Yoga and Hypermobility: Finding Balance

Did you know that hypermobility - a blessing as perceived by most, is not necessarily one?  Here’s the real picture: 

The ability to bend and twist far beyond the ordinary seems to be the key element from which yogis are made, but within it actually lies instability and potential for injury. 

What is Hypermobility?

This is a condition whereby the joints can move beyond their normal capacity of motion. It is estimated to affect 1 in 10 individuals. To understand this better, let us take the assumption of rubber bands instead of muscles; they stretch so effortlessly but have no strength to get back into shape. That is how life goes for most of the hypermobile population, and with this condition, one needs to strike a delicate balance between exploration and restraint when dealing with the world of yoga.

How to Identify Hypermobility

Identification can sometimes be challenging. Here are a few commonly observed signs:

• Easy joint hyperextension: You can bend your joints backward more than most people would. For example, hyperextending your knees, elbows, or wrists.

• Repeated joint dislocations or subluxations(partial or incomplete dislocations of a joint): These are partial dislocations where the joint pops out and then goes back in.

• Chronic pain in joints, muscles, and ligaments: This results from instability and overuse.

• Early arthritis: Hypermobility leads to overloading the joints, which increases the likelihood for later-life arthritis.

• Fatigue: It is an immense work to stabilize the joints, which in itself is stressful.

Why Hypermobility is Bad

Flexibility is good, but hypermobility brings along several drawbacks along with it:

• Instability: Loosened joints would cause instability, sprains, strains, and dislocations.

• Ligament and tendon weakness: When the ligaments and tendons are stretched beyond their normal extent, they weaken, and break more easily.

• Muscle imbalances: The muscles become imbalanced since the need for stabilizing the joint leads to pain.

• Chronic pain: Conditions of chronic pain develop mostly due to overstrained joints and soft tissues.

Hypermobility Isn't Always a Benefit

In the yogic sphere, flexibility is a blessing, but for the hypermobile, this is a double-edged sword. Deeply stretching into a pose may feel great at first, but it will overstretch the ligaments and weaken the joints further.

Hypermobility vs Hyperextension

Hypermobility and hyperextension are used interchangeably, but to make a proper difference between the two, there are the following explanations:

Hypermobility

• This is a generalized condition wherein one or more joints move more than the usual limits of their motion.

• Commonly associated with increased flexibility since the tissues forming the connective parts are loose and elastic, which also affects the ligaments and tendons but not the skin.

• Hypermobility is either asymptomatic or associated with a condition known as Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome (EDS). 

• Painful and unstable joints, easily repeated subluxations, fatigue, and sometimes systemic involvement of connective tissue disorders if present.

Hyperextension

• It is a condition where a joint exceeds its normal anatomical range of motion.

• Such a situation may appear as an effect of some related exercises, activities, or trauma.

• Sometimes, hyperextension can happen accidentally due to improper technique in performing physical activity.

• This condition is mostly related to the separate joints (such as knees, and elbows) and can lead to strain and/or sprains or other injuries if appearing as excessive.

Main Difference

• Hypermobility is more general, while hyperextension is a specific movement exceeding the normal range of a joint.  

• Hypermobility in a person can lead to hyperextension if stability and strength are not adequately present.

Management Tips

• For hypermobility, strength training, joint stabilization, and proper alignment.

• For hyperextension, learn proper movement patterns and use techniques or braces to prevent overextension during physical activities.

What is the Reason for Hypermobility?

The actual reason for hypermobility cannot be determined, although it is thought to be attributed to the following causes:

• Genetic: Hypermobility has also been known to run in families. Therefore, some genetic basis does exist.

• Connective tissue disorders: Ehlers-Danlos syndrome and Marfan syndrome often include hypermobility.

• Hormonal fluctuations: Pregnancy and changes in hormonal condition can sometimes give rise to joint laxity. 

Is Yoga Good for Hypermobility?

Yoga can be both supportive and challenging when it comes to hypermobility.

The Dilemma

Yoga might be good for the hypermobile individual in that:

• Improves body awareness: It promotes mindful movement and thus teaches one about their body limitations.

• Strengthen and stabilize: Strengthening the muscles surrounding the joints may be supportive.

