiencing frequent muscle spasms. TENS units, acupuncture, and cognitive behavioral therapy are other tools for pain management that can be helpful. There are some reports of improvement of hypermobile joint stability with the use of prolotherapy (targeted injections designed to cause scarring to strengthen weak or torn connective tissues). Off-label use of low dose naltrexone is a newer treatment with some evidence base as well.