Friday Q&A: Ehlers-Danlos Syndrome (EDS) and Yoga

Winter Leaf by Melina Meza

Q: Any comments for someone with Ehlers-Danlos Syndrome (EDS) that would like to practice yoga?
Well, most of you know by now I have comments about just about everything! And I suspect that most of you have not heard about Ehlers-Danlos Syndrome (EDS). But it turns out, I know two individuals with this inherited syndrome. I have had one regular student with EDS and know of another long time practitioner with it, too.
But before we get to my recommendations on how to approach your asana practice if you have Ehlers-Danlos Syndrome, here is the Mayo Clinic’s description of EDS:  
“Ehlers-Danlos syndrome is a group of inherited disorders that affect your connective tissues — primarily your skin, joints and blood vessel walls. Connective tissue is a complex mixture of proteins and other substances that provides strength and elasticity to the underlying structures in your body. People who have Ehlers-Danlos syndrome usually have overly flexible joints and stretchy, fragile skin. …. For example, overly flexible joints can result in joint dislocations and early-onset arthritis.”
The people with this syndrome who have the vulnerable blood vessels are much more rare than those who have joint and skin changes, so I won’t go into this truly uncommon variation of the syndrome. As for the more common presentation, I will point out right here that the overly flexible joints can start out as an apparent blessing to someone with EDS who is just starting out to learn yoga. After all, many yoga poses that have “advanced” variations often require unusual amount of joint flexibility. So, EDS practitioners might seem to “excel” quickly in mixed-level classes, where they are likely to be regularly introduced to harder postures.
The down side of this extra flexibility arises when these students do indeed start moving their joints into greater ranges of motion than most of us can do, and doing so on a regular basis. The other group of students who are also likely to have similar ability are women with the hormone Relaxin present in their bodies during and after pregnancy. While for pregnant women, this extra flexibility is short lived, this unfortunately is not true for people EDS. However, in both groups, excessive stretching of the joints can result in more and more unstable joints, which can lead to a variety of problems:

• balance can worsen
• joints can become more prone to dislocation;
• the ends of bones can rub on one another irregularly and eventually lead to early forms of arthritis
• underlying source of joint pain can develop

 So if I was informed that I had a student with EDS, I would caution them to go very gradually into poses requiring exceptional flexibility, under the guidance of a teacher who can give them external feedback on where to stop, as their joints won’t like do so. (The teacher would be using their personal and observational experiences of teaching other “normal” students the poses to gauge when the overly flexible student might need to back up or not go so far into a pose.)
And, secondly, I would encourage them to focus more on poses that promote strength and stability around the major joints, with an emphasis on contracting the muscles around the circumference of the joints while performing the pose. I’d apply this idea to the ankles, knees, hips, shoulders, elbows, wrists, and the entire spine. So, instead of encouraging the deepest, bendy-est, twisty-est pose possible, there would be more strength around all vulnerable joints, (which might limit the depth of range of motion as some joints).
As an example, in Triangle pose (Trikonasana), which could lead to overstretching of the front leg hip and knee joints, I’d suggest that prior to tipping into the full pose, you should contract and firm the muscles around the front leg hip joint and knee joint prior, and maintain the feeling of strength while entering and staying in the pose. Heck, I’d even have you do it on the way out, too! This action won’t allow you to go down quite so far into Triangle as you could by allowing the muscle around those joints to relax fully, especially the movement at the right hip joint. In addition, you front knee will be less likely to hyper-extend.
Obviously, this concept can be applied to poses more reliant on strength as well as those that favor more flexibility. And hopefully the teachers in our reading audience can emphasize to these students the deeper goals of yoga, such as promoting mental-emotional balance, non-harming (of oneself, in this instance), and longevity that might steer your EDS students to a longer-term practice that is most appropriate for their bodies and lives.
To read more about Ehlers-Danlos Syndrome, see Ehlers-Danlos syndrome by Mayo Clinic.
—Baxter
Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect