Physical Therapy for Hypermobility

Hypermobility is truly a spectrum and no two hypermobile bodies ever look the same. It's important to acknowledge that hypermobility is not inherently a bad thing, it is possible to be hypermobile and have no joint pain or health problems. But for people with symptomatic hypermobility that are experiencing a lot of pain and loss of function, it's important to acknowledge that there are some unique things about your body that might make it harder to engage with a rehab program. So whether you're a person with a connective tissue disorder such as Ehlers Danlos Syndrome or are a person who is double-jointed that's experiencing a frustrating number of injuries with activity, here are a few things you should know about your unique body as you approach your healing journey.

Autonomic nervous system differences

The autonomic nervous system is the part of your nervous system that controls all of the things that happen automatically in your body e.g. digestion, blood pressure and heart rate regulation, etc. People with hypermobility often have differences in the way that their autonomic nervous system functions that can then lead to issues with alterations in pain sensitivity, excessive muscle tension, and unusual stress responses. A good rehab program should start by focusing on the health and function of the autonomic nervous system in order for the program to be successful.

Joint stabilization

First of all, what is joint instability? Joint instability is a way to describe a joint where the two connecting bones aren't moving together properly which can cause a lot of extra stress on the surrounding tendons, muscles, and cartilage. People with hypermobility are more prone to joint instability because the ligaments holding their bones together are looser than on a typical body and because of reduced proprioception, the ability to sense where your joints are in space. Due to instability and poor proprioception, the nervous system will often create muscle spasms as a way of compensating for the loss of stability. In general, a physical therapy practice for a hypermobile person should primarily focus on joint stabilization and proprioception training and we should always be cautious about stretching into the very end-range of motion; these muscle spasms are happening for a reason and that loss of stability must be corrected in order for the muscle spasms to improve.

Pacing

Hypermobile bodies are generally more prone to having chronic health issues such as fibromyalgia, ME/CFS, mast cell disorders, and autonomic disorders such as POTS. This is due to a large variety of complex factors and it would be oversimplifying to state that hypermobile bodies have oversensitive immune systems, but this does often seem to be the case. Physical therapy for hypermobility should prioritize pacing, the practice of balancing activity and rest to prevent flare-ups.

Create a long-term maintenance plan

For people with symptomatic hypermobility, it's important to understand that regular movement is a critical part of your self-care plan. Staying physically active helps to regulate all of the body systems (nervous, immune, endocrine, etc) and keeps joints functioning correctly with minimal wear-and-tear. It can be very helpful to approach a rehab practice with the goal of developing a lifelong movement practice that makes you feel good in your body. When it's time for discharge, make sure you're clear on what exercises will be the most helpful in maintaining your goal of staying physically active.

In summary, approaching physical therapy as a hypermobile person can often feel overwhelming and confusing. It is common for bendy bodies to "fail" traditional PT, but that does not mean your body is broken—it simply means that your program was not designed for your connective tissue. By focusing on autonomic regulation, joint stabilization, proprioceptive control, and pacing, you can build a stable foundation for the activities you love most :)