Hypermobility & Bodywork

The Purpose of this Page

Hypermobility in some form and degree is extremely common. It can be highly impactful on the overall health picture, and yet is too little recognized as the sign that it is that a body may need special kinds and degrees of care. Many people who are significantly hypermobile have sought diagnosis and effective care for years for a plethora of symptoms without any care provider realizing that their symptoms arise in relation to the single genetic cause that causes their hypermobility.

The goal of this page is to help inform you, however you may have arrived here, of the broader context for extra flexibility and to collect a few great links where you can seek further information. I'll also share a few thoughts on what I have seen as helpful with respect to bodywork with hypermobility.

Context

Because hypermobility profoundly impacts the ways in which daily strains, exercise, and injuries impact the body, and because it often increases the tendency to certain pain conditions I specialize in working with, I see a lot of people whom I suspect are somewhere on the hypermobility spectrum. It's a broad spectrum. I'm going to speak of this entire group here from a clinical perspective before moving on to what research says about hypermobility.

And first I'll say that as a massage therapist in New Mexico, USA, I have only around 800 hours of initial training. Massage therapists do not diagnose or treat. I can't identify my clients as definitely hypermobile. But it is essential to doing my work well to maintain awareness of the various qualities of the soft tissues that I work with and to apply my work differently depending on the available information--both the client's history as they report it and the information that comes through interacting with, observing, and feeling the tissues as we work.

And it's not an easy thing to send these clients for diagnosis. Awareness among health practitioners is improving in recent decades, but it is still poor. There are very few specialists for diagnosis of hypermobility spectrum disorders. Average time to diagnosis of EDS at the time of this writing is 12-14 years. Wait times at specialty clinics are the better part of a year at present, I hear from my few diagnosed clients and acquaintances plus many public figures in the EDS community. There is a great deal of debate at present as to what clinical criteria should be used to confirm EDS. Genetic markers have been identified for some forms but others are still clinical diagnoses. Some therapies exist, but they're all so far for management of symptoms. Some can be transformative for some small pieces of the picture, but none are corrective.

So I'm in the position of working as closely and informedly as I can with the phenoma of the body on the table, naming the likelihood of hypermobility for the sake of the client's need to engage in further diagnostics. I study for myself what seems to work well for whom and over time, through experience, come up with stories about why I think these techniques are useful for particular people. In a relatively poorly documented but otherwise careful analog of science I develop my craft. And I have a whole model developing in my practice that is an effort at making an image of the reality of who belongs in what category. My model is based on the qualities of the body. Since I'm not trained in sciences it's loose. It won't match what doctors define, I'm sure. 

Within the group that I see as likely hypermobile. Sometimes the benefits of apparent hypermobility are more obvious than any obviously related challenges. Milder forms of hypermobility may not present much of a problem in themselves--but I think I see in practice that they may still likely relate to a greater tendency than average to certain challenges.

Type II: Relatively adaptive because the hypermobility of joints is mild or nonexistent and is controlled by high muscle and fascial tone--which also lends itself to certain strengths (namely physical strength, different but relatively functional proprioception), but I think it likely based on experience that it often comes with the same tendencies to general sensitivity, allergies, immune issues, autism, and/or etc. It wouldn't be correct to say that it's milder; it's different.

Type I: Clearly problematic mechanically, but still more often than not (so far as I've seen with clients) is not picked up on as likely co-occuring with the challenges that take them over decades to doctors who are trying to separately treat related conditions. Enteroceptive

What is Hypermobility?

Most hypermobile people know that they are "double-jointed," exceptionally flexible, prone to joint dislocations. They often have a "party trick" or two, like putting their feet behind their ears. (Don't try it--even if you can easily do it, it may not be wise for your body!) 

Many hypermobile people realize from experience that they are at greater risk of dislocations than others. They may experience more pain and realize it's related to their extra flexible body. They may bruise easily.

On the other hand, many hypermobile people have a particularly forgiving body for what they've put it through. They may excel at dance, gymnastics, or yoga. They may generally avoid injury where others wouldn't by having extra flexibility available at the outset. They may seem exceptionally strong for their build, thanks to their tendency to high tone in the muscles and fascia. 

Regardless of whether their hypermobility itself has appeared as a boon or a limitation, most hypermobile people that I see in my practice do not know that their hypermobility may cause or relate to numerous other health conditions. And in many cases they've been seeking diagnosis and effective care for years for a plethora of symptoms, commonly: gut issues, allergies or sensitivities, sensory differences, chronic faintness or fainting, heat or cold sensitivity, chronic headaches or migraines, dental issues, temporomandibular (TMJ) joint pain or dysfunction.

