Understanding Hypermobility: Risks and Management Strategies

Many individuals admire the flexibility of friends who can easily perform yoga poses or bend their joints in seemingly impossible ways. This remarkable flexibility may indicate a condition known as hypermobility, often referred to as being “double-jointed.” According to Dr. Nicodemus Oey, an associate consultant in Rehabilitation Medicine at Alexandra Hospital and Ng Teng Fong General Hospital, hypermobility occurs when some joints can move beyond the normal range due to more elastic connective tissues.

While flexibility is often seen as an advantage, hypermobility can pose significant risks. Understanding this condition, its causes, and how to manage it effectively is crucial for those who exhibit these traits.

Identifying Hypermobility

To determine if someone is hypermobile, the 5-Point Questionnaire (5PQ) is a useful self-screening tool. Brenda Lim, a senior physiotherapist at Tan Tock Seng Hospital, explains that answering “yes” to two or more questions in this questionnaire may suggest hypermobility. Clinicians often use the Beighton Scoring System, a nine-point screening tool, to evaluate joint hypermobility more rigorously. A score of four or more out of nine indicates potential hypermobility, although a complete clinical assessment is recommended for confirmation.

The Nature of Hypermobility

The genetic basis of hypermobility is not entirely understood. Dr. Oey suggests that while it may partly be genetic, hypermobility exists on a spectrum and cannot be linked to a specific gene. In contrast, flexibility refers to the range of motion available in muscles and tendons, which typically declines with age.

Hypermobility primarily affects the joints and ligaments. Brenda Lim notes that this condition allows joints to stretch further than usual, often without pain. Joint hypermobility is typically more prevalent among women and children, with many experiencing a decrease in hypermobility as they age.

Stretching and Hypermobility

Contrary to popular belief, increased stretching does not lead to hypermobility. Dr. Oey clarifies that true hypermobility is generally genetic, linked to how connective tissues are formed, particularly collagen. Individuals with naturally looser joints may inadvertently push their joints into unstable positions while stretching, increasing the risk of injury.

Activities such as yoga or gymnastics can exacerbate these issues if not coupled with strength training, which is essential for joint stability. This imbalance often leads to the phrase “flexible but weak,” highlighting the potential dangers of hypermobility.

When Hypermobility Becomes Problematic

For some, hypermobility can be a source of pain or injury. Dr. Oey has observed this frequently among individuals engaged in sports, dance, or yoga, where flexibility is heavily emphasized. Many hypermobile individuals only discover their condition after sustaining an injury.

Common problems include joint sprains, especially in the ankles and knees, as well as dislocations and tendon overuse injuries. Lim emphasizes that instability in the joints can prevent supporting structures from maintaining stability during movement. Consequently, hypermobile individuals may experience back or neck pain due to spinal instability and muscle fatigue from overcompensation.

Strategies for Managing Hypermobility

For those identified as hypermobile, the focus should be on strengthening rather than overstretching. Lim recommends building strength in the muscles that support joints, particularly in the core, hips, and shoulders. During weight training, individuals should avoid locking their joints, such as elbows and knees, to prevent injury.

Incorporating stability exercises into one’s routine can significantly improve joint control. Activities like Pilates and proprioceptive exercises, such as single-leg balance, can foster joint stability. Lim reassures that hypermobility is not inherently problematic; rather, it requires awareness and control. With appropriate strategies, individuals can remain active and injury-free.

If injuries persist, consulting a physiotherapist can be beneficial. A tailored programme can help manage symptoms and prevent further injuries. Dr. Oey suggests performing specific exercises three to four times a week, focusing on form rather than repetitions.

Here are some recommended exercises:

1. **Hip Strengthening: Glute Bridges**
Lie down and use your core to lift your buttocks off the ground. Hold for 10 seconds and repeat 10 times.

2. **Hip Stabilising: Side-lying Leg Lifts**
Lie on your side and lift the top leg until it forms an “L” shape with your body. Slowly lower the leg and repeat 10 times for each leg.

3. **Core Control: Planks**
Get into a push-up position, ensuring your upper body and torso are straight. Hold for at least 30 seconds.

4. **Shoulder Stability: Wall Angels**
Stand against a wall with slightly bent knees. Raise your arms to form a “W” against the wall, then slide them up to form a “Y.” Repeat 10 times.

5. **Knee Control: Mini Squats with Bands**
Loop a resistance band around your knees and stand with feet hip-width apart. Bend at the hips followed by the knees, lowering until your thighs are parallel to the ground. Return to standing and repeat 10 times.

Recognizing and understanding the implications of hypermobility can help individuals navigate their physical capabilities and reduce the likelihood of injury. With the right approach, those with hypermobile joints can lead active and fulfilling lives.