Your Hypermobility Crash Course

Yoga for Bendy People: Post #2

This is the second post for our book club featuring Yoga for Bendy People by Libby Hinsley. If you have not yet ordered the book, I encourage you to do so here and join us!

Also, please be sure to register for our conversation with Libby on June 29th at 9am Pacific. I’ll put the registration link at the bottom of this post. If you’re not a paid member and you’d like to join us, consider upgrading your membership.

(To go back and read posts from the beginning, click on Yogaland Book Club in the top navbar)

Chapter 2: Hypermobility 101

There are two big takeaways for me in Chapter 2. The first is that it’s important to understand the difference between flexibility and hypermobility. The second is that getting a diagnosis of Ehlers Danlos Syndrome or Hypermobility Spectrum Disorder can be a slog, largely because there is not enough awareness of these disorders.

To dive deeper, Libby starts Chapter 2 Libby by offering definitions of common terms that are often used when we discuss hypermobility. Here’s a shorthand recap:

• Range of motion (ROM): The amount that a joint can move in any direction.

• Active range of motion: The amount you can move a joint when you are using your muscles.

• Passive range of motion: The amount that you can move a joint when someone or something (like a yoga strap) helps you move it.

Libby also describes mobility, flexibility, and hypermobility:

• Mobility is movement available to a joint due to bone shape and the joint capsule and ligaments surrounding it.

• Flexibility is movement available to a joint due to muscle strength, length, and resting tone.

• When it comes to understanding the difference between flexibility and hypermobility, Libby offers this helpful tidbit (and I’m paraphrasing): Whereas hypermobility refers to what’s going on in the joint specifically, flexibility refers to the ability of the muscle and nervous system to use the range of the motion that the joints have.

What does this mean if you are a yoga teacher? It means that you might not be able to “see” hypermobility. A student might not appear flexible because tight muscles hinder their range of motion. But these tight muscles could be the result of a body trying to stabilize hypermobile joints.

Alternately — and this is very important! — you might see a very flexible person with a lot of range of motion who is not at all symptomatic of a hypermobility syndrome. If they don’t have hypermobility symptoms, then it might never be a problem for them.

On page 53, Libby talks about guiding your students without overstepping — it’s not a yoga teacher’s role to diagnose:

Keep in mind there’s a giant leap between observing someone’s impressive mobility in your class and diagnosing them with a hypermobility syndrome. However, yoga teachers are in a unique position to raise awareness about hypermobility, have conversations, and ask questions that may lead someone to a greater understanding of their condition.

If you’re a yoga teacher and a student reports symptoms you think are related to hypermobility, an in-depth examination is warranted. A good place to start is with their primary care physician or physical therapist.

With terms established, Libby goes on to explain what hypermobility syndromes are and what causes them. Spoiler alert: No amount of stretching that is done in yoga class will cause hypermobility. However, if a hypermobile person stretches excessively, they are more likely to experience pain and injury.

Here’s what does cause hypermobility:

In many cases hypermobility is caused by an underlying genetic difference in the collagen within connective tissue. (p.45)

These genetic differences lead to more laxity (or floppiness, as I like to call it) in connective tissues that contain collagen, such as joint capsules, ligaments, tendons, and fascia. The result is joint hypermobility that is more likely to be associated with increased injury risk and symptoms across multiple systems of the body. That’s when its referred to as a joint hypermobility syndrome or disorder.

Libby has the most common connective tissue disorder that includes hypermobility as a symptom, Ehlers-Danlos Syndrome. There are 14 subtypes of EDS and the hypermobile type (hEDS) is the most common.

A few years ago, the International Consortium on EDS narrowed down the diagnostic criteria for EDS, which means that now fewer people fit all the criteria for a hEDS diagnosis. These people are instead given the diagnosis of Hypermoblity Spectrum Disorder (HSD).

Bottom line: There is crossover between hEDS and HSD. This is, in part, why Libby refers to people with HSD or hEDS as “bendy.”

Libby closes the chapter by, importantly, telling her story of suffering with vague but intrusive symptoms for some time before she was able to get diagnosis. She describes experiencing joint pain, fatigue, heart palpitations, brain fog, and depression.

She explored numerous avenues to no avail. She saw acupuncturists, PTs, naturopaths, an integrative MD as well as a rheumatologist, gastroenterologist, and a cardiologist, none of whom put the clinical pieces together. It wasn’t until she was referred to a geneticist that she found validation for all she’d been experiencing — and he diagnosed her nearly immediately after reading her paperwork.

Her story is painful to read and speaks to the importance of continuing to advocate for yourself if you know, in your gut, that something is not right.

I’m curious to know — did this chapter clarify things or add confusion? Anything you’d like to ask Libby after reading it? Did her experience of being diagnosed (or going undiagnosed for some time) resonate? Let me know in the comments.