If you’re struggling to touch your toes in yoga class, you’re probably envious of your super-flexible friend. Yup, the one who can effortlessly place both palms flat on the floor without bending her knees – or grimacing.
You could chalk up your friend's flexibility to her consistent practice or that she is born with flexible hamstrings. Or the off chance that she may have hypermobility, especially if she is also able to bend her thumb back to touch her forearm (more of that in a bit).
Hypermobility is what people refer to as "double-jointed" or that “some of your joints can move beyond the normal range, almost like the connective tissue or ‘glue’ that holds the joints together are extra bendy”, said Dr Nicodemus Oey, an associate consultant with Division of Rehabilitation Medicine at Alexandra Hospital, Ng Teng Fong General Hospital and National University Hospital. “We can think of it as being naturally more flexible than average.”
But isn’t being flexible more of a blessing than a curse? Not always, according to mobility experts. Here’s what they say about hypermobility:
(Photo: iStock/fizkes)
One self-screening tool for hypermobility is the 5-Point Questionnaire or 5PQ, said Brenda Lim, a senior physiotherapist with Tan Tock Seng Hospital’s Department of Physiotherapy. “If you answered ‘yes’ to two or more of these questions, it may suggest hypermobility.”
You could have hypermobility if you can bend your thumb to touch your forearm. (Photo: iStock/Tatiana Foxy)
What clinicians use is the Beighton Scoring System, a nine-point screening tool to measure joint hypermobility, said Lim. “A score of four or more out of nine may indicate hypermobility, although a full clinical assessment is recommended to confirm,” she said. And the "tests" are very similar to the 5PQ:
“The underlying cause of hypermobility is thought, in part, to be genetic factors,” said Dr Oey. However, hypermobility comes in a “spectrum” and “often cannot be ascribed to any particular gene”. “Most of the time, we cannot know for sure what is the cause of hypermobile joints,” he said.
As for the difference between hypermobility and flexibility, UK osteopath Stephen Makinde wrote on Perfect Balance Clinic that the latter is a broad term referring to the available range of movement in your body. “(Flexibility) is determined by the level of give in your muscles, fascia and nervous system. We are all born with a high level of flexibility and this naturally declines as we age.”
Makinde wrote that your daily flexibility can be affected by activity levels, temperature and hormonal changes. But “hypermobility remains relatively consistent with only minor age-related changes”.
Hypermobility is also more about your joints and ligaments rather than your muscles. “Hypermobility occurs when the connective tissues that support your joints, such as ligaments, are more elastic than usual,” said Lim. “This allows the joint to stretch further, often without pain.”
According to Lim, hypermobility can affect a few joints (localised hypermobility) or throughout the body (generalised hypermobility). “Joint hypermobility tends to be more common in women than men, and also within the younger population as hypermobility decreases as you get older,” said Lim.
Not exactly, said Dr Oey. “You can increase flexibility with stretching but true hypermobility is usually genetic – you’re born with looser collagen in your ligaments.” Lim agreed: “It is linked to how your connective tissues are formed, particularly the collagen.”
In fact, those who already have some joint looseness can push their joints into unsafe zones, which may lead to instability or injuries, if they over-stretch, warned Dr Oey. “Think of a rubber band left stretched out too long.”
He added that “yoga or gymnastics won’t change your genetics but they can push your joints into unstable ranges if you’re not strengthening alongside stretching”. “That’s why ‘flexible but weak’ often leads to injuries,” he said.
For some people, hypermobility can lead to pain or injuries, according to Dr Oey. In his practice, he often sees such issues in people who practise yoga, dance or sports where flexibility is overemphasised.
Lim also sees hypermobile patients sometimes, “although it is often not the main reason why they are referred”. “Many of them only discover they are hypermobile after an injury or persistent joint issue,” she said.
(Photo: iStock/LSOphoto)
As it turns out, hypermobile individuals are more prone to joint sprains, especially in the ankles and knees. “They are also more prone to dislocation or partial dislocation of the kneecap or shoulders, or tendon overuse injuries,” said Lim. “They occur due to joint instability, where the supporting structures are unable to hold the joint in a stable position during movement.”
If you suspect you have hypermobile joints, you may often suffer from back or neck pain due to the “instability of the spine and fatigue, or muscle tightness from overcompensation by the surrounding muscles”, said Lim.
During sports or physical training, hypermobile joints can “move into positions that go beyond the fully straight range” called hyperextension, said Lim. “This may put added strain on your joints and soft tissues, increasing the risk of injury over time such as joint wear-and-tear, muscle overuse and strain as well as poor posture and movement patterns.”
For example, when performing a plank or push-ups, your elbows may lock out instead of the core muscles working, said Dr Oey. “Hyperextension stresses the ligaments and can cause early arthritis or tendonitis.”
