Hypermobility Syndrome
How much should you stretch a hypermobile joint? Is “NOT AT ALL” too obvious?
Technically, this is too wordy for an introduction, but all of it needs to be said. And when I brought up the topic in an anatomy class in India, every head turned, particularly when I talked about the connection with anxiety.
To be semantically correct, since 2017, the correct term is “Ehlers Danlos Syndrome Hypermobility Type (H-EDS). However, let’s stick with Hypermobility Syndrome (HS). HS is a genetic condition where the connective tissue of your body is more stretchy than most, and it affects many a good famous yogi. Once you know what to look for, you can just spot it. Unfortunately, it’s more of a medical condition than a quality, which in a way I can see it as being mindful to “own” but stretching hypermobile joints is certainly not a way to liberation outlined Yoga Sutras. Rather, stretching joints that are already unstable is, in a way, doubling down on the source of the problem, much as if an asthmatic took to smoking cigarettes. Which is too bad because yoga otherwise has so much to offer. Hypermobility syndrome turns out to be WAY more common than people think. It’s strongly linked to chronic pain, to include both neck and back pain, and surprisingly anxiety, particularly panic attacks.
Do you have it? If you are female (it’s about 3x more common in females) and you like yoga, odds are that you do. Learn for sure in about 1 minute by doing these self tests.
So what’s the connect with anxiety? That’s actually fascinating and knowing it leads to solutions your psychologist probably doesn’t know about. FYI, I have a love hate relationship with psychology. I love the RESEARCH, it truly is insightful, but much like physical therapy, what the average CLINICAL doctor knows is so far removed from the best of research findings average it hardly does any good at all. So would I tell a loved one with depression and anxiety to see a psychologist or psychiatrist? Unless I knew the persons work ahead of time, no I would not. Otherwise research tends to suggest that little has changed since Timothy Leary found in the 60s that with any given treatment or method a third get better, a third get worse, and a third stay the same.
Digression aside, the link between hypermobility and anxiety is a little complicated but can be summed up as such. Tendons and ligaments are made of collagen which extra stretchy in those with hypermobility. Blood vessels walls are also made of collagen and are extra stretchy too. Such that when a person with hypermobility stands up, like anyone blood wants to rush out of the head and into the abdomen and legs. This happens extra in people with hypermobility owing to the looser blood vessels, and as such there is a tendency to get light headed and pass out. The heart attempts to compensate for this by beating harder and faster to return blood to the head. If successful you won’t pass out, but the elevated heart rate simulates a panic attack. The brain gets the heart to pump faster by secreting the “fight or flight” (which also feels like a panic attack) hormone adrenaline. But this perpetual secretion of adrenaline and racing heart rate for no apparent reason makes you feel crazy, yet it’s a physical problem. Worse the increased adrenaline is thought to be one of the reasons why people with anxiety don’t sleep well, combined with lying in worrying (RUMINATION) about why you can’t sleep in spite of the fact that you feel fatigued. The combination of sleep loss and rumination then appears to be the primary link between anxiety and depression. The increased pain secondary to unstable joints isn’t doing you any favors when you try and go to bed at night either.
The plot thickens in relation to muscles and anxiety. Those with postural tachycardia (rapid heart rate upon standing) literally have smaller hearts, so when they try and beat to keep blood in the head their stroke volume (the amount of blood pumped per heart beat) is measurably less. This is thought to be because hypermobility makes the joints less stable running and jumping in proportionally more difficult. So they are often less athletic as children, often preferring arts and science to sports and recess. It’s not that their heart size is genetically smaller, but that the lesser physical activity does not make the heart grow to it’s normal size. Worse is that often when they do try and be more active their heart, because of it’s smaller size, races more, again simulating/causing a panic attack, which can be very discouraging. The fantastic news here, however, is that recent research has shown that a combination of cardiovascular and strength training, started gradually and increased over time has been shown to be highly effective at increasing heart size, stroke volume, lessening heart rates in patients suffering orthostatic tachycardia.
Another thing about that blood pooling in the legs and abdomen? Interestingly only about 30% goes in the legs while 70% pools in the abdomen. Stretching/loosening your abdominal wall with back bends? It’s hard for me to think of something worse. On the contrary strength training increases muscle tone or tightness, and you get a lot more core strength and muscle with a tight push-up than with an floppy upward dog. A tone that better supports the blood vessels helping with venous return.
Oh, and that “emotional release” you sometimes see in yoga? Wherein after doing core stretch/squish exercises, someone will, for no apparent reason, break out into tears? And the instructor runs over to comfort them, talking about “repressed memories” brought to the surface or “emotions stored in the connective tissue?” NO! That’s a tachycardia, a panic attack, or blood rushing from your brain into your abdomen, and you needed strength, not stretch. The supportive environment, the “collective energy” of the group, is truly awesome, and part of what’s great about modern yoga. But it needs to be connected to better exercise. #SpineFitYoga
And finally, yes, I understand that if you have hypermobility, your muscles feel tight. That’s because they are trying their hardest to hold your joints together. Muscle spasms are your body’s attempt to make you hold still. Stretching only makes their job harder. Make it easier for them by strengthening and contrary to your expectations you’ll feel loser and more relaxed.
