5 Tips to Safely Deal with Hypermobility
Hypermobility joint syndrome (HJS), is not a disease in a real sense. 10% or even more people, in some population groups, have looser joints. This means that they have a much greater range of motion than others.
The Brighton Score test  is a way to see if you have hypermobile joints. It is a simple 9 points system that quantifies joint laxity and mobility. In general, if you say yes to any of the following questions, you are likely to be hypermobile:
- Pull either of your thumbs down to your wrist?
- Hyper-extend a knee or an elbow by 10 degrees? In another word, if you lock your elbows/knees, do they form a curve line?
- Bend a little finger back to 90 degrees?
- Put your palms flat on the floor without bending your knees?
As some of your yoga students will be able to bend forward and place the palms on the floor with straight legs, due to training, the easiest way to spot potential hypermobility in your students is to look at their elbows and knees:
- If they stand with their knees straight and locked, do they form a curve line?
- If they stretch their arms to the fullest degree, does the arm bow?
Why Hypermobility Can Be an Issue?
1. The ligaments around the joints might get strained, resulting in inflammation and eventually injury
When a joint is hypermobile and therefore able to extend to far, the stabilizing muscles around that joint are relaxed, and the entire body weight hangs in the ligaments around the joints. Since ligaments are not designed to sustain weight, over time, this will cause potential problems such as inflammation, rupture or tear.
2. The cartilage around the ends of the bones might get inflamed, resulting in arthritis-like symptoms and degenerated cartilage in the long-term
When a joint is hyper-extended beyond its intended range, there is a chance that the protective layer of cartilage on the ends of the bones get rubbed together and start to get inflamed. In this case, one might develop arthritis-like symptoms with swelling in the night or after some physical exercise.
On the long run, this friction between the articular cartilages of two bones, might result in a permanent wear-and-tear and inflammation of the bone cartilage and joint capsule.
3. The risk for injuries and sprains is increased when the hypermobility is exploited in combination with weight-bearing
There are certain risks involved in hypermobility. Human muscles are attached to bones in such a way that they work optimally within a certain range. The strength of muscles is maximum when they are in the mid-point. Muscles are weaker at the extremes.
That is why when you squat too low with a weight in a gym, you may not be able to stand up. It means that those living with hypermobility are at higher risk of moving their joints to extreme ends, where the muscles are least effective. Which considerably increases the risk of injuries, sprains, and strains.
Is Hypermobility a Curse or a Blessing?
Hypermobility is not a curse if it is recognized and appropriately exploited. People with extreme hypermobility can use it in their favor.
Most researchers think that inherited flexibility is rather an asset in many cases than a liability; it is especially true when participating in performance arts.  For those born with hypermobility, it means achieving better results with less training.
It is not a disease, just a condition that increases the risk of trauma in specific circumstances. One has to learn to avoid getting into those conditions.
Yoga and Hypermobility: What a Yoga Teacher Should Keep in Mind
Interestingly, those with hypermobility are more probable to join yoga classes than other people. After all, these are the individuals who know that they can do most yoga poses or asanas with little practice.
In fact, the biggest explanation for not practicing yoga is the hypomobility or body stiffness. It is common to hear people complaining that “I can’t do yoga as I cannot even touch my feet.” It means that those who have inherited flexibility are at a particular advantage.
However, this benefit of hypermobility is exaggerated. Since those living with hypermobility are at a higher risk of hurting themselves when trying to over-exploit their loose joints, they are more probable to hurt their muscles, tendons, and ligaments.
This does not mean that yoga is bad for hypermobility, it means that we as yoga teachers have to be cautious when teaching people with hypermobility joint syndrome.
Yoga and Hypermobility: 5 Cautions for a Safe Yoga Class
1. Do not over-appreciate hypermobility
Students with hypermobility can easily perform certain asanas that take others months or even years to learn. Teachers therefore are often tempted to use these students to demo such postures. And as these students are able to conform much quicker to our conditioned ideas of a perfect alignment and a beautiful pose, it is tempting to praise them for it. Even though we recommend praising your students for their efforts on a regular basis, make sure you do not over-appreciate the hypermobile person for their ability to do a particularly deep expression of a pose.
Two reasons for that: Firstly, other students who do not possess such a great range of flexibility might feel discouraged. And secondly, the hypermobile student might over-exploit their mobility and cause damage in the long-term.
2. Bring the awareness to unconscious movement patterns
Hypermobile people need to focus on learning to keep their joints at a healthy angle. The pattern to stand, walk and exercise with hyper-extended knees is particularly worrisome for the health of the knee joint and the spine. Bearing all your body weight on hyper-extended knees will eventually damage the ligaments, cartilage or menisci. As the knees are locked, the alignment of the pelvis changes as well, often leading to a lordosis in the lumbar spine.
Therefore, regularly remind your students to become aware of their joints, and as a thumb-rule if they feel at ease with an extension or flexion of a joint, reducing that said extension or flexion by a notch. So for example, while standing, ask them to keep the knees soft (to them it will initially feel as if the knees are bent).
Watch out for:
- Hyper-extended (locked) knees in standing postures such as Mountain Pose, Dancers Pose and other standing balances where one of both legs are straight.
- Hyper-extended (locked) elbows in weight-bearing postures such as Downward-Facing Dog and Inclined Plane.
3. Encourage them to NOT go to extremes
Intentionally avoid going to extremes, so that not to injure oneself. As at the extreme range, muscles are weaker and more probable to get hurt. Many people with hypermobility may hurt themselves just by being over-enthusiastic, just trying to prove that they can do specific asanas in their first attempt and quickly. Remind your students to move slowly and train the brain to be aware of the smallest of movement.
4. Focus on strengthening
Hyper-mobile people need to develop muscle strength, instead of trying to exploit inherited flexibility. That is the key to practicing yoga safely and effectively. Strengthening the muscles around the joints won’t reduce the inherent hyper-mobility, but it give more stability to the joint. This significantly reduces the risk of sprains and strains, or other kind of injuries.
5. Give feedback
Just as with any other student, verbal feedback and gentle physical assists will help hypermobile students understand how to improve their alignments. This also means to tailor your instructions to their needs. In a deep back bend for example, where most people will focus on moving deeper into the pose and lengthening the front of their body, you could ask your hyper-mobile student to stay slightly active in their core and restrict the movement.
About the Author
Kalyani Hauswirth-Jain is a senior teacher & the Creative Director at the Arhanta Yoga Ashrams since 2013. She is a lead trainer for the 200 hour Yoga Teacher Training, 300 hour Yoga Teacher Training as well as a variety of 50 hour courses like Yin Yoga and Vinyasa Yoga, for more than eight years now.
She has also co-authored the book Hatha Yoga for Teachers & Practitioners: A Comprehensive Guide to Holistic Sequencing.