Hypermobility Spectrum Disorder / Can you be too flexible?

We usually think of joint and soft tissue flexibility as desirable. However, there is such a thing as being too flexible. Hypermobility Spectrum Disorders (HSD) are a group of connective tissue diseases that can cause an individual to have chronic joint looseness/instability and can lead to persistent pain. HSD can be localized to a few joints and be the result of injury or training (e.g. dance or gymnastics), or it can be generalized.

In Generalized Hypermobility, the body’s connective tissues are not as strong and elastic as they should be. Connective tissues are a very important part of our body structure. They are found throughout our bodies, in skin, tendons, ligaments, muscles, blood vessels, nerves, and organs. Normal connective tissues are strong and elastic, able to stretch and return to a normal length without tearing. In Generalized Hypermobility, the collagen in the connective tissue is abnormal, making it less resilient and too loose. As a result, there can be wide ranging impacts on many body systems. Hypermobile Ehlers-Danlos Syndrome is one extreme type of hypermobility disorder. Because it is relatively uncommon (estimates range from 1 in 2500-5000), people with this condition often go undiagnosed for decades.

Hypermobility particularly affects joints. Strong, elastic connective tissue is vital to joint stability. Because the connective tissues are weaker in people with HSD their joints are “loose” and have more than normal range of motion. People with HSD ¬often have multiple painful body parts and joints that can go out of place more easily than they should. The hypermobility of the joints also means a person’s proprioception (sense of position of a joint) is altered and so they are more at risk for joint injury. They are also more prone to osteoarthritis in their joints. People with HSD may develop chronic pain because of increased stress on their joints or because of nerve damage in the connective tissues. As with many other systemic conditions, fatigue is a prominent feature. HSD is typically not recognized and diagnosed until people have suffered difficulties for years, resulting in a lot of frustration and barriers to receiving appropriate care.

Physiotherapy can be a great asset in the management of pain and dysfunction associated with HSD. Progressive strengthening, coaching regarding alignment, education, splinting/bracing advice and self-management strategies are all helpful in minimizing pain and risk of injury in people with hypermobility syndromes. People with HSD particularly need to strengthen and work on alignment under the expert guidance of someone who understands the pathology of these conditions, as well as being trained in exercise prescription.

At Best Health Physiotherapy, we have experience working successfully with people with HSD, and take a multi-faceted approach to dealing with these conditions. More information on these syndromes can be found through the Hypermobility Spectrum Disorders Association: https://www.hypermobility.org or the Ehlers-Danlos Society: https://www.ehlers-danlos.com.