Estimated reading time: 6 minutesJoint pain and instability, including subluxations and dislocations for many people, is probably one of the most challenging aspects of managing symptomatic hypermobility and EDS.
These are all interconnected and impact each other, so we need to take a management approach that affects our overall well-being. I tend to look at whole-body integration through the Integral Movement Method (IMM) as opposed to single-joint applications. When it comes to hypermobility and EDS we need to take a different approach to movement, taking this into account.
Understanding Hypermobility and Its Impact on Joints
Hypermobility is defined as the ability of joints to move beyond their normal range of motion (1). For dancers, athletes, musicians, and gymnasts this can actually be quite beneficial. It enables them to move with greater flexibility and perform outstanding movements.
As Dr. Leslie Russek often reminds us in her presentations for The Zebra Club, “Hypermobility is not the same as instability.” Ligament laxity can be measured objectively in joints that move beyond their normal limits (1). Instability or functional instability is often accompanied by reports of feeling like the joint will give away, subluxations, or dislocations (1).
Instability does cause pain. Pain often results from the body’s attempt to compensate for instability. When the joints feel unsupported, the surrounding muscles have to work harder to try and provide stability. These muscles get tired and angry, they get inflamed, and they also hurt.
The problem arises from that laxity in the ligaments that support the joints. The joints can become less stable and more prone to injury, including subluxations. If left untreated, this can lead to discomfort and chronic pain.
With repeated injury and feelings of instability, a fear of movement or kinesiophobia could start to develop. If I am constantly worried about pain every time I move my arm or hip, then I might start to develop avoidance behaviors or adapt my movements into compensatory movement patterning. This is the body’s way of working around impairments.
This faulty patterning can also lead to pain in different areas of the body. This may also lead me to become less active because I am fearful of the pain. This can create a vicious cycle because we know that movement and exercise are hugely important to establish and maintain muscular tone to support the joints and movement and reduce fatigue.
I have found that breaking this cycle requires a comprehensive, but gentle approach.
We can’t jump straight into strengthening tired and angry muscles. That rarely works. However, muscle strength is very important so that the joints can move with stability. The IMM introduces muscle strengthening work at an appropriate time, and with its focus on controlled, mindful movement, it can really support joint health.
Pain management strategies will also be important to break that cycle and get us moving comfortably again. This, combined with education and awareness about how hypermobile bodies operate and function, allows us to make choices to help prevent strain and reduce injuries.
Hypermobility and Instability
While hypermobility of joints does not necessarily mean joints are instable, instability is a feature of the diagnostic criteria for hEDS and HSD – though it is not a requirement.
Hypermobility and instability exist on a spectrum, and the degree to which each of us is affected varies. The joints that are affected seem to vary too. I have done a series of blogs addressing symptomatic hypermobility and instability in different regions of the body, including research and my recommendations from a movement therapy perspective.
Effective Exercises for Strengthening Joints in Hypermobility
My YouTube channel has a wide variety of classes and tips for joint strengthening. It is super important to start slow and avoid pushing and forcing through any pain. As I tend to tkae a whole body approach, I tend to start at the feet and work up. But here are a few of my favorite exercises for building joint strength in different body parts.
- Pelvic rolls – The lumbar spine is often a very mobile area. Pelvic Rolls are a great supported movement you can do supine and, on the bed, too. These can help us learn lumbar control.
- Knee rolls – These are great exercises for pelvic stability and hip stability.
- Bridges – This is a whole-body exercise that loads the feet, hips and allows controlled spinal elongation.
- Side-lying work like bent leg lifts – this helps build hip joint stability.
- Heel raises – These are great for foot and ankle stability.
- Shoulder glides – These are simple supine shoulder retraction exercise to bring stability to the shoulders
- Isometric shoulder exercises – These are another fantastic exercise for these very mobile joints.
- Four-point kneeling – These are great for learning to stabilize the hips and shoulders at the same time. For some people, just being in this position is enough to start with.
- Baby squats – Even though these are “baby” or smaller versions of squats, you can still benefit hugely. We don’t need to go all the way to the floor to get our hips and knees working stability.
Lifestyle to Manage Hypermobility Symptoms
Movement and exercise are going to be key factors in management. It is important to find a form of movement that suits your body.
