Thoughts on Hypermobility

It wasn’t until coming to Cressey Performance that I’ve run into a good chunkful of clients, athletes, and regular people who are hypermobile or display signs of hypermobility. The idea of hypermobility and having too much range of motion due to unchecked ligamentous and/or capsular laxity is something that is rather foreign to me. Although I thought it was always a cool party trick to have the ability to pop BOTH my shoulders out both posteriorly and anteriorly (subluxations!), this is actually too far down the extreme of “being loose,” with the other end of being much too “tight”, that you cannot touch your toes! Whether I was more predispositioned to choosing dancing and gymnastics type movements, or I chose it, there are good things and bad things about being hypermobile.

Screen individuals for hypermobility by using the Beighton Laxity Test. It is relatively simple, and will take roughly about all of 1.2 seconds of talking with the client or athlete to assess if they are hypermobile. If they are, exercise selection should be chosen carefully.

If you score 9/9 on the test, can sublux both of your shoulders on will, can sublux your patella on command, and have the general looseness akin to a bowl of spaghetti in a dish washing machine, (aka similar to myself!) then I’m going to blanket statement a few things:

• Olympic Lifts could be contraindicated. Why? This is due to the large amount of distraction forces that is experienced in the glenohumeral joint upon throwing and catching a [power] snatch, clean, or even clean & jerk. Further, depending on the severity of the hypermobility of the athlete, the amount of forces being placed upon the wrists and hands could be counterproductive if the only goal is to increase power – there are many other avenues available (medicine ball work, band resisted jump training, kettlebell swings, etc.).

• Overhead work could possibly be contraindicated. It is dependent on rhythm of the scapulothoracic area, and general laxity of the anterior capsule; overhead work (dumbbell and barbell presses) could prove to be too taxing on the muscles on an already loose anterior glenoid capsule. One does not need to look any further than Bankart Lesions and Hill-Sachs Lesions to see why overhead pressing in an overhead athlete (such as baseball pitchers, who are somewhat loosey goosey as it is) is contraindicated.

• Stretching is not necessary in a hypermobile crowd. If we stretch someone who is already very loose, we may not be stretching their muscles anymore. We have to respect that beyond muscles, we have ligaments and capsular entities that we need to be aware of – if we continue to stretch ’til the cows come home, we may not be providing best practice for our athletes and clients. That being said, I haven’t stretched purposefully in a program in over 3+ years. And I’m better off without it.

• “Get long. Get strong. Train hard.” The first part of this often quoted phrase can be crossed out. If we are already long, we don’t need to get longer. If you can sublux your shoulders out of their sockets, get stupid strong in your back muscles (traps, rhomboids, rotator cuff muscles). If you can sublux your patella and/or hips on command, or if you have anterior knee pain in general, we will need to get ridiculously strong butt muscles, relative to the subluxation patterns. Simply, the joint centration is not there for these particular joints. Centrate, activate.(Random side note on how often I sublux my patellas: Coaching from 5am to 7pm, see if you can spot me randomly trip over literally nothing – this is my patella being subluxed right in front of your very eyes. I never understood why I trip so randomly – that is until I understood that I can medially deviate my patella and have my femur shift hard, genu valgus style, because I my glutes don’t work nearly as much as they need to during sub-submaximal times, such as walking around. Although the following picture is not my own personal knee, it might as well be because it looks exactly like that when I sublux.)

• When I was talking with Michael Mullin of the Postural Restoration Institute about hypermobility and how he would attack it, he mentioned to me how he would use not only an activation of one type, but simultaneously activate another muscle group. For example, alluding to the 90/90 Hip Shift with a Ball between the legs to activate L Adductor, we would now add in a mini-band around the knees to also co-activate the hip external rotators. I have yet to personally see how this mindset pans out for a wider [hypermobile] audience, but anecdotally it feels valid during my own warm-ups.

  

• According to Clinical Application of Neuromuscular Techniques, Chaitow/DeLany hypothesize that trigger points have a functional purpose – to offer an efficient means of short-term stability in an otherwise unstable environment. This point was presented to me by Eric Cressey at the Cressey Performance Seminar, and I also had brief chats with both Chris Howard (LMT, CSCS) and Nate Tiplady (DC), who also presented at the CP Seminar in October. This point may be difficult to accept at first – most people want to demolish and destroy trigger points. However, if a trigger point is holding two adjacent joints (or more) in a stable position due to friction of the joints, musculature, and viscous means, then should we be aiming to eliminate this trigger point? Is it evil? The key words are short-term stability in an otherwise unstable environment – get rid of the trigger point/aberrant pattern, but be sure to help the client and athlete re-establish a stable environment.

• If you are going to perform exercises that exacerbate certain conditions, such as a [straight bar] Back Squat, be sure to utilize proper filler exercises that help drive stability back into the joint. In regards to a powerlifting style back squat, when setting up underneath the bar, externally rotating the shoulder joint can lead to some funkiness down the line (due to the propensity that the glenohumeral joint may exhibit to dislocate anteriorly and the position that a low back squat places on the shoulder joint itself). Filler exercises such as a Prone External Rotation in between sets can be clutch as a shoulder saver, and it can give you time to breathe as well.

[youtube http://www.youtube.com/watch?v=48Z2Q_qp0zI]

• Off the record, I’ve been attempting a different approach to my lifts and general posture. Generally, I am avoiding hyperextension of the knees and elbows during “lockout”, and rather stopping at “neutral” range. To provide a metaphor for what it feels like to be in “neutral” for someone who is so hyperextended, it feels like you are in space. There are no reference points, no localized tension from the hamstrings when I try to touch my toes, and definitely no checks and balances when in this “neutral” zone. If I were to bring myself into a neutral zone, that would be akin to getting 2/3 reps on everything. Very weird to wrap your head around if you yourself are not hypermobile. Rather, my norm is hyperextension so I am resting on passive bony structures, as dirty as that may sound. If this were to go unchecked for my future years to come in regards to posture of the spine, legs, and shoulder areas, we are talking herniated discs, degenerative shoulder issues due to subluxations, and anterior knee pain due to lack of glute control. Interesting as to how this may pan out in my future years to come.

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Any questions or comments about hypermobility and how to train around or through it? Drop a line on the comment box or hit me up otherwise!