Hypermobility and Stretching

Estimated reading time: 6 minutes We know feeling tight is a common experience in hypermobility. When we have looser joints, our muscles often tighten up to try and stabilize. It can feel good at the time to stretch them. We must remember that our muscles are tight for a reason.

The tight muscles are trying desperately to stabilize in the face of joint laxity. However, they may not be the right muscles to stabilize which can lead to the feeling of tightness. In hypermobility, there can be a tendency to recruit the larger, global muscles as stabilizers over the smaller stabilizing muscles. When the global muscles get involved, they get fatigued quicker and begin to hurt and complain.  My YouTube video Top Tip No. 1 – Tight Muscles in Hypermobility explains this in more detail.

I spoke recently with physical therapist and upper quadrant specialist Michael O’Reilly. He said “stretching is always tricky, isn’t it? There are areas that need to be unloaded but I’d be cautious in giving general advice on that because those areas are going to be specific to that person and we don’t want to stretch what’s already lengthened.” This was refreshing to hear.

I have heard so many stories of hypermobile patients receiving manual therapy to ‘stretch out’ those tight areas, but this has left them in more pain. If you take away the very architecture that is attempting to stabilize the structure, you can destabilize everything.  This can lead to more pain and instability. So we do have to approach the hypermobile patient differently when it comes to stretching tissues. It is important to remember that a lax joint will stretch more before you get to the tight muscle.

 Why I think dynamic stretching is preferable to static stretching in hypermobility.

In nature, we don’t see animals stretching – or at least static stretching. They move into a position and out in what is known as pandiculation. This naturally occurs around sleep-wake cycles – like yawning often occurring with pandiculation of the arms (1). It is a natural, integrated movement.

Robert Schiep, renowned researcher and anatomist in the fascia world, states that regular use of dynamic stretching can “positively influence the architecture of the connective tissue in that it becomes more elastic when correctly performed (2).” Elasticity is something we want to be encouraging in hypermobility.

Schliep also concludes that dynamic stretching can yield long-term improvements in activities like jump height, speed, and force (2). Hypermobile patients may not be looking to increase speed or improve their jumping ability, but it gives us some evidence of the resilience and tissue changes that can occur with dynamic stretching.

I have always had an issue with static stretching. With static stretching, you hold a stretch for an extended period of time. I find that with hypermobility since we lack proprioception, this leads to extending to the end of range (or beyond) and just hanging. One of my phrases is “just because we can, doesn’t mean we should”. Schliep states that slow, melting movements stimulate the fascial tissues (2). I am always encouraging softening of tissues in my classes and with clients. So stretching can take the form of a slow, controlled movement that softens the structure, but I am wary of holding poses or stretches for too long. In fact, Schliep advocates slow, flowing form of dynamic stretching over static stretching (3).

I will always champion dynamic stretching. This is what I always do with my clients and in The Zebra Club . In this method of stretching, we move in and out of different ranges (not end of range). We can get those tight places moving.

Why does it feel so good to stretch?

When we look at stretching for pain numerous studies report that it can help. One review postulates a few theories behind this, one of them being that stretching may impact the balance between the sympathetic and parasympathetic balance of the nervous system. They state stretching can increase the parasympathetic influence (rest and digest), potentially influencing pain perception and increasing relaxation. The inverse can be true with stretching to the point of discomfort increasing sympathetic (fight or flight) activation. They did not clarify what method of stretching was involved (4).

Anecdotally, I have heard and experienced that it can feel so good to stretch at the time, but if we overdo it and overstretch, we may wake up in more pain than we started with. Overstretching can lead to injury (5).

I am not saying not to stretch, but let’s be clever about how we choose to stretch.

 What the research says about stretching

When it comes to studies on stretching in the general population there is a lot of often contradictory research out there.  One recent systematic review assessed over 300 research trials on healthy athletes with the goal of providing an overview of stretching. In these studies, they found the research was biased towards adult male athletes in sports that did not require extreme ranges of motion, they looked mainly at acute effects of stretching not a long-term practice, and that the outcomes they measured were generally limited to performance testing (6). This is a very different context than I usually see in my hypermobile clients.

The research does not say much at all about stretching (dynamic or static) in hypermobility. When it is mentioned in the literature, it is often included in treatment recommendations and the method is not specified (7). Or it is mentioned, that due to lack of proprioception and our ability to easily reach end range motion, unstable joints can be made even more unstable (8).

