How to Improve Stability When You Have Hypermobility

Ever come across someone (maybe yourself) who says, “I’m super flexible.” This person is most likely hypermobile. While some individuals can flaunt their ability to perform impressive feats of flexibility, for others, this inherent “looseness” can lead to instability, pain, and a plethora of other health implications. It is within this delicate balance of flexibility and stability that our focus lies. Hypermobile joints need stability. Rest assured, there are therapies and modalities that can help you regain control and reduce stress on overly “flexible” joints. This post will address the symptoms and causes of hypermobility, why stability is a requirement for hypermobile individuals, and how to incorporate exercises and other techniques to help improve your stability and reduce pain due to hypermobile joints.

**This is not medical advice. Please consult your medical provider for more information.

Signs and Implications of Joint Hypermobility

Joint hypermobility simply means that your joints move beyond what is normal or expected. When you hear the common phrase, “I’m double jointed,” this essentially refers to the joint(s) being hypermobile. Now, is joint hypermobility bad? Not necessarily. But if joint hypermobility begins to disrupt our daily life, causes pain, or contributes to other symptoms, then it may be a problem that needs intervention.

Hypermobile joints can be part of your genetic makeup as something you are born with. Females tend to have more lax joints compared to males. Hypermobility can also be related to conditions like Ehlers-Danlos syndromes (EDS) or Hypermobility spectrum disorders (HSD). Individuals with either of these conditions can experience joint hypermobility along with other symptoms such as chronic pain and fatigue, GI issues, and headaches. Because these diagnoses are considered spectrum, not every individuals will present the same way.

Hypermobility Spectrum Disorders (HSD)

HSD is a connective tissue disorder affecting joint stability and can be painful. There are four different types:

• Localized HSD (L-HSD): joint hypermobility occurs at a single joint or a group of joints in the same area
• Peripheral HSD (P-HSD): joint hypermobility at the hands and feet
• Generalized HSD (G-HSD): joint hypermobility throughout the body
• Historical HSD (H-HSD): history of generalized joint hypermobility throughout the body, but not presenting with evidence at examination

More research needs to be done to determine the differences (if any) between HSD and hEDS. There is currently no definitive tests for either of these diagnoses. Because there is no definitive test, there is currently no differentiation between the two. Some experts believe they are two separate conditions, others believe they remain relatable on a spectrum, while others believe they are the same condition. To learn more about HSD and EDS, head to the Ehlers-Danlos Society website here.

The Beighton Score

If you believe you are a hypermobile individual, The Beighton Score can be used as a screening tool and general assessment for joint hypermobility. It is graded on a 9-point scale as follows:

1. Base of the right 5th digit (pinky)
2. Base of the left 5th digit (pinky)
3. Base of the right 1st digit (thumb)
4. Base of the left 1st digit (thumb)
5. Right elbow
6. Left elbow
7. Right knee
8. Left knee
9. Lumbar spine

Running through this screening tool is simple and can be performed very quickly. Everything will be performed on both sides. Start with your hands. Can you pull your pinky back beyond 90 degrees (a right angle)? If you can only do this on one side you get one point. If both, then add two points. Then, move onto the thumb. Can you pull your thumb down and back to the point where it can touch your forearm? Give yourself a point if you can touch you forearm with your thumb.

Next, stand in front of a mirror. Straighten your arms all the way out to the sides with your palms facing the ceiling. Do your elbows hyperextend more than 10 degrees? That is 10 degrees beyond 0 degrees neutral, or perfectly straight. Add a point for each side that extends beyond 10 degrees. Next, stand with your knees locked. Do your knees hyperextend beyond 10 degrees? This is similar to the elbows, just at the knee joint. Add a point for each side that extends beyond 10 degrees. Finally, stand with your legs straight. Without bending your knees, can you bend forward and touch your palms flat to the ground? If you can do this, add one point.

A positive score in an adult before the age of 50 is a score of 5/9 or greater. Remember, this is a generalized tool and does not mean you have HSD or hEDS. All it means is that if you have a positive score, there is a likely presence of generalized joint hypermobility. There are also many other joints where hypermobility can be present that the Beighton Score does not test for.

