The terms hypermobility and flexibility are often used interchangeably. Visually they may look very similar but hypermobility and flexibility are two different adaptations within the body.
What is hypermobility?
Hypermobility arises when there is laxity (less tension) within the ligaments surrounding a joint. This gives the joint a range of movement beyond the expected normal.
Joint hypermobility can be acquired e.g gymnasts and ballet dancers or congenital (something we are born with). Usually, there will be other family members with hypermobility as this trait tends to be inherited.
The level of hypermobility in an individual can be quantified using a simple points system known as the Beighton Scale.
For many people, joint hypermobility causes few problems. Some individuals can start to experience symptoms such as persistent muscle pain and aching, tendonitis, and frequent dislocations.
Benign Joint Hypermobility Syndrome (BJHS) is the term used to describe these musculoskeletal symptoms attributable to excessive joint movement. There is no underlying systemic cause for BJHS.
There are some rare medical conditions that affect connective tissues within the body such as Marfans and Ehlers-Danlos Syndrome.
Individuals with these conditions are at a higher risk of hypermobility because the condition alters collagen, a protein that gives many tissues in the body its strength and structure.
What is Flexibility?
Flexibility is a broad term referring to the available range of movement in the body. This is determined by the level of give in your muscles, fascia, and nervous system.
We are all born with a high level of flexibility and this naturally declines as we age. Day to day flexibility can be positively and negatively affected by activity levels, temperature, and hormonal changes.
In contrast, hypermobility remains relatively consistent with only minor age-related changes.
Hypermobility, exercise and injury prevention
Hypermobility often masquerades as flexibility. A hypermobile individual can often perform stretching activities with apparent ease. However, on examination, their muscles will be very tight. It seems counter-intuitive until the movement being performed is closely observed.
For example, consider bending forward to touch the floor with your hands. Assuming suitable flexibility the hamstrings will lengthen allowing you to reach the floor.
In hypermobility, the hamstrings are likely to be very tight so the movement must be adjusted for elsewhere. In this case, the forward bend can be achieved by any laxity of the ligaments at the knee joint.
This allows the knee to drop into hyperextension creating the appearance of flexibility.
Ligaments provide proprioceptive feedback to the brain about the joints position in the environment around it. Hypermobility at the joints, particularly the lower limb can affect the accuracy of this feedback.
This increases the risk of injury and developing symptoms of BJHS. Ligaments do not have the same elastic properties as muscles and are unable to return to their starting length once stretched.
Laxity creates instability and the joint is vulnerable not only to injury but increased wear and tear.
Individuals with hypermobility can reduce their risk of developing injury and BJHS by:
Improving muscle tone
Exercise that helps build muscle tone will assist in reducing the demands on hypermobile joints. Muscles help generate, decelerate and dissipate the force from movement sparing the ligaments. Good muscle tone can also create some stability around joints.
Any movement regardless of its nature, be it flexibility, strength, or conditioning work should be performed accurately with control and awareness.
Focusing on the correct engagement of the muscles and initiating good movement patterns will help protect vulnerable joints.
Feedback is essential in the early stages of re-learning movement so ask for guidance from an experienced practitioner (Osteopath, Physiotherapist, or Sports Therapist).
Wherever you fall on the scales of flexibility or hypermobility the key to injury prevention is achieving a good balance between movement and stability.
This article was written by our Osteopath Liz Mcgirl.
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Here are some of our E-Books to help you
Krivickas, L.S. and Feinberg, J.H., 1996. Lower extremity
injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness. Archives of physical medicine and rehabilitation, 77(11), pp.1139-1143.
Simmonds, J.V. and Keer, R.J., 2008. Hypermobility and the hypermobility syndrome, part 2: assessment and management of hypermobility syndrome: illustrated via case studies. Manual therapy, 13(2), pp.e1-e11.
Beighton, P., Grahame, R. & Bird, H. (1999) Hypermobility of Joints. (3r
d edn). Berlin: Springer-Verlag.