I treat a number of clients who have hypermobility or are hypermobile (sometimes mis-described as being double jointed) . Most of them are aware but some are not.
There are varying degrees of hypermobility in each client, with some it’s quite subtle, with others it’s extreme.
Every silver lining has a cloud
Whilst it might appear advantageous being one of these ‘bendy people’ especially in a yoga class, it’s not all fun and games.
The ligaments and in part, the tendons normally hold our bodies in their natural position, stopping us from flopping around all over the place.
In a hypermobile person there is often more relaxin present in these ligaments, relaxin is produced in woman during pregnancy to aid the movement of the pelvis and child birth.
You can find in an already hypermobile person a pregnancy or multiple pregnancies can make the condition worse or can sometimes take someone with ‘normal’ range of motion to being hypermobile.
Take note that hypermobility is an actual diagnosis. You may find that your joints are less firm and more flexible after pregnancy but you may still not be diagnosed as being in the hypermobile range.
It can affect all joints of the body and it is common to find increased curvature in the spine the lower back or lumbar region is particularly susceptible to back pain.
Other symptoms include pronation in the feet or flat footedness, hyper-extended knees with a sway back posture, over extension of the elbow joint, sway back posture as the hip flexors over extend, easily dislocated shoulders and shoulder pain. Sadly the list goes on.
I have successfully treated many clients with hypermobility for their immediate problems and they leave with reduced or absence of pain.
Postural assessment work is key in order to determine the areas to focus on and what needs strengthening.
Muscle strength testing is very useful to highlight imbalances and helps to decide how to treat each client, also each treatment is unique and will vary dynamically according to what is found during the soft tissue / massage treatment.
During massage treatments more care is needed almost straight away, for example ensuring bolsters are positioned under knees while the client is lying on their back (prone), as knees will often hyperextend without them.
Although you may not be aware and it does not cause pain, it is not advisable to keep clients in this position for long during massage.
A more holistic body approach to treatment is needed to ensure all affected muscles and fascia that may need attention are treated, as hypermobile people use other secondary muscles to help the prime movers more often than normal.
Somewhat strangely, stretching is still helpful as part of the treatment to alleviate pain but needs to be undertaken in an even and controlled way to maintain muscle length and ensure that there is no increase to an already over extended range.
A careful soft tissue release technique, with good pinning, focused at the muscle mid point / knotty area is very effective.
I favour Neuro Muscular Techniques (NMT), trigger point therapy, deep transverse strokes in the deeper belly of the muscles which are more effective, but all clients are different so it follows that every treatment is different.
Kinesiology taping works well in aiding treatment, used for support, unloading tension and posture re-education and awareness but care should be taken to avoid dependency.
I regularly use tape on my clients and probably the most common taping I do for hypermobile clients is at the back of the knees helping to reduce the sway back posture and also across the back to bring the shoulders to their correct position.
General Client Advice
Clients should consider the following:-
- Stop-if they are commonly and voluntarily subluxing shoulders or popping hips etc;
- Take regular breaks during daily activities eg even standing in one position at a cooker or sink can often induce pain;
- Watch or avoid pro-longed sitting positions;
- Avoid carrying heavy loads on one shoulder;
- Buy good foot-wear with arch supports;
- Use a good neck support pillow while traveling especially on overnight flights;
- Avoid sleeping face down with sustained rotation of the head (a softer mattress may be more help);
- Try to avoid static postures and resting at end of range – no locking knees into hyper-extension so body awareness and posture are very important.
Fitness & Strength Training
For long-term benefits I believe that fitness and strength training can be more helpful than frequent soft tissue treatments.
Muscle strength promotes joint stability and together with posture awareness and correction is the starting point in improving symptoms.
I encourage my clients to try exercise like swimming, cycling, dance, and Pilates as well as the other specific exercises below where relevant, and consider these to be an essential part of the long-term treatment.
Clients need to be aware that they need to work their muscles harder to produce stability.
They are more likely to incorporate other secondary muscles to help in the task than someone who is not hypermobile. Personally I think that isometric exercises like pilates can be more useful than traditional methods.
This can explain why hypermobile people tend to tire easily, lack good balance or their gait may be slightly different when they run.
Unfortunately it is likely, (but not always the case) that clients will have recurrent problems throughout their lives.
Exercise and treatment may need to become a part of normal life.
I can help with specific problems but clients may take longer to heal than others, advise which muscles to strengthen, and help re-educate posture and gait.
I sometimes advise or refer clients to an orthotics specialist in shoes but only after a few treatments to ensure muscle and skeletal balance are correct before proceeding with this option.
Soft Tissue Therapy which advances on Sports and Remedial massage is effective for hypermobile clients experiencing pain provided the therapist fully understands the condition.
It is important during treatment the client and therapist communicate well and treatment work is carefully thought out and slowed down.
Advice around posture, use of tape and strengthening muscles may in the longer term be more beneficial.
There are medical conditions that can cause hypermobility including EDS consult your doctor if you are unsure of anything relating to your mobility.
If you would like a consultation please call Jason on 07980 339 864 to discuss your personal situation.