What is hypermobility?
Hypermobility refers to excessive flexibility/movement in the joints of the body. A hypermobile joint has a large range of movement and can sometimes feel a little ‘sloppy’ and loose. It is not necessarily widespread and may only affect a few joints in the body.
Flexibility itself however tends to refer to global elasticity of muscle, fascia and nerve mobility, and we can be flexible without being hypermobile. In fact hypermobile people often have areas of inflexibility, commonly seen in the thoracic region, hamstrings and calf.
How do we become hypermobile?
True hypermobility is of genetic influence found in the encoding of the proportions of collagen, elastin and fibrin in the tissues. Our ligaments The ‘stretchy’ nature of the tissues therefore can be found not only in the joints but in the more internal systems of the blood vessels, reproductive and digestive tract also.
This is why those who are hypermobile can be at greater risk of prolapsed, digestive disorders and poor circulation.
How do we measure it?
One of the measuring tools for hypermobility is the beighton scale. This is an objective scale that gives a score out of 9.
The Beighton Scale also forms part of the Brighton Criteria. The Brighton Criteria is a scale that determines the level of BJHS (benign joint hypermobility syndrome). This syndrome covers a range of joint and muscle pain symptoms over a period of time in the absence of any rheumatological conditions. The symptoms are hypermobility and pain in multiple joints. It is a non progressive condition, therefore not worsening over time. In fact the hypermobility will improve as we age and stiffen, which is a natural process.
The muscles that are designed to move us are different from the muscles that support our joints. Often hypermobile people are strong in their big movement muscles, but weak in their postural, stability muscles. This can lead to poor tolerance in sustained positions such as sitting and standing. We often see the hypermobile person slumping and wanting to lean on things as holding themselves upright against gravity is tiring with such a weak support system.
As a result of a weak stability system, the more global muscles will work harder to both move and stabilise. As a result these muscles are prone to tightening and shortening, and often aching. A common example would be seen in the low back, calf and hamstrings.
The stability muscles of the body require specific training to make up for the lack of ligamentous support. Repetitive, prolonged or sustained actions, particularly those which take the joint into an extreme end range of movement, can be stressful on both the muscles and joints resulting in pain and injury.
Why is this concern for the dancer?
It is of obvious benefit for the dancer to be ‘flexible’ and mobile. By nature of dance however the joints are often, and repeatedly, taken to their limits and frequently under load and speed (as seen with jumps, kicks, splits). Injuries such as shoulder dislocations / ligament ruptures and pelvic dysfunctions are more likely to occur with the hypermobile dancer as the joint is more unstable. Subsequent injury unfortunately can mean the untimely end of a career for a dancer. Knowledge, understanding and specific training of the stability system of the body is essential. The dancer needs precision timing of their stability and global system throughout a large range to be able to cope with the demands put upon the body by high level 3 dimensional dynamic movement.
How Physiotherapy can help the management of Hypermobility
Physiotherapy treatment should consist of:-
- Stability training programme to control the joints- a clinical pilates programme is a great approach
- Balance and proprioception training
- Strength training to facilitate correct use and timing of the global muscle system
- Nutrition guidance to ensure the body has good tissue building nutrients to promote strong muscles/fascia/ligaments
- Lifestyle modification (avoiding overtraining and looking at pacing)
The physio will evaluate your level of hypermobility and educate you on the condition so you understand your limitations!
The Beighton Scale is the current diagnostic test used for assessing hypermobility. You can use this to check if you are really hypermobile or just flexible.
- Score one point for each elbow that will hyperextend > 10 degrees.
- Score one point for each knee that will hyperextend >10 degrees.
- Score one point for each thumb that will bend to touch the forearm.
- Score one point for each hand where you can bend the little finger back beyond 90°.
- Score one point if you can bend and place your hands flat on the floor without bending your knees.
The maximum score that can be attained is 9. There is no universally accepted cut off point, but a score of 4 or more out of 9 is generally accepted as indicative of hypermobility syndrome.