So in the first installment in my Thoughts on Hypermobility, I more or less provided stream of thought ideas on what hypermobility meant to me in a practical sense. In this next portion, I’ll be discussing the anatomical and physiological reasons why we may display signs of hypermobility from a congenital standpoint.
REASONS FOR HYPERMOBILITY
JOINT & SOCKET
Of the many types of subluxations, in particular to an overhead athlete and general population is a subluxation of the glenohumeral joint. There are various ways to sublux: anterior – which is the most common, posterior, and inferior – the least likely to occur. However, an individual just cannot “choose” which way to sublux – it either happens congenitally or acutely (such as an automobile accident).
In regards to the shoulder joint, it has often been described as a golf ball on a tee, and it may be the most accurate metaphor to date. However, imagine if the tee that holds our golf ball was very small in nature – the golf ball will naturally “slip” or fall off the tee with the slightest disturbance. On the other end, if our golf ball and the tee are both equally small, then the same can apply.
In a very roundabout way, this is how our humerus (golf ball) and glenoid cavity of the glenohumeral joint (tee) interact. With such great amounts of movement available, a congenitally lax person will traditionally have a large range of motion to move about at the glenohumeral joint (or shoulder). If we have the ability to sublux or “fall off” the tee, then that means we have the ability to “pop” our shoulders out, sometimes at will, other times without our control. In reality this is a very scary thought – if I perform an overhead movement, what is stopping my shoulder joint from dislocating? And will it return back to its “normal” state” after popping it back into place?
So if you have this predisposition for such laxity, we have a few options:
-First, determine in what “ways” we are unstable and prone to subluxations. One individual’s case will not be the same as anothers – point being, my bony structure is going to be different than another individual’s, and along with that I may have different contraindicated activities than another individual. Determine how an individual may be prone to dislocations in an initial eval, and go from there in terms of exercise selection.
-Since we are so hypermobile, we will need equal or greater “hyperstability” in the surrounding musculature. Reason being is that since we cannot rely on passive structures (ligaments and connective tissue) to create our stability for our joints, we must use our active structures, such as our muscles, to create this stability.
-Wear protective or pro-active jackets, such as the IntelliSkin. This will enable one to go about their day without having to worry 24/7 about postural issues (to a certain extent).
HORMONES & COLLAGEN
In this portion, I alluded to having skin looseness, or having easily stretched skin. This could be indicative of an individual’s lack of ability to absorb collagen, a protein that is found in connective tissue (ligaments) and skin. Since ligaments are tough fibrous bands of tissue that hold many of our bones together, if we are unable to properly absorb this protein, it can be deduced that ligamentous laxity will occur in said individual.
Further, hormones also play a factor in laxity in individuals. There are a few hormones (that specifically affect women also) that have the ability to grant individuals to be hyperflexible, such as oestrogen and relaxin – both of which may have a large effect on collagen absorption.
In terms of solutions, I’m not positive on anything that can help alleviate or increase our collagen absorption. Collagen creams are a big farce in the skincare world, but at the end of the day, there are numerous types of collagen that must be accounted for, with various methods of treatment – collagen absorption through the skin, while one “method”, may not be the most effective use of one’s time and money (although there are collagen injections as well, but that probably won’t help us in the long run either!).
Awareness, or rather the lack of awareness, of “where we stand” in its most literal sense may not be an actual cause, but it can contribute to our hypermobility. If we have zero proprioceptive skills, the feeling is akin to floating in space, and in order to “become grounded” we will have to lock out our joints – much to the point of hyperextension.
However, this factor has a large practical portion to take into consideration – if an individual is already hypermobile, and they are likewise equally physically active (lifting, running, dance, etc.), then to what extreme do they take their joint’s range of motion? If an individual has 15deg. of extra elbow flexion, how does that affect their ability to bench press or do push-ups? Go to neutral, or lock it out despite the obvious implications it has on our joints? More often than not, if they haven’t gotten injured yet because of the impact of such forces on their passive structures (bony end range, ligaments etc), then perhaps we can intervene before it gets too out of hand.
In this case, re-education of where neutral is in our everyday movements and for the athletic population, compound movements (bench press, squat, deadlift, etc.) are in order, along with possibly scrapping or altering powerful movements (such as Olympic weight lifting or plyometric jumps). If someone is constantly hyperextended, then teaching them where “neutral” is will help facilitate movement, either away from injury or from a pattern soon to be an injury.
In place of such movements, maybe have a redundant system in place to reduce the amount of impact that is displaced on the joints, such as band resisted broad jumps or box jumps, or medicine ball work in order to work in a power phase.
If we have particular athletes that do not know they are in a hypermobile state, all it takes is a quick 20 second assessment of the 9 (or 5 really) screens in the Beighton Laxity Test, to determine if they should or should not alter their exercise program. This doesn’t mean the hypermobile athlete is debilitated – rather it means we must aim for other methods that don’t cause discomfort, pain, or injury.