Ttouch the inside of the forearm with the tip of the thumb. Bill. Elbows and knees bending 10 degrees or more in the wrong direction. Double check. Pinky fingers that bend backward 90 degrees or more. Almost. Place hands flat on the floor with straight legs and feet together. Comfortable.
If, like me, you can do most of these things, and other joint-breaking feats that make non-flexible people feel a little queasy, chances are you’re hypermobile. For most of my life, I’ve believed this is a good thing: I often feel smug during yoga classes, and am not one to be challenged to the cereal game that involves picking up a cardboard box from the floor with your teeth. Many world-class athletes, from swimmer and most decorated Olympian Michael Phelps to multi-medal-winning gymnast Simone Biles, also have hypermobility. So I’m in good company.
But I’m starting to worry that there may be a downside to joints that are too flexible, such as an increased risk of falls and frailty in old age. Recent research has suggested that hypermobile teens may have an increased risk of joint pain as they get older. So is hypermobility a blessing or a curse, and is there anything flexible people can do to protect themselves from injury?
Hypermobile joints are joints that flex beyond the typical range of human motion, due to variation in the shape of people’s bony sockets and hinges, or the stiffness of the connective tissue that holds these structures in place. “We think that with hypermobility the ligaments are a little looser, which allows the joints to bend more backwards,” says Emma Clark, rheumatologist and professor of clinical musculoskeletal epidemiology at the University of Bristol.
Some people have only one such joint, while others may have many excessively mobile joints, known as generalized joint hypermobility (GJH). One way to diagnose this is to use the Beighton test, which assigns a score from zero to nine based on the flexibility of a person’s thumbs, little fingers, elbows, knees and spine. For children and adolescents, a score of six or more is indicative of GJH; for men and women under 50 this is five or more, while for those over 50 a score above four would be sufficient.
Although this tool does not assess all joints, and these limits have been internationally debated, “it does give an indication of this general hypermobility or laxity in the joints,” says Jane Simmonds, professor of physiotherapy and health education at University College London, who works with children and adolescents with hypermobility-related problems, such as joint subluxations and dislocations.
Scientists have also used the Beighton score to assess the prevalence of joint hypermobility in populations. When Clark and her colleagues assessed 6,022 British 14-year-olds, they found that 45% of girls and 29% of boys had hypermobile fingers; while 27.5% of girls and 10.6% of boys had a Beighton score of four or higher.
Among adults, up to 20% of the population suffers from generalized hypermobility, with women and people of African-Caribbean and Asian descent more likely to suffer. Many of these people are completely healthy or have only mildly debilitating symptoms. I tend to twist my ankles on rough terrain and I suspect I am clumsier than average because I frequently stub my toes or bump into the same old pieces of furniture; some studies have suggested that proprioception – the sense of where your body is in relation to things around it – may be somewhat disturbed in people with hypermobility.
However, hypermobility can also be beneficial. “Some of the greatest athletes in the world are hypermobile,” says Simmonds. a study of students and professional dancers at the Royal Ballet School in London found that hypermobility is eleven times more common among dancers than the general population. Hypermobility is also more common among people elite swimmersincluding Phelps, who many experts believe is hypermobile shoulders, knees and ankle joints. “Swimming lends itself to hypermobility. If you have more range, you can push more water and propel yourself,” says Simmonds.
So is hypermobility something to worry about, or should we celebrate our flexibility? “I think it’s probably important to realize that joint mobility is on a spectrum – from people like me who are very stiff on one end, to people who have a lot of joint hypermobility but don’t have any problems, like athletes and musicians, to people with a recognized clinical syndrome,” says Shea Palmer, professor of physiotherapy at Cardiff University.
Somewhere between the last two categories are people with so-called joint hypermobility syndrome, who do not quite meet the diagnostic criteria for a connective tissue disorder, but whose hypermobility causes them pain or other problems. Research by Profs Palmer and Clark found that joint hypermobility in early adolescence was associated with a doubling in the risk of moderately bothersome shoulder, knee or ankle pain when those teens turned 18.
“If you add obesity to that, they were 11 times more likely to have at least moderate knee pain at age 18,” says Palmer. “What we think is happening is that if you have a lax joint, its parts will move a lot more, and the joint surfaces will be rubbed together more often than in a healthy person, which could be causing some of the pain cause.”
People with joint hypermobility syndrome or connective tissue disorders are also more susceptible to this fatigue – possibly due to the effort associated with constantly trying to keep the joints stable – as well as more common joint injuries, easy bruising, stretchy or soft skin and stomach and digestive problems, because connective tissue is important in the composition of the intestines, skin, blood vessels and joints.
Of course, ordinary people can also suffer joint injuries. What a doctor would look for is whether there is a pattern to these injuries, Palmer says. “If you have recurring problems in multiple joints, it is very apparent that you are hypermobile and have difficulty controlling movement in these joints, and you may have other signs associated with connective tissue disorders, then this package would indicate that your hypermobility may be a factor.
In such cases, the remedy will likely focus on strengthening the muscles around the joints, as well as exercises to improve posture and daily movements – as standing balance exercises on a wobble board to improve balance, or basic mat-based Pilates moves and resistance band exercises to build strength, as well as aerobic exercises that get the heart pumping, such as walking or swimming.
“By strengthening the muscles and relearning how they control movement in the joints,” says Palmer, “we hope to reduce the amount of irritation that occurs in the joint and reduce pain – or certainly prevent it from occurring in the joint.” worsens over time. the long term.”
Researchers led by Muhammad Maarj of the University of Newcastle in Ourimbah, Australia, are also investigating whether custom-made shoe or heel inserts, known as orthoses, can help improve gait and balance in children with generalized joint hypermobility. In a small one study Published last year, they found that children reported less lower limb pain and had a better quality of life after wearing custom-made orthoses for three months.
As for hypermobile but largely healthy individuals like me, the advice is simply to stay active. “As we get older, we need to do more activity, not less,” says Clark. “I see people who did a lot of sports as a teenager, then life gets busy, their exercise level drops and I see that they get pain in their hypermobile joints.”
Her hypothesis is that joints previously supported by strong muscles are less well supported, and this could be the cause of their pain. Exercise can also help people maintain flexibility, says Clark, showing me her own hypermobile fingers and thumbs. She is a violist and believes this trait has aided her ability to comfortably reach the notes on the instrument’s neck. Now that she is in her fifties, only the fingers of her left hand – the one that plays these notes – are still hypermobile. The other hand is slightly stiff. “That’s not very scientific evidence, but it does make me think that the theory that exercise maintains hypermobility is probably correct,” she says.
So if you are hypermobile, you can continue with joint avoidance contortions, provided it does not cause you pain or other problems. And if your loose joints become problematic, staying active is probably the best medicine there is, although you should consult a doctor for further advice. As for me, I’ve decided to do more yoga, pilates and swimming which I love – especially as such exercises are likely to facilitate balance and joint control. And if you’d like to challenge me to a round of breakfast cereal, then you’re welcome to join us.