Why Hypermobile Individuals Need Stability

Unlike the common belief that super flexibility is a blessing, it often turns out to be the opposite. It leaves your joints under constant threat of injury with even the most simple of movements. Imagine walking around your neighborhood only to roll your ankle two separate times. You might notice that after standing in line at the grocery store for a while with your knees locked out in hyperextension, all of a sudden, your knees hurt. It’s issues like these that convince you that your hypermobile joints need stability.

Stability for your joints means you are providing a protective means for joint care and health. Think of stability as a way to fortify your body’s defenses. The ligaments around your joints are made up of connective tissue. This is what provides inherent stability for your joints. If the joint(s) is/are lax due to connective tissue issues, your body loses inherent stability. You then have to train the muscles surrounding the joint to provide the stability that your connective tissue is lacking. Working on improving proprioception can also help your body determine where it is in space, furthering your body’s natural defenses to protect against injury.

When you body is really flexible beyond control, you notice you easily injure yourself, or you feel this overall sense of “wobbliness” or lack of stability when walking or doing tasks, your body is telling you something. You have to provide your body with the stability that it is currently lacking to continue to protect it.

Flexibility vs. Mobility vs. Stability

Flexibility is the body’s ability to achieve a certain position, which may involve outside forces. Simply speaking, it refers to the ability of your muscles to stretch. For example, imagine an athletic trainer stretching one of their athlete’s hamstrings. The goal is to feel a stretch, pushing the limit of the hamstring beyond what the athlete may be able to perform on their own. This would be an example of flexibility.

Mobility is your own ability to actively move your body into certain positions without any assistance. Mobility speaks to the range of motion within our joints. Now imagine you are on the ground and trying to lift your leg as high up as it can go without bending your knee. In this case, mobility refers to how high you can lift your leg without any help from a strap, your hands, or somebody else pushing your leg.

Stability is the joint’s ability to maintain and control proper alignment and resist excessive movement. Without stability, both flexibility and mobility can easily go too far, resulting in injury. Let’s take a gymnast as our example. Gymnasts have incredible mobility and flexibility. They also have incredible stability to be able to bend as much as they do and still control it to prevent injury from occurring. Now, at the same time, accidents occur and the body loses a split moment of control that it does have, which does result in injury.

Your body requires a harmonious blend of flexibility, mobility, and stability to lay the foundation of a lifestyle that supports activity without the constraints of injury with the simplest of tasks. Where do you get stability from? Answer: strengthening.

Why Strengthening is Essential for Joint Stability

Prioritizing strengthening exercises that support the connective tissue surrounding our joints can significantly mitigate the stress inflicted on them daily. It may seem counterintuitive to strength train hypermobile joints with the fear that that would lead to injury. I get it. It can be scary! But the only way to get your muscles, bones, and joints used to heavier activities than you are used to is to condition them to it. This means strengthen!

And if you are still uncertain about adopting a strengthening program, here is a list of ways strengthening aids your body:

• Improves joint stability: strong muscles help support and stabilize hypermobile joints, reducing the risk of dislocations, subluxations, and sprains.
• Reduces pain: strengthening the muscles around hypermobile joints can decrease strain on ligaments and reduce chronic discomfort.
• Enhances proprioception: targeted strengthening improves body awareness, providing a sense of where you are in space to help you better control joint movement and positioning.
• Prevents injury: strong, balanced muscles help protect vulnerable joints (and other areas of the body) from overuse injuries and other soft tissue damage.
• Supports daily function: having muscle strength allows you to train for life—heavy yardwork, lifting bulk items at Costco, and being ready to help a friend or family member move.
• Improves posture and alignment: strengthening stabilizing muscles (especially core, hips, and deep neck flexors) enhances alignment for better posture.
• Builds confidence in movement: as strength improves, so does movement efficiency and confidence, allowing you to engage more comfortably in physical activity.
• Promotes long-term bone and joint health: consistent strength training preserves joint function and increases bone density

Furthermore, this study shows how incorporating heavy shoulder strengthening exercises in individuals with HSD and shoulder pain was not only safe for the individuals to undergo, but also resulted in positive participant feedback, improved shoulder muscle strength measurements, and clinical tests indicating a reduction in shoulder instability. Ferrell et al found significant improvements in pain reduction and proprioception with an 8-week strengthening program emphasizing proprioception training and closed-kinetic chain exercises in individuals with hEDS and HSD (previously known as joint hypermobility syndrome or JHS). As you can see, strength is essential for life and healthy aging. It is also a requirement for those dealing with hypermobility.

