The Difference Between Flexibility, Hyper-mobility & Instability

The Difference Between Flexibility, Hyper-mobility & Instability

Hyper-mobility and flexibility are not the same and instability is where the difference girl with elbows hyper-extended in quadrupedlies. While some may mistake hyper-mobility as flexibility, especially in children, the difference is seen in movement and musculoskeletal function. In this blog you will learn how flexibility is a sign of health while hyper-mobility is instability, requiring extra measures to prevent injury and dysfunction. 

Flexibility vs Hypermobility 

Flexibility is a term that refers to the ability of a joint or joints to move without any restrictions. This requires muscles to lengthen allowing for movement. For example, if someone cannot reach and touch their toes this can be due to tight and short muscles of the hamstrings and tension in the lower back. Otherwise, someone whose muscles are overly tight, restricting mobility, may be considered inflexible.  

Hypermobility, however, refers to the excess laxity of the joints/ligaments. For example, this would be a person who:

  • Is considered “double-jointed”
  • Can hyperextend their elbows
  • And can manipulate their fingers beyond what the normal range of motion is

While being hypermobile, especially when you’re young, can seem like a cool thing and is sought after in certain sports, it can literally hurt you.

Hypermobility Affects Movement and Pain

When it comes to hypermobility, what is often ignored is the impact on movement, posture, and joint health. Because the ligaments and structure of a hypermobile joint allow for excess movement, the following must be considered:

  • Increased risk for joint dislocation
  • Postural instability 
  • Dysfunctional movement 
  • Increased risk of musculoskeletal injury 
  • Pelvic Floor Dysfunction 
  • Pathological breathing patterns 
  • Lack of coordination and balance 

When it comes to my practice, patients tend to come in with “unrelated issues” in their minds and we help connect the dots! At that point, it becomes obvious that their hyper-mobility either adds to their problem or is the root cause of their issue(s).

The most logical and effective way to create stability in otherwise unstable joints of the hyper-mobile individual is through  Dynamic Neuromuscular Stabilization and Postural Neurology. That is duplicating the methods with which the limber, helpless infant is able to become the strong, running toddler.

Hypermobility, Instability, and EDS 

Hypermobility can be present on its own or can be associated with other conditions such as Ehlers-Danlos Syndrome (EDS). If you have EDS, it is important to know the impact of hypermobility on your musculoskeletal system (bones, muscles, tendons, ligaments) and how its impact on movement can lead to pain. This is explored more in detail in the blog Ehlers Danlos Syndrome, Pain, and Posture.

Best Exercises for Hypermobility and Instability 

For someone who is hypermobile, full body stabilization exercises with attention to detail are crucial. You see, a hypermobile person can easily trick the untrained eye and appear to be performing the exercise correctly. This is because they have learned to function with joints in an extreme position, but it is holding a neutral position that becomes challenging. In fact, the biggest challenge is keeping stable in movement becomes the ultimate test.

Hyper-mobile individuals are no strangers to doctor’s offices; from gastrointestinal issues to headaches and neck pain. Even with injuries and re-injuries; they are typically great in sports such as gymnastics, cheer, ballet, and acrobatics. When it comes to those injuries, it is easy for them to see physical therapists and chiropractors and be treated the same way as others without hypermobility. That is where the continuous visits will continue.

Unless the rehab. provider, chiropractor, or physical therapist is familiar with functional rehabilitation such as Dynamic Neuromuscular Stabilization (DNS), those with hyper-mobility can suffer from pain, frustration, and disappointment.

Below is an advanced Dynamic Neuromuscular Stabilization exercise that when done correctly, points to the improvement of stability in our hyper-mobile patients and is a great milestone that we celebrate together.

Working with hypermobile individuals is different than those without hypermobility and there are specific ways to achieve the milestones of stability. Don’t hesitate to contact us when you are ready to start your adventure to a more stable world. You may also visit us on YouTube for Functional Movement Exercises and join our over 100K followers on Instagram for daily tips and tricks.

Dr. Shakib

Ehlers-Danlos Syndrome, Hyper-Mobility, and Posture

Ehlers-Danlos Syndrome, Hyper-Mobility, and Posture

Ehlers-Danlos Syndrome (EDS) and other hyper-mobility conditions are much more common than people realize. It seemed like a great thing to have as kids, being called double-jointed and doing great in sports requiring flexibility. But the reality is flexibility and instability are not the same. EDS and other hyper-mobility conditions end up in many musculoskeletal and posture issues later on. Most often, the symptoms are not considered different ‘chapters’ of the same ‘book’. In this blog, I cover the musculoskeletal aspect of EDS and the top 3 exercises I do with hyper-mobile patients.

While not curable, there are many stability exercises you can do to bring more structure to your movement and posture! The lack of which can lead to many issues including pelvic floor dysfunction!

What is Ehlers-Danlos Syndrome?

According to the Mayo Clinic, “ Ehlers-Danlos syndrome is a group of inherited disorders that affect your connective tissues — primarily your skin, joints, and blood vessel walls… People who have Ehlers-Danlos syndrome usually have overly flexible joints and stretchy, fragile skin.”. Again, for this blog, we will focus on the effects EDS has on connective tissue such as tendons and ligaments. We will also discuss how this impacts posture and movement.  

Now, connective tissue such as tendons and ligaments are responsible for holding your many joints together. Tendons connect muscles to the bones and cross over joints making movement possible. Ligaments connect bone to bone playing a vital role in joint stability. 

