What is Hypermobility?

Hypermobility is rarely discussed in the fitness world, even though 10%–30% of the population has it. Many individuals remain unaware of their condition, which can lead to risks such as injuries, pain, and fatigue during physical activities.  

What is Hypermobility?

Hypermobility refers to joints that move beyond the typical range of motion. While some individuals may experience hypermobility without any associated problems, others may develop symptoms and complications due to joint instability. Hypermobility becomes a disorder when it significantly impacts daily life through joint instability, subluxations, dislocations, sprains, and other injuries, or through acute and chronic pain.  

Causes of hypermobility

Hypermobility is primarily genetic, influenced by factors like bone structure and connective tissue elasticity. Certain bone shapes and loose connective tissue may naturally allow for a greater range of motion. For example genetic conditions like Ehlers-Danlos Syndrome affect collagen, the protein responsible for tissue strength and elasticity. Hormones like relaxin can temporarily increase joint laxity, especially in the pelvis during pregnancy.  

Symptoms and Identification of Hypermobility 

Hypermobility can be identified by joint laxity, which can feel like unstable and “loose feeling” joints. Frequent dislocations, pain, and fatigue in certain joints can also be an indicator. The Beighton Test is a standard test to diagnose joint hypermobility, which uses a nine-point scoring system that measures the flexibility of certain joints.   Signs of Hypermobile Joints also include: 

• The ability to bend your little fingers backward at a 90 degree angle
• The ability to bend your thumbs to your forearms
• Elbows that hyperextend 10 degrees beyond neutral
• Knees that hyperextend 10 degrees beyond vertical

 

Health Implications

 

Risk of injury 

Individuals with hypermobility have increased risk for strains and sprains due to lack of joint stability. A common misconception of hypermobility is that it only affects athletes. However, regular movements can cause a joint to dislocate. If an individual is not aware of their range of motion in a specific joint, this can elevate the risk for injury.   

Proprioception issues

Hypermobility has been found to have proprioception impacts by allowing a wider range of motion that can diminish proprioceptive feedback, making it harder to accurately sense joint position and movement. This can lead to increased risk of injury and motor issues.  

Nerve compression

Hypermobility can lead to nerve compression due to the excessive range of motion and instability in the joints. When joints are overly lax, the surrounding tissues, such as ligaments and tendons, may fail to maintain proper alignment. This instability can cause nearby nerves to become pinched or compressed during movement, leading to symptoms like pain, numbness, tingling, or weakness. Additionally, the repetitive strain from unstable joints can create inflammation or swelling, further contributing to nerve compression.  

Other issues (fatigue, bowel issues, etc)

Hypermobility can lead to systemic issues like fatigue and bowel problems due to its impact on connective tissues and the nervous system. Fatigue often results from the extra effort required to stabilize joints, as muscles must work harder to compensate for joint laxity. Additionally, hypermobility may correlate with dysautonomia, a dysfunction of the autonomic nervous system, which can contribute to chronic fatigue. Bowel issues can arise due to the involvement of connective tissues in the digestive tract, potentially leading to symptoms like constipation, bloating, or irritable bowel syndrome (IBS).  

Hypermobilty vs EDS

Ehlers-Danlos Syndrome is different from hypermobility, but hypermobility is a characteristic symptom of this condition. EDS is a group of inherited connective tissue disorders that affect collagen production and function. It includes joint hypermobility, skin hyperextensibility, and tissue fragility.   

The Connection Between Hypermobility and ADHD

New studies are finding a potential connection between hypermobility and ADHD. In fact, those with neurodivergence are four times as likely to be hypermobile than the rest of the population. Theories of why hypermobility and neurodivergence are concurrent include genetic overlaps and the impact of ADHD on the body’s physical stress response, potentially exacerbating hypermobility symptoms. For example both have links to dysautonomia (improper function of the autonomic nervous system) and an impaired sense of proprioception, which can affect physical coordination. Joint discomfort and instability can also exacerbate ADHD symptoms by increasing restlessness and discomfort, particularly in settings requiring stillness.   

The Importance of Stability Training 

Individuals with hypermobility need to make important considerations with exercise and training. For example, hypermobile individuals need to be careful with stretching, especially activities like gymnastics and yoga, and need to focus instead on strengthening joints and improving balance and stability.   Physical Therapy in conjunction with personal training is optimal for hypermobility to ensure that movements are done to stabilize and strengthen the joints while avoiding injury. Setting up a solid routine is nuanced, and both trainers and physical therapists need to be on the same page through strong communication facilitated with each other or through the affected individual. Strength training should have an emphasis on unilateral training for upper and lower body, and executing movements in a slow and controlled cadence. Exercises that increase proprioception can also be beneficial for those with hypermobility and need to be accounted for in PT and training.    Additional considerations include prudence around high impact activities and stretching activities like yoga.   Want to learn more about Hypermobility? Listen to episode 213 of the Stronger Than Your Boyfriend Podcast: Hypermobility. 

Sources Cited: 

Effective Effort Consulting. (n.d.). Hypermobility and ADHD. https://effectiveeffortconsulting.com/hypermobility-and-adhd/ Pires, G. N., Teixeira, C. W. B., Luz, J. F., Albuquerque, L. L., Abreu, R. L., & Filho, G. B. (2021). Hypermobility and ADHD: An exploratory study. Frontiers in Psychiatry, 12, 786916.  https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.786916/full Medical News Today. (n.d.). What’s the link between ADHD and hypermobility? https://www.medicalnewstoday.com/articles/link-between-adhd-and-hypermobility