When we stretch, we are interacting with our fascia. In fact, it is thought the fascia is actually the first tissue to limit the motion when we stretch (9). Since the fascia – our connective tissue – is altered in Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder (10), it makes sense that we may need to take a different approach and care with stretching than the general population (which the vast majority of stretching research addresses).

We have to be mindful of the fascia – slow and steady

One benefit of stretching safely (and movement) is that it is thought to increase circulation and hydrate tissues, which they need for metabolism, stability, and mobility (5). We can take a fascia-friendly approach to how we choose to stretch, and this doesn’t involve focusing on specific body parts but looking at the body as a whole, where everything works together.

These connections are demonstrated in the literature. It has been shown that targeting stretches to only one lower leg can increase the range of motion in the other leg (11). Another showed that stretching the lower leg caused an increased range of motion in the cervical spine (neck) which they attributed to the fascial connections (12,9). It is all connected, we are integrated beings!

When we approach stretching with a slow and dynamic way of moving, we aren’t targeting isolated muscle groups but engaging long myofascial chains. This is described as different from conventional isolated muscle stretch or lengthening Hatha yoga poses in that “multidirectional movements with changes in the angles, diagonal movements, and spiraling are used (3)”.

I encourage spirals in The Zebra Club classes – we even have one class called Twists and Sprials and a refreshing class on the beach called Stretch and Twist on Youtube. It is essential to remember that the tissues are not linear.  There are no straight lines in the body so any movement activity must incorporate this multidirectional tissue.

My tips for dynamic stretching

• Move slowly: when we choose slow dynamic stretching we can engage our long myofascial chains involving large parts of the network – remember, our body does not work in isolation (3). My YouTube class called Speed of Movement looks at why this is important.
• Encourage softening of the tissues: we want the tissues to be able to glide
• Work on control: it is not about forcing into a stretch but thing of it as exploring a movement with awareness and control. That way, we can avoid overstretching and injury.
• Even it it feels really good, don’t hang about in the stretch for too long: Move in and out of it.
• Jerky, fast movements should be avoided: Pay attention to the smoothness of the movement (2)
• Low Impact with the ground: If movements can become quiet – then you are using the elastic quality of the tissues. For example, keeping your foot interaction with the ground quiet. I always notice people out running – the ones who I can hear hitting the ground hard are the ones with the least amount of elasticity. I envisage foot, ankle, knee, and hip pain for these runners. We want bounce and resilience.

In this video I talk a little about my views on stretching and lead you through a feel-good dynamic stretching movement practice.

Literature Review by Catherine Nation, MSc, PhD

Works Cited 

1. Bertolucci, Luiz Fernando (2011). Pandiculation: Nature’s way of maintaining the functional integrity of the myofascial system? Journal of Bodywork and Movement Therapies.
2. Schleip & Muller (2012). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies.
3. Muller & Schleip (2012). 24 Fascial Fitness. Fascia: The Tensional Network of the Human Body Eds Schleip, Findley, Chaitow, & Huijing. Churchill Livingstone.
4. Behm et al (2021) Effects of Acute and Chronic Stretching on Pain Control. Journal of Clinical Exercise Physiology.
5. Myers and Fredrick (2012). 7.20 Stretching and Fascia. Fascia: The Tensional Network of the Human Body Eds Schleip, Findley, Chaitow, & Huijing. Churchill Livingstone.
6. Afonso et al (2024) What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials. Sports Medicine.
7. Atwell et al (2021) Clinical Review: Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care. JABFM.
8. Palmer et al (2014) The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review. Physiotherapy.
9. Stecco et al (2020) Fascial or Muscle Stretching? A narrative Review. Applied Sciences)
10. Wang & Stecco, A (2021) Fascial thickness and stiffness in hypermobile Ehlers-Danlos syndrome. American Journal of Medical Genetics: Seminars in Medical Genetics Part C.
11. Chaouachi et al (2015) Unilateral static and dynamic hamstrings stretching increases contralateral hip flexion range of motion. Clin. Physiol. Funct. Imaging.
12. Wilke et al (2016) Remote effects of lower limb stretching: Preliminary evidence for myofascial connectivity? Journal of Sports Science.