Jill Miller, who has written about her problems with hyperflexibility
Over the last year or so, I have had more and more students asking me about “hyperflexibility” and more specifically if their excessive flexibility at certain joints could be dangerous in any way. Hyperflexibility has also been a topic of discussion in the teacher-training program where I teach experiential anatomy when we discuss “how much flexibility is enough?” To start, I always tell these students that it is fairly common for many people to have one or two joints that are more mobile than average, or hyperflexible. For these people, they might want to take care not to overstretch their hyperflexible joints (see my yoga recommendations below). However, if you have multiple (more than two) hypermobile joints, you may have joint hypermobility syndrome or generalized joint hypermobility, so it’s worth your while to learn more about these two conditions, especially because joint hypermobility syndrome is a commonly overlooked cause of chronic pain.Inspired by these students as well as by some new information in a recent journal article for primary care doctors entitled Joint Hypermobility Syndrome: Recognizing A Commonly Overlooked Cause of Chronic Pain,, I felt it would be helpful to share what I have discovered about this joint hypermobility syndrome and the closely related condition generalized joint hypermobility. I will also discuss how these conditions, as well as hyperflexibility in one or two joints, might impact your personal yoga practice or the way you teach yoga to your students who have it. Let’s start by looking at the differences between joint hypermobility syndrome and generalized joint hypermobility.Joint hypermobility syndrome is condition that is typified by the presence of hyperflexibility of multiple joints (usually four or more, but this varies), joint pain (especially in the knees and ankles), and fatigue. It is based on your history and by examining your joints for hypermobility. (There is no blood test or X-ray that can confirm the diagnosis, which is why it is classified as a “syndrome.”)Those with this condition also often have poor proprioception (for unclear reasons) that may contribute to joint injuries. They also have less muscle mass and strength, too, possibly due to the looseness of the tendons, but also maybe due to the fear of precipitating pain with activity that may have started as early as in adolescence, leading to a deconditioning effect on the muscles. In up to 75 percent of people, there are additional symptoms including anxiety and depression, postural hypotension (low blood pressure when changing posture), headaches, and GI and urinary complaints. The condition is considered by some (still some controversy on this point) to be an inherited condition that affects the connective tissue of the body, with a defect in the collagen. Interestingly, this condition is considered non-progressive and non-inflammatory. And as you age, and become somewhat stiffer, the symptoms may improve on their own. All right! A benefit to aging! However, the joint looseness in this condition can lead to increased chances of injuring the soft tissues of the joints, and also may lead to early osteoarthritis in the joints if your activities are not modified. Joint hypermobility syndrome has some similarities to Elher-Danlos syndrome, another condition with hypermobile joints that we have written about on the blog, and some researchers even consider it to be on a continuum of conditions that includes EDS. Others consider joint hypermobility syndrome a stand-alone condition. (See my post on yoga and EDS Friday Q&A: Elher-Danlos Syndrome and Ram’s personal story Coming Out: My Personal Experience with Elher-Danlos Syndrome).There is also is a much milder condition of increased joint mobility called generalized joint hypermobility. Those with generalized joint hypermobility have many joints that are more mobile than the average person’s. But according to one study of college students, even though people with this condition are more flexible, they are not at additional risk of injury from their extra movement or the other symptoms that affect those with joint hypermobility syndrome. Generalized joint hypermobility affects about 20% of the population, women much more frequently than men, and probably accounts for most of the students I see in class who are hyperflexible. Joint hypermobility syndrome, on the other hand, only affects about 3 percent of the population.Especially because joint hypermobility syndrome can be an under-diagnosed cause of chronic pain, I encourage anyone who is hyperflexible and suffers from ongoing joint pain to see your doctor for an accurate diagnosis. They should rule out more serious diseases associated with hypermobility that can lead to early death, specifically, Marfan syndrome and Ehlers-Danlos syndrome, vascular type.Practicing with HyperflexibilityAfter you have been diagnosed with joint hypermobility syndrome or if you have generalized hypermobility syndrome without any present joint pain, how should you proceed with your yoga practice? Let’s start with a look at what is usually recommended by your doctor.In the western medical system, lifestyle modification is considered the most important treatment option for joint hypermobility syndrome and possibly generalized joint hypermobility (the jury is still out on whether this second condition can lead to first), although studies confirming the benefits of this are lacking at this time. They include the following recommendations, which I list here due to their direct relevance to yoga asana:
- Avoid excessive joint movement (due to risk of injury to joint structures).
- Exercise regularly while being careful not to over train, and avoid focusing on increases in flexibility.
- Increase strength to stabilize specific joints.
- Stretch specific tight muscles in a way that does not affect the joints, as this may reduce symptoms and may also improve balance and control.
- Focus on improving proprioception (with activities that combine strength, balance and agility), which may also lessen symptoms.
