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Hypermobility vs Flexibility: Do you know the difference?

Georgina Watson, author of this blog is a talented physiotherapist in Birmingham, she does targeted physiotherapy for circus athletes. Given many of you stretch and contort your way through many of our classes, instructors too, we thought this blog would be of interest.

Keep your body safe and work within it's limits.

Hypermobility vs Flexibility: Do you know the difference? Hypermobility is something most dancers, contortionists, gymnasts and aerialists envy because those that have it obtain positions easier and quicker e.g. box splits, than they have been able to achieve. But should they be?

Whilst flexibility refers to the ability to lengthen muscles, hypermobility refers to a laxity in a person’s ligament or ligaments.

A brief overview – A muscle is a tissue that produces movement when it contracts and a ligament connects one bone to another. Ligaments do not contract, instead, they provide stability to our joints to allow our body to move in a way that we require.

Hypermobility refers to a condition involving laxity of our ligaments, due to a genetic anomaly that influences the extensibility and elasticity of our connective tissues. Severe joint hypermobility includes conditions such as Ehlers-Danlos and Marfan syndrome. These conditions as well as including severe laxity of the ligaments can also cause widespread joint pain, repeated injuries and joint dislocations/subluxations, poor proprioception, fatigue and more.

A lot of people may have hypermobility in one or two areas of the body, but only a small percentage of the population will have all over hypermobility and will score 9/9 on the Beighton Score, which is derived from observation of:

• Bilateral knee hyperextension beyond 10 degrees • Bilateral elbow hyperextension beyond 10 degrees • Bilateral flexion of the wrist to touch the thumb to the inside of the forearm • Bilateral ability to place the palm flat on a table and lift the middle or index finger to a vertical position • Ability to place the hands flat on the floor without bending the knees

Each position is rated as 1 in the athlete can achieve this position of 0 if they cannot, thus achieving a total score of 9. Recent work has shown that a score of 7 points or more may require additional attention from a physiotherapist.

So, what happens when we stretch? When we stretch, we are attempting to reduce the tone of our muscles (this is a whole topic or another blog but simply put, we don’t alter length of our muscles but if they got longer then contortionists would just be a gangly mess of long floppy limbs). This tone will either continue to reduce as you continue with regular stretching or, it will return to its original state. Ligaments however, do not return, once they are stretched then that is it for them. A lax ligament will no longer support the joint which can result in pain and injury for many of those who do not know how to properly strengthen the appropriate muscles surrounding the joint. Overstretching a ligament is therefore a great big “no no”.

Is stretching if you’re hypermobile safe? If you are someone who has hypermobility in one or two areas then the answer is yes, but, if you score 7 or above on Beighton’s score then you may benefit from a consultation with a doctor or physiotherapy first. These appointments can help to reduce pain and risk of dislocations, improve muscle strength and fitness and improve posture and balance. Like with every condition, each individual is unique and what works for one may not work for another. Strength-based training is ultimately the way forward with most clients having to work on body weight based exercises initially. Those who have true hypermobility sometimes say that gentle stretching actually eases their pain and also find yoga a helpful tool as this improves their muscle strength around their joints and improv

es their stability. This being said, it is advised that you:

• Take your time and pace yourself as some find an hour long yoga class too intense initially • Look after your joints – hypermobile people may not often feel the stretch initially but may experience pain the following day, therefore it is recommended that you start off slowly and gradually go deeper each time, reviewing the pain the following day (trust me! I have hypermobility in my hips and I participated in intense stretching one day and the following week I had to get my boyfriend to put my shoes and socks on for me because the pain of bending was unbearable) • Watch your positioning – lack of proprioception (your bodies awareness of where you are in space) means that it is easy to ‘over-bend’ into positions so working in front of a mirror if learning a new pose, having a qualified yoga instructor or taking photos could benefit you • Don’t slump into your joints – actively engage in your stretches so that your muscles are holding you and not your ligaments. A sustained passive stretch could increase your risk of injury. • For more information I recommend this blog that was created by someone with personal experience of yoga with Ehlers Danlos.

What about contortion? Again, each individual is unique. Whilst some will struggle with pain daily as a result of their condition, others can utilise their hyper mobility and indeed create more to further push their limits. The golden rule for contortionist as stated by Betsy Shuttleworth (a professional contortionist) “stretch what you strengthen and strengthen what you stretch”. If you are looking to take up contortion, making sure you have an experienced coach such as Hannah Finn (UK) or Catie Brier (USA) is essential.

Any questions?

Find Georgina's website here: or drop her a message via email to: and find her on Facebook and Instagram –@fizzylemonphysiotherapy

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