In recent decades much has been done to learn and to show that autoimmunity, autism, autonomic dysregulation, and other health challenges often also occur in people who are hypermobile. And important internal challenges such as heart or vascular conditions can also result.

Although the most dangerous co-occuring conditions tend to be rare (on the order of one in a million), while around a third of us are estimated to be hypermobile to some degree, due to the emerging evidence that hypermobility so often occurs in relation to a lot of the daily complaints that 

Hypermobility and Bodywork

Many people who are hypermobile benefit greatly from bodywork, but certain principles are important for hypermobile clients to keep in mind and for bodyworkers to know well in order to work both safely and effectively. Some bodywork techniques are more useful for the various body types of hypermobility. Others are unnecessarily risky and ineffective. Different types of hypermobile presentations call for different techniques in bodywork to be most effective. See more below under "Implications for Bodywork."

Causes

Hypermobility can be caused by a variety of factors:

Classifications and Incidence

New and more precise classifications are likely to be found within the general classifier of Hypermobility Spectrum Disorder, which is used to diagnose individuals whom the current more precisely known classifications don't fit.

Some form of widespread hypermobility is thought to affect between 10 and 30 percent of people. Most hypermobile people go undiagnosed--especially common if their cases don't impact them greatly.

Some of the above classifications are easier to identify in principle if the right care provider is found--they may offer strong visual and clinical characteristics that make them easier to identify. Some are less visible. Some classifications and cases are less impactful than others altogether. All of them are often missed for years even in highly symptomatic cases, in part because they are relatively uncommon. Since the symptoms often impact areas throughout the body and any of those issues may be the primary concern which brings parties to the doctor, years may be spent trying to address those additional complaints as sole diagnoses without recognizing the common cause of genetic soft tissue variations.

Seeking Diagnosis

Diagnosis is important in some types of hypermobility to rule out dangerous health complications. Others may likely be benign. If you are seeking diagnosis, consider looking for a provider with the associations for and of people diagnosed with relevant hypermobility conditions. These often list providers who take a special interest in or specialize in diagnosing or working with the conditions. These lists are a good place to start seeking diagnosis since many providers remain unfamiliar with the conditions.

For local hypermobility that is impacting your health or quality of life, it may be worthwhile to find a provider who is familiar with the other forms of hypermobility, as many of their insights on therapeutics will apply. Physical therapists will likely be able to help in this case too, as they work often with joint instability from injuries.

Implications for Bodywork

I'm working on an article that I'll link here soon. Here are some general points.

In clinical practice I see two relevant classifications of hypermobility.

For most people with significant hypermobility throughout their body or even in any particular area that is being worked, an average massage may be relaxing but will likely be of low value for pain relief and for correcting imbalances that lead to and perpetuate pain. Massage therapists unfamiliar with the condition may either remark on how relaxed the body feels (in some types of hypermobility) or on the other hand be astonished at how tight the muscles are (classic in other forms). Some bodywork techniques can present danger to a hypermobile body--most notably stretching, which can pull unstable joints out of place, injure delicate tissues, or cause spasms. Others need special cautions taken. On the other hand, a skillful bodyworker who understands hypermobility will be able to apply techniques that may profoundly reduce pain, tension, and other impacts of hypermobility. 

Techniques that tend to work well for people who are hypermobile include

Techniques to avoid:

There are further prioritizations to be made depending on the type of build the client presents, by the above two classifications I describe. I'll elucidate those in further work and link the article above.

Finding a Bodyworker Skilled with Hypermobility

Practitioners with high level training and a fair bit of experience in any modality are more likely than not to be more familiar than others with hypermobility and how to work with it well. Hypermobility is so common that any bodyworker has seen quite a lot of it. The ability to work with it well comes largely from clinical experience and investment in a strong understanding of physiological variability and the technicalities of bodywork. Beyond that, because certain conditions so often arrive along with hypermobility, certain specialties are in my opinion a bit more likely to come along with a technical, practical understanding of what works if not a theoretical one. Those include at least specialization in working with the following groups:

I'll soon add a few links to practitioner lists kept by some organizations that I trust to provide high quality training. These trainings tend to draw massage therapists and other bodyworkers who are serious about their work and often have a fair bit of experience.

Other Conditions to Watch Out For

If you suffer from hypermobility, various other conditions such as anxiety, migraine, and gut disorders are all more likely to be challenges for you than for others. I address migraine and gut issues in my book, coming soon.

Contact Me

There's a lot more that could be said here...and it's on a backburner due to other projects. Please feel free to be in touch if you could benefit from guidance toward the right resources or help troubleshooting a specific bodywork and hypermobility related issue.