Yoga, Myself & My... Hypermobility

"I would come to yoga but I'm so un-flexible, I'd be terrible"

"My doctor told me yoga is bad for me as I'm already too bendy"

Just two sentences that I regularly hear when discussing yoga with my patients.  Clearly these show two ends of the spectrum.  So which is right?  Is either right?  Or is yoga actually about something more than the shapes you bend yourself into?

What is Hypermobility?

Benign joint hypermobility syndrome is a generalised laxity of multiple joints.  It is thought to be due to a genetically determined change in a type of protein called collagen which is found throughout the body in tissues like skin, ligaments, tendons, blood vessels and the gut.  It is estimated that anywhere between 13-20% of the population live with hypermobility, with rates in children and adolescents much higher.  Some people will never notice, or may even consider it a blessing if they have a hobby of ballet or gynmastics for example.  Others however will find regular aches and stiffness in muscles, clicking joints, recurrent injuries, dizziness, fainting, thin skin or digestive problems.

So why might hypermobile joints be a problem? 

Whilst many people aspire to the grace that vast flexibility affords say dancers and some yogi's, such a large amount of available movement means that significantly more control is required to keep the joint safe throughout this range.  Without regular exercises to ensure good muscle strength and joint coordination, a hypermobile person may be much more likely to injure themselves.  

Over time, other parts of the body may compensate for this lack of stability by stiffening up to act as a sort of anchor.  This stiff area can often cause discomfort in itself but is difficult to address without tackling the underlying instability first.

Can anything be done?

There is no known cure for hypermobility syndrome, but exercise and physiotherapy have very good results.

  • By training muscle strength and stamina, joints are more supported.  
  • By practicing a range of movement patterns the joints are less likely to suffer injury in an unfamiliar task.  
  • And by specifically working on something called proprioception, the information from the joint to the brain is increased, allowing a better subconscious awareness of where the joint is in space at all times, again making it far less likely to go into a place that may cause harm.  
  • Those chronically stiff areas may also be able to release and let go when they are fully supported by adequate muscle control.

So where does yoga come in?

Anyone who has tried a variety of yoga classes will testify that there certainly are teachers out there who will push you into new realms of your flexibility.  In these cases I agree with the commonly held notion that if you know yourself to be hypermobile then these classes may be best avoided.  But as always with yoga it is how it is taught, and the intention behind it.

Yoga basics - "Root to Rise"

Whilst yoga is many things to many people, whether you are naturally stiff or bendy, to me yoga is never about the final shape.  

Traditional yoga teaches us about Bandha's, which literally translates as "locks".  These are areas in the body where when strengthened and used well, the energy and stability that they can provide make all sorts of advance d inversions and floating transitions possible.  Whilst philosophically and energetically very different, western anatomy mirrors these areas beautifully by teaching us about pelvic floor, core and deep neck control among others.  Whichever viewpoint you come from, it is clear that to progress to a more advanced yoga practice, the basics require stability first and foremost.

What to look out for?

So the first thing is finding the locks on your own body.  A good yoga teacher with an awareness of this will be able to help you explore movements in your pelvis, core and neck so you can learn how this stability feels in your own body.  

Secondly, look out for the joints you know are your bendy ones.   Common examples are elbows bending slightly backwards in downward dog or plank, or front knees hyper-extending in triangle pose.

Thirdly, stay within your safe zone.  Common advice says to stay within 80% of your capability as if you the joint is already hypermobile, stretching it further is not necessary, and ligaments don't tend to return to their original length when overstretched.  

Lastly, know your habits.   Maybe you are used to folding into poses with ease, or enjoy the feeling of the deep stretch.  Neither of those things are bad but practice mindfulness in your movement and check in with your joints.  Most yoga postures are not designed to be effortless, so if you find yourself falling into end position without control do a body scan, see if there are areas where you could support and lift your muscles a little more.  The benefits of increasing strength will soon follow.

Ask your yoga teacher to help you find and stick to these principles in class.  Once you have these rules as habit you will start to see the benefits of a possibly more reserved, but definitely more effective practice!  The class is then yours to explore!

As a physio I recognise that any exercise that offers a huge variety of whole body movements, balanced on the left and right with weight bearing, strengthening and balance ticks every box for hypermobility rehabilitation and injury prevention.  And whilst there are many activities that can offer this, yoga with a good teacher certainly doesn't need to be avoided!  Find whats right for your body and enjoy!

 

Hayley is a physiotherapist specialising in using yoga and Pilates as rehabilitation. She has a masters in neuropsychology and is passionate about improving the movement of her clients and classes. If you have any comments or questions on anything raised in this article, Hayley would love to hear from you.  

Hayley@LatitudeWellbeing.com,

www.LatitudeWellbeing.com


This article is intended as reference only.  It is always advised to seek and follow medical advice where required.