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What is Hypermobility, and how can physical therapy help?

Hypermobility is steadily raising awareness in the world, and more and more folks are recognizing it in themselves, their friends, and their bodies. As a physical therapist, I absolutely love working with Hypermobile humans, or "Zebras," because I think we're a wonderfully unique population that's under-served and misunderstood by most medical professionals. With great motion comes great responsibility, and that can be really exciting. But we'll get to that.

Before we get into it, let's make sure we're on the same page.


Hyper: extra, or more.

Mobility: range of motion*

Hyper + mobility = extra range of motion.

*(I usually use mobility to describe range of motion + strength, but in the context of hypermobility, it is describing an increase in available range of motion).

Hypermobility can come in a few different varieties. There's trained hypermobility for example, in baseball pitchers. They have waaaaay more range of motion in their pitching arm compared to their non-pitching arm, because they've spent years training it. So that joint would be described as "hypermobile."

You can also find hypermobility that's due to the shape of the bones themselves; shallower hip sockets might give someone more range of mobility. It's like trying to move a stick that's stuck in a deep cup, versus a shallow one; the stick in the shallower cup will be able to move further. For some folks, it might just be one joint, or a matching set on either side of their body.

And lastly, there is hypermobility that is driven by a collagen variation. Collagen is one of the foundations of our bodies, building everything from our bones to our ligaments and organs, to our vascular system and our brains. There are certain genetic variations of the genes that produce collagen, and from the list above, a genetic variation in this gene is going to affect the whole body.

The most common one is Ehlers Danlos syndrome. Ehlers Danlos is a great example of of hypermobility and collagen variations, because the presentation can vary from person to person. Individuals with Ehlers Danlos might notice they can hyper-extend all of their joints, past 180 degrees at knees and elbows, bend their thumbs back to touch theri forearms, and easily touch the floor.

But let's talk about *what* the variation in collagen is actually doing. Collagen is tehnically meant to be "elastic," like a rubberband. Which means it's supposed to allow stretch, and then exert force to rebound back to its original shape. With most hypermobile collagen variations, there's a decrease in the 'elastic' part, or the rebound part. Which means that hypermobile skin, tissue, ligaments, all those things that are supposed to hold us together can stretch, and stretch, and stretch, but don't naturally rebound on their own.

What's key about this, is that most people think hypermobility is only joint related, and it's not. Collagen is present throughout our body, so this variation has global impact. For example, hypermobile folks are more likely to be diagnosed with POTS, or Postural Orthostatic Tachycardia Syndrome. Why? Because when at rest, their blood vessels expand and stretch, and stretch as blood collects in the lower extremities. Remember, blood only returns to the heart when muscles are contracting and helping actively pump it back.

In hypermobile folks, there's less passive pressure from the walls of the blood vessels to help push it back. So the blood collects in whatever part of the body is closest to the point of gravity, and blood pressure plummets.

Want to know how I spot hypermobiles in public? I look for the people who want to sit on the ground, or who sit with their legs tucked underneath them, because we're literally trying to keep our blood as close to your heart as possible.

Here's a list of some other common symptoms in folks with a collagen variation.

- Blood pressure variations, low blood pressure, or "going dark" regularly upon standing or sitting up.

- GI issues, slow digestion, easy bloating, IBS, constipation.

- Concurrent diagnosis of ADHD or Autism.

This one is truly fascinating, but if you think about the collagen in the brain, it means that the brain is structurally different than those without collagen variations. And therefore, it might function differently. Check out this amazing article looking at the overlap between the two.

- Increased discomfort during sitting (airplanes especially suck)

- Increased fatigue during sitting unless especially supported (because your muscles are constantly on keeping you upright, because you can't rely on your ligaments to passively hold you up)

- Stretchy, elastic skin, or skin that people describe as "Oh my gosh, you're so soft!"

- Decreased awareness of where you are in space; feeling clumsy all the time.

So, looking at that list, hypermobility might seem like it sucks. But like I wrote earlier, with great motion comes great responsibility. There are definitely challenges. It can be hard, navigating a body and brain that function differently.

So why am I excited whenever I work with hypermobile individuals in physical therapy? Because there's so much amazing potential. Many Cirque du Soleil performers are hypermobile. Contortionists, athletes, gymnasts, ballerinas, pole dancers. All that extra motion can be harnessed to do amazing things.

From the perspective of physical therapy, I don't see the extra range of motion as a problem. I see the lack of control and the lack of strength as the issue. As a physical therapist, when I'm working with a bendy body, I focus a lot on strength, throughout the whole range of motion. If you have to rely on your muscles more to keep your joints in place, that means they need to be really strong, and have a good deal of endurance to handle the day to day. Which means strength training.

That's right; in rehab with me, strength training and weight lifting is key. And I find for a lot of people, it can be incredibly empowering to not only understand what's happening in their body, and then be able to lift weights they'd never considered before, safely.

Physical therapy can help address a lot of the symptoms of hypermobility because we're targeting your weaknesses to give you more control of your body. It gives you the strength to prevent your joints from subluxing so often, and can help reduce chronic pain by giving you more stability.

When someone asks me what physical therapy can do for someone with hypermobility, I often feel like it's more like "what can't we do?"

So, if that sounds like you, or you want help getting empowered in your bendy body, reach out at!

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