These connective tissues, in someone who has EDS or other hyper-mobility conditions, have more laxity compared to someone without it. This means less stability in the joints including the joints throughout the spinal column making up the:

  • Lower back
  • Mid-back
  • Neck
  • And pelvis

Now let’s discuss how this impacts posture and can contribute to pain. 

Does Ehlers-Danlos Syndrome Cause Bad Posture?

Hyper-mobility of the joints that come with Ehlers-Danlos Syndrome contribute to poor posture and dysfunctional movement. But that does not have to be the case! Although hyper-mobility cannot be cured, there are things you can be doing to bring stability to the hyper-mobile joints which we go over in the next section.  

Looking at the picture below you can see the complexity of the ligaments surrounding just the torso, pelvic region, shoulders, and arms. For people with EDS, these ligaments allow for more movement within a joint compared to that of a non-hypermobile person. What is considered a normal range of motion in the elbow joint for example, a person with EDS would be able to go into what is called hyper-extension (or extension beyond the norm). This applies to every joint, not just the elbow.

ligaments highlighted on skeleton

Although hyper-mobility is a quality that is unfortunately desirable in specific sports like gymnastics, dance, or ballet, what is ignored is the dysfunction that comes with it. The video below best explains dysfunctional movement vs functional movement. It’s like driving home sober vs drunk. You may still reach your destination, but the quality of the drive, and how you got from point A to point B, are not the same.

Unfortunately, banging up he car is not going to be a surprise when intoxicated. The ‘car’ is the body of the hyper-mobile/EDS person that is constantly impacted as a result of instability in posture and movement.

Functional Movement and EDS

Depending on the degree of hyper-mobility in our patients, we find a collapsed posture displaying little structural integrity. Through functional movement assessments, the same lack of stability is seen in movement. For someone with EDS, in the example above, it’s like driving drunk 24/7. You have to be more alert and aware of your movements to avoid injury and stop doing things that “feed” your dysfunction.

Fortunately, with Developmental kinesiology type exercises, such as DNS, over time, it is easy to impact the blueprint of movement in the brain, making the movements and posture more functional vs dysfunctional.

When it comes to posture and functional movement, full body stabilization is the key. Find out how to achieve this in the section below! Bear in mind that the exercises shown are just a sample of what we do at our clinic to achieve the results our patients are looking for.

Best Postural Stability Exercises for Ehlers-Danlos Syndrome

With every EDS patient, the priority is stability and what we find works the best is Dynamic Neuromuscular Stabilization (DNS) exercises which involve:

  • Breathing
  • Core Stability ( including the whole spine, neck, and pelvis!)
  • Whole Body Functional Movement 

In my blog, How to Improve Posture with DNS, I mention that, “Dynamic Neuromuscular Stabilization or DNS is a new rehabilitation approach (but nothing new!), from The Prague School of Rehabilitation and Manual Medicine, that utilizes the developmental movement pattern that every person around the world follows to develop proper movement and body function from around 3 months of age throughout the first years of life.”. 

Why reinvent the wheel when we already know what works and makes sense? This is how we all, as babies, develop functional movement patterns and proper stabilization to go from being a helpless newborn to rolling over, crawling, walking, then running. So we re-walk this path to restore proper function always.

The 3 steps below are the basics of what it takes to be stable and move functionally. This is where we start with all EDS patients. 

Breathing 

The most important thing is the very first thing we all did when we were born which is to breathe. Believe it or not, almost every patient we see is doing it incorrectly! Watch the video below to understand how to breathe properly (engaging the barrel) and why it’s important for every musculoskeletal condition, especially EDS. 

Core Stabilization and EDS

Once the breathing is corrected, you have what it takes to start building the core stabilizing muscles. If you are thinking of abdominal crunches, you are mistaken. In the video below, I share what we all did as 3 to 4-month-old babies. That is developing the oblique muscles necessary for core stabilization, connecting the mid-back to the lower back, and for the whole spine to ‘dance’ in unison! 

No babies ever lift weights, see a PT or a chiropractor, or take supplements to boost their muscles and movements. We are all programmed to follow the same path of movement! So why not use that to strengthen what is needed and move gracefully as we are meant to move? Common sense, right?

Full Body Functional Movement 

Once the basics of breathing and core stabilization are established, you can try something we all did at around 9 months of age! It’s important not to mechanically reproduce a movement or exercise but to do so functionally.

If movement is like a concert, the body parts are the musicians! The spotlight is focused on one musician while the others play in the background. In movement, this means every part of your body does its job while the spotlight is on the mover. In the video below, the spotlight is on the legs and glutes while the torso stabilizes and the arms ‘dance’ with the legs! 

I Have Hyper-Mobility. Where Do I Start?

If you have Ehlers-Danlos Syndrome or other hypermobile conditions and are not sure where to start when it comes to correcting your movement, posture, and getting out of pain, contact us. Just because hyper-mobility cannot be reversed does not mean you do nothing! Strengthening joints and overall stability is vital in preventing injuries such as dislocations/subluxations which are common to those who are hypermobile.

It is common to have pelvic floor dysfunction associated with hyper-mobility, but this is typically overlooked. My blogs on pelvic floor dysfunction explore the many presentations of pelvic floor dysfunction. Use the link to find out how addressing postural stability, many of the symptoms and signs of pelvic floor dysfunction go away.

If you think you have a hyper-mobility condition, or have EDS with mobility, spine, or musculoskeletal issues, and need help, contact us.

Dr. Shakib