A hyperextended elbow. (Photo: iStock/Awart)
The key thing is to strengthen, not overstretch, said Lim. “Focus on building strength in the muscles that support your joints, especially in the core, hips and shoulders.” If you’re doing weight or resistance training, she recommended not locking your joints such as your elbows and knees.
It is also a good idea to work on control and stability. “Pilates and proprioceptive exercises (such as single-leg balance) can help improve joint stability,” said Lim. “Hypermobility is not inherently bad. It is about awareness and control. With the correct strategies, those with hypermobile joints can stay active, strong and injury-free.”
But if you keep sustaining injuries, consult a physiotherapist. “A tailored programme can make a world of difference in managing your symptoms and prevent injuries,” said Lim.
(Photo: iStock/Lyndon Stratford)
To help “build muscle control, balance and endurance”, Dr Oey suggested trying these exercises three to four times a week, two to three sets of 10 to 15 repetitions per exercise. “Prioritise form over reps; it’s about control, not speed,” he said.
Hip strengthening: Glute bridges
Lie down and use your core to lift your buttocks up and off the ground. Hold for 10 seconds. Repeat 10 times.
Hip stabilising: Side-lying leg lifts
Lie on your side. Lift the top leg until it forms an “L” with your body. Slowly bring the leg down. Repeat 10 times for each leg.
Core control: Planks
Get into the push-up position. Keep your upper body/torso straight and aligned with your back and legs. Hold this position for at least 30 seconds.
Shoulder stability: Wall angels
Stand against a wall with slightly bent knees. Raise your arms and place your forearms and the backs of your hands against the wall, forming a "W". Slowly slide your arms up the wall, maintaining contact with your back, head, elbows and hands, until your arms are extended overhead in a "Y". Repeat this 10 times.
Knee control: Mini squats with bands
Loop resistance band around your knees. Stand with your feet hip-width apart, and toes out at the 10 and 2 o'clock positions. Bend at the hips first and then the knees, slowly lowering yourself down until your thighs are parallel with the floor. Come back up and repeat 10 times.
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You could chalk up your friend's flexibility to her consistent practice or that she is born with flexible hamstrings. Or the off chance that she may have hypermobility, especially if she is also able to bend her thumb back to touch her forearm (more of that in a bit).
Hypermobility is what people refer to as "double-jointed" or that “some of your joints can move beyond the normal range, almost like the connective tissue or ‘glue’ that holds the joints together are extra bendy”, said Dr Nicodemus Oey, an associate consultant with Division of Rehabilitation Medicine at Alexandra Hospital, Ng Teng Fong General Hospital and National University Hospital. “We can think of it as being naturally more flexible than average.”
But isn’t being flexible more of a blessing than a curse? Not always, according to mobility experts. Here’s what they say about hypermobility:
(Photo: iStock/fizkes)
HOW DO YOU TELL IF YOU’RE HYPERMOBILE?
One self-screening tool for hypermobility is the 5-Point Questionnaire or 5PQ, said Brenda Lim, a senior physiotherapist with Tan Tock Seng Hospital’s Department of Physiotherapy. “If you answered ‘yes’ to two or more of these questions, it may suggest hypermobility.”
- Have you ever been able to place your palms flat on the floor without bending your knees?
- Have you ever been able to bend your thumb to touch your forearm?
- As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
- As a child or teenager, have you ever dislocated your kneecap or shoulder on more than one occasion?
- Do you consider yourself “double-jointed”?
You could have hypermobility if you can bend your thumb to touch your forearm. (Photo: iStock/Tatiana Foxy)
What clinicians use is the Beighton Scoring System, a nine-point screening tool to measure joint hypermobility, said Lim. “A score of four or more out of nine may indicate hypermobility, although a full clinical assessment is recommended to confirm,” she said. And the "tests" are very similar to the 5PQ:
- Being able to bend your pinky back beyond 90 degrees.
- Bending your thumb to touch your forearm.
- Being able to hyperextend your elbows beyond 10 degrees.
- Being able to hyperextend your knees beyond 10 degrees.
- Being able to bend forward and placing your palms flat on the floor with the knees straight.
WHAT CAUSES HYPERMOBILITY? HOW IS IT DIFFERENT FROM FLEXIBILITY?
“The underlying cause of hypermobility is thought, in part, to be genetic factors,” said Dr Oey. However, hypermobility comes in a “spectrum” and “often cannot be ascribed to any particular gene”. “Most of the time, we cannot know for sure what is the cause of hypermobile joints,” he said.
As for the difference between hypermobility and flexibility, UK osteopath Stephen Makinde wrote on Perfect Balance Clinic that the latter is a broad term referring to the available range of movement in your body. “(Flexibility) is determined by the level of give in your muscles, fascia and nervous system. We are all born with a high level of flexibility and this naturally declines as we age.”
