Yoga and hypermobilility

What is hypermobility? People whose joints have a more-than-normal range of motion are called hyperflexible or hypermobile - the clinical term is joint hypermobility syndrome (HMS), which may also be an expression of the more serious Ehlers Danlos Sydnrome.

Research suggests that up to 3 in 10 adults may be hypermobile to some degree, with women being more likely to be affected than men due to the relaxing effects of female hormones. Many people with hypermobility have a 'harmless' variety: that is, they experience no unusual effects except being more bendy than the rest of us. But for others, HMS can be debilitating, causing chronic pain.

In either case, people who are hypermobile are generally more prone to injuries, fractures and dislocated joints, because their joints have more mobility than stability.   

Yoga and hypermobilility
Hypermobile people may come to yoga because of an injury, one of those inexplicable "I was just walking/running/surfing/playing tennis and then I felt this pain..." injuries that are common among the super-flexible. Or they naturally gravitate to yoga because of their flexibility. Once in a yoga class, super bendy people are often told they are "amazing" by teachers who don't recognise or understand their hypermobility. 

Some may even quickly want to become teachers themselves, since after only a few months of practice they find themselves doing "advanced" poses with ease. And in a yoga culture that increasingly idolises the physical performance of postures that require extreme flexibility (just do a pinterest search for yoga if you don't believe me!), it may be hard for people to believe that extreme bendiness is not actually what yoga is all about.

However, underneath that ease in bending a hyper-flexible body is the danger that hypermobile joints are lacking the muscular resistance to properly support the joints in the range of motion that yoga puts us through. This may manifest slowly, through unexplained aches and pains after a seemingly "easy" practice; or it may manifest all of a sudden through an injury: a dislocated joint, a chronic pain, or a repeatedly inflamed muscle or tendon.

And yoga is not a miracle-cure: 
over time, the sustained practice of yoga without counter-balancing hyperflexibility can lead to a dangerous instability in the joints, that can manifest in chronic joint pain and even symptoms of early arthritis.

How can I tell if I'm hypermobile?
You may be hypermobile to some extent if any of the following sound familiar to you:

• You have always been able to place your hands flat on the floor in a forward bend or flop into the splits
• Your friends and family all remember your "crazy" flexibility as a child
• You feel a constant need to stretch but it never seems to satisfy you
• You are deep in a pose that is supposedly challenging, but you don't "feel" anything
• After hardly any time at all, you put your body into the positions of 'advanced' yoga poses such as the splits, one-legged king pigeon pose, or touching your head to the ground in wide-legged standing forward bend
• You sometimes feel fatigued after simply stretching or doing gentle yoga
• You find it hard to sit comfortably in a chair for a long time and are constantly folding yourself into different positions

In addition, you may be hypermobile in some joints while having a normal or less than normal range of motion in others.

So, should hypermobile people do yoga?
It's easy to understand why many doctors and physiotherapists who work with hypermobile people advise against doing yoga. 

However, many hypermobile people find that the right yoga practice can help them a great deal by building body awareness and helping them to develop the strength that they will need to balance their natural flexibility. The key thing to remember is that yoga is about balance: in this case, achieving a balance between flexibility and strength.

Guidelines for choosing a yoga class if you are hyper flexible:

• Find an experienced and well-qualified teacher, preferably someone with some yoga therapy experience or someone familiar with hypermobility, and make them aware of what you are working with. Get them to help you create some goals for your practice that don't rely on flexibility alone.
• Avoid styles of yoga that emphasise short, fast movements, such as ashtanga or vinyasa flow, until you have built up a solid foundation of strength that will keep you stable and safe from injury in these movement-oriented styles.
• Instead, choose styles of yoga that emphasise proper alignment, stability and strength, such as Iyengar yoga.
• Complement your yoga with strength and resistance training, and with core strength building  exercises like pilates (again, with an experienced teacher) that will help you isolate important muscles and begin to build strength in key areas.

Advice for practicing yoga if you are hypermobile:

• Focus on harnessing muscular energy: engaging your muscles in a pose, instead of 'flopping' into it. For example in any forward bend, strongly engage your quadriceps and feel as if you are trying to "suck" the floor up through your leg muscles.
• Make sure you always put a micro-bend in your knees and elbows to avoid putting too much stress on your joints - combine this with the muscle engagement above, and you will be properly supporting your joints!
• Always keep your head supported by your neck muscles, and avoid the temptation to let your head flop back in upward-looking poses or backbends.
• Avoid the temptation to go as deep as you can into a pose, and instead focus on engaging your muscles as much as you can. Consider 'gapping' your joints - for example placing a small rolled up towel in between your belly and your thighs in a standing forward fold, or placing your hands behind the backs of your knees in a seated forward fold.
• Avoid hyper-extending backwards in backbends by strongly engaging your abdominal muscles and focusing on the sensation of lengthening your spine.
• If you can, see a qualified yoga therapist for a one-on-one session to get a personalised assessment and advice.
• Avoid starting a practice on your own or with a DVD: until you have more experience, you should work with a teacher who can tell you if you are hyper-extending.