Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

The Darker Side of Hypermobility

I was teaching a musician wellness class for a group of high schoolers (with a few college students/grownups mixed in), and the bulk of the girls were very hypermobile, especially in their knees and elbows.  They were also, coincidentally very disembodied and disconnected from their body, as many teenagers can be. When I explained what hypermobility is, and how to tell if your knees are hypermobile, one girl immediately said "This is how I always stand (knees locked out beyond 180 degrees).  Should I not do that anymore?  It doesn't hurt."  I in turn suggested that she not lock out her knees or elbows, but it reminded me of another side of hypermobility - that of pain, joint dysfunction, and potential damage to the surrounding tissues that may take years to manifest.

Aside from hypermobile knees and elbows, many people have unstable wrists, fingers, thumbs, and other joints.

Aside from hypermobile knees and elbows, many people have unstable wrists, fingers, thumbs, and other joints.

I've mentioned hypermobility before, but mostly in terms of fingers that won't behave in the context of music (piano, violin, clarinet, etc).  Joint hypermobility syndrome is often characterized by many hypermobile joints, i.e. joints that move beyond normal range of motion.  Yet, hypermobility is also a result of inherited (genetic) factors, lack of proprioception (knowledge of the where the body is in space), muscle weakness/strength imbalances, as well as all-over joint instability and susceptibility to soft tissue and joint injuries, as well as pain.  It can also be part of a larger diagnosis, such as Ehler-danlos syndrome or Marfan syndrome, amongst others.  (*Ehler-danlos syndrome is a connective tissue disorder than can manifest in many other non-hypermobile ways, including internal organ and skin dysfunction). 

This woman's standing left leg is locked out past 180 degrees, meaning that the joint is not stable and her left hamstrings and calves aren't supporting her weight.  In addition, her right leg easily moves to 180 or more degrees, so the result is that neither group of muscles is being stretch but instead ligaments are doing the bulk of the work here.

This woman's standing left leg is locked out past 180 degrees, meaning that the joint is not stable and her left hamstrings and calves aren't supporting her weight.  In addition, her right leg easily moves to 180 or more degrees, so the result is that neither group of muscles is being stretch but instead ligaments are doing the bulk of the work here.

I read a very insightful blog this week in Yoga International, about a woman diagnosed with JHS, working with a wide range of symptoms including joint pain, excessive range of motion, immunity challenges, osteoarthritis, and a host of other health challenges.  When someone who is hypermobile loads an unstable joint with weights or body weight, they are not using muscles to hold themselves up, but instead ligaments are bearing the brunt of the job.  Most hypermobile students do not need to stretch unless they can do so in a way that respects a conservative range of motion and expands proprioception.  They often instead need to build strength and stability within a joint, rather than continued expanding range of motion.    I myself am not particularly hypermobile, but I have seen excessive ranges of motion glorified in yoga, gymnastics, exercise, and other movement disciplines as a "goal."  I've also had some of my yoga teachers tell horrifying stories of debilitating pain after yoga classes in which they used their inherent joint instability to "achieve advanced poses" or perform impressive feats, only to regret it later.  Even if you're not a yoga teacher or practitioner, it's important to be sensitive to the fact that most people who are hypermobile don't know that they are, and don't know that there's a potential for long term tissue damage and pain.  As musicians, music instructors, and movement educators we have the ability to help our students find their natural joint ranges of motion, get them standing better, and help them in their own journey of kinesthetic learning.