When we are diagnosed with a hypermobility syndrome or with Ehlers-Danlos Syndrome, we are often advised to take up exercise by medical professionals. Exercise is important for various reasons with these conditions:
Being hypermobile can make you more vulnerable to musculoskeletal imbalances that cause pain and instability. If we can improve muscle tone and postural tone through exercise, this can help reduce the imbalances in the body.
Pain sensitization can be common – the tissues become sensitive to the slightest movement. Can we use exercise to help calm the nervous system and reduce this pain sensitization?
Ligaments and joints are loose – making them susceptible to injury.
o Gravity can pull them out of alignment
o Tights muscles can pull them out of the correct position
o Weak and inactive stabilizing muscles can lead to functional instability
People with hypermobility often have poor body awareness and lack proprioception (or where their body is in space). This can make us clumsy or injury-prone. It also means we can go to end-of-range movements without being aware of it. This can potentially cause strain and tissue damage leading to pain.
Sadly, many people with hypermobility report giving up on exercise because of pain, fatigue, fear of movement, and being given inappropriate exercises. This is all too common and unfortunately can lead to a downward spiral where we move less, but the less we move, the more the pain increases. And the more the pain increases, the more fearful we become of movement. It is a cycle we ideally want to break as soon as possible because movement is medicine for hypermobility. It can be a valuable cornerstone of any hypermobility management plan.
But why does it go wrong?
EDS patients are not like other patients who go to physical therapy. They don’t tend to ‘get better’ in a 6-week window or so. It’s time the approach changes so that people with this condition are not expected to ‘perform’ and improve to a pre-defined time frame. We have ups and downs. It is rarely a linear pattern of rehab. We have good days and bad days. Some days we can do more. Some days we need to take it very easy. Time is often limited with patients so sessions can be rushed with the emphasis being firmly placed on strengthening those hypermobile joints.
But that’s a mistake in many cases. With the body out of alignment due to hypermobility, it is not sensible to dive straight in with strength and resistance work. We will be strengthening the body in incorrect alignment and potentially contributing to the pain and poor movement patterns.
Where should we start?
In my many years of experience working with the EDS and hypermobile community, I have developed a method called the Integral Movement Method (IMM) which takes into account the specific needs of the hypermobile body. This is outlined in my book Hypermobility Without Tears. I firmly believe that we need to be starting slow and with fundamental practices like Breathing and Relaxation. These will immediately start to help with calming the nervous system and building that important body awareness.
This is the part of the method I refer to as Unwind. People with hypermobility often carry muscular tension caused by poor postural habits or repetitive actions in daily life. We can also hold anxiety and stress related to the health condition; this can cause tension which leads to muscle pain. The Unwind section of the IMM is vital to changing this. This is where we start to unwind and let go of muscular and mental nervous tension that may have built up in the body that day (or longer if we have been suffering from stress and pain for some time). It also starts to build the essential proprioception or body awareness so that we can become more conscious of our actions and movements.
It can start with awareness - closing the eyes, observing the breath, and switching off the thinking brain. It is time to stop and be aware of the body. It is time to notice the body and whether we can become aware of what I refer to as ‘holding patterns’. Through the process of unwinding, we can immediately start to release the tension from the mind and body that we may not have been aware of during the day. In this process we allow the bones, tissues, and organs to soften and start creating the space that the body and mind crave. It is time to stop fighting and allowing the body to let go a little. The more we can notice the body and its weight resting on the floor, the greater the degree of proprioception.
After a sense of awareness and alignment is established, we move on to Proprioception, Stability, Balance, and finally Posture.
Proprioception is the kinesthetic sense that enables us to sense the relative position of the parts of our body, our posture, our balance, and movement. Lack of this awareness means that we are often not aware when we have locked our joints, for example. When joints are locked, this action places pressure on the joint and surrounding structures leading to wear and tear and a greater chance of injury. With a locked joint, the muscles no longer have to work to support the body. You are relying on the ligaments to do the job of the muscles. In turn, these muscles become deconditioned and weaker. With deconditioned tissue, pain increases.
Working on proprioception can start to introduce light resistance with a soft ball or a TheraBand to help learn motor control. Motor control means we are able to activate the correct muscles and not activate muscles that should not be active. We start to build balance in the body.
With an understanding of motor control, Stability will follow. Exercises can become more challenging in a side-lying position, a four-point kneeling position, and standing. It is important, however, that stability does not mean guarding or bracing. We don’t want to brace to stabilize the joints – that would be encouraging muscular tension and holding patterns again. My method promotes fluidity with control and a whole-body approach to stability.
Balance is essential for everyday life. The act of walking is itself a balancing act, as we transfer body weight from one foot to another. If we are not comfortable in standing balance work, we may experience fear around walking and mobility. This can clearly impact our daily functionality. So it is an important aspect of any movement program, but it needs to be approached safely and slowly. Avoid jumping onto a wobble board straight away. Start with simple standing awareness with even weight distributed through both feet, left and right and front and back. Build from that solid base – maybe heel raises and standing on one leg whilst holding onto a support. Balance work doesn’t have to be scary.
Posture cannot be ‘fixed’ or ‘static’ like a soldier on duty. Posture needs to be dynamic, changeable, and elastic. With a dynamic posture, the body becomes responsive to its environment. It changes with you, with the demands you place upon it. It reacts appropriately to the ground force and gravity. With hypermobility, we have a tendency to let gravity drag us down and we resort to ‘hanging’ into our posture as opposed to making the muscles work effectively. This is the final stage of the method – it brings together everything we have explored so far. Posture cannot be taught – otherwise, it would be fixed and static. Posture needs to be the embodiment of all the learning in the previous stages. Then it can have a lasting impact.
My YouTube channel has a variety of classes to follow the IMM.