Makinde wrote that your daily flexibility can be affected by activity levels, temperature and hormonal changes. But “hypermobility remains relatively consistent with only minor age-related changes”.
Hypermobility is also more about your joints and ligaments rather than your muscles. “Hypermobility occurs when the connective tissues that support your joints, such as ligaments, are more elastic than usual,” said Lim. “This allows the joint to stretch further, often without pain.”
According to Lim, hypermobility can affect a few joints (localised hypermobility) or throughout the body (generalised hypermobility). “Joint hypermobility tends to be more common in women than men, and also within the younger population as hypermobility decreases as you get older,” said Lim.
CAN YOU BECOME HYPERMOBILE FROM STRETCHING MORE?
Not exactly, said Dr Oey. “You can increase flexibility with stretching but true hypermobility is usually genetic – you’re born with looser collagen in your ligaments.” Lim agreed: “It is linked to how your connective tissues are formed, particularly the collagen.”
In fact, those who already have some joint looseness can push their joints into unsafe zones, which may lead to instability or injuries, if they over-stretch, warned Dr Oey. “Think of a rubber band left stretched out too long.”
He added that “yoga or gymnastics won’t change your genetics but they can push your joints into unstable ranges if you’re not strengthening alongside stretching”. “That’s why ‘flexible but weak’ often leads to injuries,” he said.
WHEN DOES HYPERMOBILITY BECOME A PROBLEM?
For some people, hypermobility can lead to pain or injuries, according to Dr Oey. In his practice, he often sees such issues in people who practise yoga, dance or sports where flexibility is overemphasised.
Lim also sees hypermobile patients sometimes, “although it is often not the main reason why they are referred”. “Many of them only discover they are hypermobile after an injury or persistent joint issue,” she said.
(Photo: iStock/LSOphoto)
As it turns out, hypermobile individuals are more prone to joint sprains, especially in the ankles and knees. “They are also more prone to dislocation or partial dislocation of the kneecap or shoulders, or tendon overuse injuries,” said Lim. “They occur due to joint instability, where the supporting structures are unable to hold the joint in a stable position during movement.”
If you suspect you have hypermobile joints, you may often suffer from back or neck pain due to the “instability of the spine and fatigue, or muscle tightness from overcompensation by the surrounding muscles”, said Lim.
During sports or physical training, hypermobile joints can “move into positions that go beyond the fully straight range” called hyperextension, said Lim. “This may put added strain on your joints and soft tissues, increasing the risk of injury over time such as joint wear-and-tear, muscle overuse and strain as well as poor posture and movement patterns.”
For example, when performing a plank or push-ups, your elbows may lock out instead of the core muscles working, said Dr Oey. “Hyperextension stresses the ligaments and can cause early arthritis or tendonitis.”
A hyperextended elbow. (Photo: iStock/Awart)
WHAT CAN YOU DO IF YOU’RE HYPERMOBILE?
The key thing is to strengthen, not overstretch, said Lim. “Focus on building strength in the muscles that support your joints, especially in the core, hips and shoulders.” If you’re doing weight or resistance training, she recommended not locking your joints such as your elbows and knees.
It is also a good idea to work on control and stability. “Pilates and proprioceptive exercises (such as single-leg balance) can help improve joint stability,” said Lim. “Hypermobility is not inherently bad. It is about awareness and control. With the correct strategies, those with hypermobile joints can stay active, strong and injury-free.”
But if you keep sustaining injuries, consult a physiotherapist. “A tailored programme can make a world of difference in managing your symptoms and prevent injuries,” said Lim.
(Photo: iStock/Lyndon Stratford)
To help “build muscle control, balance and endurance”, Dr Oey suggested trying these exercises three to four times a week, two to three sets of 10 to 15 repetitions per exercise. “Prioritise form over reps; it’s about control, not speed,” he said.
Hip strengthening: Glute bridges
Lie down and use your core to lift your buttocks up and off the ground. Hold for 10 seconds. Repeat 10 times.
Hip stabilising: Side-lying leg lifts
Lie on your side. Lift the top leg until it forms an “L” with your body. Slowly bring the leg down. Repeat 10 times for each leg.
Core control: Planks
Get into the push-up position. Keep your upper body/torso straight and aligned with your back and legs. Hold this position for at least 30 seconds.
Shoulder stability: Wall angels
Stand against a wall with slightly bent knees. Raise your arms and place your forearms and the backs of your hands against the wall, forming a "W". Slowly slide your arms up the wall, maintaining contact with your back, head, elbows and hands, until your arms are extended overhead in a "Y". Repeat this 10 times.
Knee control: Mini squats with bands
Loop resistance band around your knees. Stand with your feet hip-width apart, and toes out at the 10 and 2 o'clock positions. Bend at the hips first and then the knees, slowly lowering yourself down until your thighs are parallel with the floor. Come back up and repeat 10 times.
Continue reading...