- In working one on one with thousands of hypermobile clients, I have found gentle, controlled movements are safe for our bodies. Reducing range and building control is my mantra. You may have heard me say it before -“It’s not about the range, it’s about the control.”
Pacing is essential. This is true whether you are just beginning to move again, or are continuing to build strength and stability.
- You want to avoid over-exertion – this is particularly important if you are new to movement or are managing an energy limiting condition. As we always say in The Zebra Club, “Start Low, Go Slow”. One way to do this is to break movement into manageable Movement Snacks throughout the day.
Postural tone and alignment can help with joint stability
- I am a firm believer that the more aligned our bony structure is, the less the muscles and joints have to work to support the whole structure. The feet can be a great place to start.
Stress management can really help.
- This can include the use of relaxation techniques and good sleep hygiene. Stress can impact pain, especially if I am worried about moving in general, as discussed earlier.
Nutrition and Diet: Fueling Your Joints
Proper nutrition supports overall joint health because it can help reduce inflammation. If you have MCAS, this is particular important as overactive mast cells can contribute to pain.
Hydration is also a key factor, this is true for everyone but is particularly important if you are managing dysautonomia. Maintaining the electrolyte balance can be key.
When it comes to diet always recommend consulting with a registered dietician or nutritionist. There are lots of theories and ‘experts’ online, but with nutrition, you want to ensure you are getting evidenced-based advice unique to your needs. Check out further info from Lorna Ryan on diet and EDS. I also have this great video of her debunking nutrition myths from the EDS and hypermobility world.
Navigating Daily Life with Hypermobility
Here are some of my recommendations for navigating daily life
- Listen to your body – if something causes pain, modify it as needed, don’t push through.
- Try to notice any habits you may have that might be contributing to joint instability. For example, I used to stand with my legs crossed and one hip hiked up – literally hanging off my joints. I was stretching and straining those tissues around my hips and legs by doing this. It would have been contributing to my pain.
- Use support as needed – braces, orthotics, walking aids. They can really help. There is a myth that they only serve to make you weaker, I debunk that myth here.
- Incorporate rest and prioritize it. Pushing through rarely works out and could lead to more pain and fatigue, especially if you are dealing with post-exertional malaise.
- Watch for those hyperextending joints – we all have them! Elbows and knees are classic examples where it is easy to hyperextend, but these repeated hyperextensions put more strain on the joint and stretch the soft tissues.
- Prioritize relaxation and stress management.
- Learn to say NO – prioritize yourself and your self-care.
- Find a support network that really gets you and supports your unique needs. I am so proud of the supportive community in The Zebra Club.
- Seek help from qualified professionals – the management of hypermobility is probably going to involve lots of different practitioners. I know this can be difficult but when you can, build your team of people who understand EDS and HSD. If not, seek a provider that is willing to listen and learn with you. The Ehlers-Danlos Society has a database where EDS-aware providers can submit their information.
- Education – seek out info and resources to learn more about your body. Empowerment can be really helpful especially when navigating the challenges of EDS / HSD healthcare. This is one of the pillars of The Zebra Club – we have a deep library of presentations from EDS specialists in many different fields with new presentations each month.
Here is a short routine I created to start addressing instability.
FAQ
Are hypermobile people weaker?
Not necessarily! Research has shown that hypermobile people can gain strength like non-hypermobile people, but it will just take longer generally. The instability due to laxity can make it harder for muscles to stabilise which gives the impression of weakness. However, you can improve both strength and stability.
What do hypermobile people struggle with?
They can struggle with joint instability and pain, and inflammation of tissues. Fatigue can impact energy and the ability to exercise. There may be increased risk of injuries or falls for some. Gastrointestinal and autonomic issues are common too.
What does hypermobility pain feel like?
This can vary for each individual. But pain may be experienced to different degrees as sharp, stabbing pains during movements, muscle pain like tension or soreness, or sometimes burning. Nerve pain like tingling or numbness can occur. Some people have chronic widespread pain.
Jeannie Di Bon is a movement therapist, educator and author specializing in hypermobility, Ehlers-Danlos Syndrome and chronic pain. She is the founder of The Zebra Club app and the creator of the Integral Movement Method.
- Nicholson, et al.(2022) International Perspectives on Joint Hypermobility: A Synthesis of Current Science to Guide Clinical and Research Directions. Journal of Clinical Rheumatology.
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