Two more tangential factors: A lot of yogis are vegetarian or vegan. I’m pescatarian myself so I very much approve. However, there is research that found that vegetarians, and more so vegans have diets low in salt. Low salt diets can lower blood pressure, which for most people is a good thing. However, for those with orthostatic hypotension/tachycardia the lesser blood pressure is in part related to a lesser blood volume. So not only are the muscles often weaker and looser, but because salt makes the blood hold more water, a low salt diet, lessen blood volume, so there is literally less fluid hold pressure in the brain. That’s worth taking into account with salting your vegetables, or taking some salt tablets. I have not yet scienced up the ideal dose, but 4 grams per day (5 grams is a teaspoon) is the recommended daily allowance. Maybe mention that to your doctor if you have “postural anxiety.” Last (for now) low levels of creatine, generally found in meat has been associated with higher levels of depression. Creatine Monohydrate has been used for decades as a safe and natural supplement for weightlifters to increase muscle strength, and more recent research shows it helps with depression. The good news is that it seems to work particularly well for vegans and vegetarians because their normal diets are low in creatine and better still the supplement does not come from animal sources. 5 grams per day is what I take and is a fairly evidence based dosage. It’s also very inexpensive these days, with a years supply often costing less than $50.
In closing this section I should add that not everyone with hypermobility has pain. If your muscles are strong enough to support your joints hypermobility can allow moves and grace that others only dream of. Ballet is literally based on it. However, what everyone needs to know is that if there is pain and “feelings” of stiffness, more stretch and more passivity is NOT what you need. Downshifting your yoga practice into more passive forms such as “yin” or “restorative” yoga is literally the worst thing you can do. In doing so you are losing any strengthening that more active yoga had, while doubling down on stretches that really were the culprit. I would go so far as to say “yin” and restorative yoga are a final link between hypermobility and fibromyalgia and will eventually leave you with nothing else but yoga nidra with the old ladies. I’ll have more criticisms of “yin” yoga at a later date. However, I should make it clear that I am Taoist. I’ve read the Tao Te Ching several times. Like Bruce Lee I love my Alan Watts! I have felt the flow of the howling Tao on numerous occasions, and I think the concepts of yin and yang fit very well with yoga. They fit very well with most anything for that matter. So I’m not so much criticizing “yin” yoga for being bad yoga. It is, but more so it’s bad Taoism.
Progressive Fitness
How much should you stretch a hypermobile joint? Is “NOT AT ALL” too obvious?
Exercise taking you from rehab to advanced, EFFICIENT, TOTAL BODY FITNESS , ALL AT HOME. If you can max Level-3, film it, cause YOU’RE THE FIRST.
Coming from my background in weightlifting, plus what I have seen rehabilitating those with neck and back pain is that “use it or lose it” is very real. And that’s just one problem with low intensity “rehabilitative” exercise you have perhaps been given by your physical therapist. It’s doing some marginal good, maybe, but are clams, bridges and side twists really building any kind of fitness? I think you the answer. So what’s the motivation to keep them up after your pain resolves? If you aren’t even sure that it’s working, what’s the motivation to keep it up even until your pain resolves.
That’s what I like my modified weight training programs for back pain. People could start with as little as 1-2 pounds, that was considerably easier than conventional bodyweight, home-programs style exercises. The weights could be progressed steadily as strength increased and pain decreased, equalling and eventually surpassing bodyweight resistance levels, and each step of the way was very concrete, you knew exactly how well you were doing and how far you had come. Doing so built real strength, inspired confidence, and really increased stability of the spine, all while it was teaching one to grove spine sparing movement patterns. So one of the major challenges for me was to find, modify, arrange, and invent bodyweight exercises and progressions that did much the same thing. Overall, I think I nailed it. In some ways weights still have an edge but for our purposes it’s very close, and in other ways I actually think SpineFitYoga surpassed the weights, and it’s absolutely more convenient.
Level-1 is designed to be appropriate even if you are injured, though read the precautions section to see if you are too injured. Level-1 one is also meant to be weight insensitive, so that even if you are out of shape and have put on some pounds you should still be able to do it. Starting with just 5 repetitions per exercise you progress as slow or as fast as you feel comfortable to being able to perform 20 repetitions. When you can do a given exercise with 20 repetitions pain free and with good technique you are ready to move to Level-2, starting with as low as just 5 reps. When you are maxing out the reps on Level-2 you are overall pretty fit and a lack of strength and endurance is no longer your problem with regards to neck or back pain. Level-3 progresses beyond basic fitness to what we could call exceptional fitness. I’m sure somebody will, but so far nobody has maxed out the full sequence on Level-3. I’m still trying, and having something to always work towards is part of what keeps it fun. The best part about Level-3 is that regardless of how hard you push, so long as you endeavor to keep your technique clean it’s been designed, and continually redesigned to be healthy for the spine. Level-3 is definitely inspired by Patanjali’s Sutra 3:47, if one wants go that route.