Adapting Daily Activities for Joint Protection

When you live with hypermobility, adapting your daily activities is not just about protecting your joints from injury. It’s about redefining your relationship with your body and becoming confident with movement again. The way you move through your day can either support your joint care efforts or detract from them. Paying attention to joint protection is necessary.

• Low-impact exercises can be used as a modification if you are dealing with an active injury or days where pain is worse and becoming a hinderance. Activities like swimming and cycling can keep you active while minimizing the stress on your joints.
• Pilates is an excellent choice for hypermobile individuals. Pilates focuses on core strength, balance, and body awareness to improve posture and proprioception without overly stressing your joints.
• Avoid “hanging out” on locked out ligaments to preserve your joints. This basically means avoid standing with hyperextended and fully locked out knees or holding up your body weight on extended arms with locked out elbows. Keep a slight bend in either your knees or elbows to make your muscles work to hold you steady instead of “hanging out” on your ligaments and pushing them to the limit. When you lock out your elbows or knees, you or relying on the inherent support of your ligaments only and not using your muscles to assist. This wears down your ligaments over time and can contribute to pain.
• Incorporate strengthening exercises to build muscle strength around your joints, providing them with additional support.

Remember, consulting with healthcare professionals, including physical therapists, can be a shining light when dealing with hypermobility. Physical therapists can provide personalized strategies and strengthening programs for optimal joint protection and support based on your presentation and other comorbidities. Your journey towards gaining stability in the midst of hypermobility begins with these small, yet impactful, adaptations in your daily life.

The Importance of Professional Guidance in Managing Hypermobility

Medical experts well-versed in the nuances of connective tissue disorders and with a strong foundation of the musculoskeletal system will be invaluable resources. Physical therapists will be one of the healthcare professionals to reach out to. Physical therapy, specifically curated for those with hypermobility, focuses on muscle strengthening, improving balance and proprioception, and preserving joint health. With the right balance between strength and flexibility, you can enhance your stability without compromising your body’s natural movement.

Maintaining Motivation and Setting Realistic Goals

Remember, while hypermobility lends unusual flexibility, the search for stability is a gentle reminder of the importance of establishing protective muscular support to your joints. This process requires patience, consistency, and a compassionate approach to listening to your body’s cues. Setting realistic goals is pivotal and maintaining motivation throughout this process is challenging. Having a trusted physical therapist not only acts as your professional guide, but they will also be there as your cheerleader and keeping you on track towards reaching your goals.

Other Related Articles on Hypermobility, Stability, and Proprioception

• 7 Important Exercises for Shoulder Instability
• A Comprehensive Guide to Chronic Ankle Instability
• Understanding Hypermobile EDS and How Physical Therapy Can Help
• Why Single Leg Stability is Important for Daily Function
• Unlock Your Athletic Potential With Core Stability Exercises
• A Complete Guide to Mastering Balance Exercises

References

Ferrell WR, Tennant N, Sturrock RD, et al. Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility syndrome. Arthritis Rheum. 2004;50(10):3323-3328. doi:10.1002/art.20582

Liaghat B, Skou ST, Jørgensen U, Sondergaard J, Søgaard K, Juul-Kristensen B. Heavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study. Pilot Feasibility Stud. 2020;6:97. Published 2020 Jul 10. doi:10.1186/s40814-020-00632-y

TL;DR

Hypermobility involves joints moving beyond the typical range and can lead to pain and instability if not managed well. Understanding where you fall on the hypermobility spectrum helps guide appropriate care. While flexibility may seem like an asset, strength and stability are key to protecting hypermobile joints. Physical therapy can help with customized strengthening, joint protection strategies, and goal setting to support long-term wellness.