• Posture improvement: Yoga improves posture imbalances and corrects body alignment in general.

• Reduces stress: Practicing yoga can help regulate stress, which often worsens the symptoms of hypermobility.

Yoga, on the other hand, may:

• Worsen previous injuries: Deep stretching and intense positions may worsen joint issues.

• Ligament overstretching: Overstretching will only weaken weak ligaments further.

• Promote instability: Some poses will increase instability and the potential for injury. 

Objective vs. Subjective

It is important to take a customized approach to yoga. What works for one may not work for another.

Higher Tone

The focus should be on building strength and stability rather than extreme flexibility. Engage the muscles around the joints and maintain proper alignment.

Glorification of Hypermobility

The yoga world needs to break free from the glorification of extreme flexibility. It is time to emphasize that flexibility is not the end, and strength and stability are as important.

Is there a resolution?

The answer lies in finding a balance between exploration and restraint.

Yoga is more than just physical postures. It also encompasses:

• Mindfulness: Cultivating present-moment awareness can help to reduce stress and improve overall well-being.

• Breathwork: Deep, conscious breathing can help to calm the nervous system and reduce pain.

• Meditation: Regular meditation practice can help to reduce stress, improve focus, and cultivate inner peace.

Advice for Practicing with Hypermobility

• Listen to your body: Pay close attention to your body's signals and avoid pushing yourself too far.

• Stability: Engage core muscles to stabilize through the pose.

• Modification of poses: Use blocks, straps, and blankets for ease of performing the poses and minimizing tension.

• Practicing with an experienced teacher: Take classes from a yoga teacher who understands how to teach hypermobile practitioners.

• Gentle styles: Take up gentler styles of yoga, such as Yin Yoga or Restorative Yoga.

5 Common Poses That Can Cause Injury in Hyper-Mobile Practitioners

Yoga is about achieving balance—both mentally, as in cultivating a calm and steady mind, and physically, as in maintaining proper alignment in each pose. This balance is rooted in the concept of sthira (stability) and sukha (ease), as described in the Yoga Sutras of Patanjali. However, in the world of social media, it is often the very flexible who dominate the public perception of yoga poses, demonstrating extreme ranges of motion. This has led to yoga being so strongly associated with flexibility that students are often encouraged to push deeper into every pose.

This is rewarding for people who have naturally flexible or hypermobile bodies because this is what their bodies are used to. The dramatic shapes also feed the ego, making them believe they are performing the poses "correctly." Hypermobile people are more susceptible to injury in yoga than stiffer-bodied people.

This is because hypermobile practitioners depend more on their joints rather than their muscles to move and stabilize. A joint is a place where two bones meet, held together by ligaments, which are connective tissue that links bones to each other, and tendons, which link muscles to bones. Unlike muscles, ligaments and tendons are composed of connective tissue that has a bad blood supply; they do not easily heal if they become overstretched or torn. The more this "elastic" tissue is stretched to its limits, the higher the chances of a possible injury-that's why injuries and surgeries caused by overuse continue to grow, and so is the number of yoga practitioners and teachers.

Safe and long-term practice for people with hypermobility requires a delicate balance between strength and flexibility. This time, it will not be the deepest stretch, but controlled movement and stability. That would mean pulling way back from the edge of every pose to develop balance, perhaps very different from that feel-good feeling one gets through the usual stretches. Although that would not allow you to get your feet behind your head, it does allow you to set a priority of longevity and preventing injuries-not only for today, but for many years ahead.

These are examples of commonly practiced yoga postures where over-stretching in hypermobile individuals can be identified along with practical ways to stabilize those shapes:

• Downward-Facing Dog (Adho Mukha Svanasana)

• Triangle Pose (Trikonasana)

• Plank Pose

• Low Lunge

• Upward-Facing Bow Pose (Urdhva Dhanurasana)

Example of Hyper-mobility in Downward Facing Dog (Adho Mukha Svanasana)

In Downward-Facing Dog, a hypermobile individual is likely to be able to drop his heels to the ground which over-stretch the hamstrings and calves.

Correction of Hyper-mobility in Downward-Facing Dog (Adho Mukha Svanasana)

Squat with a block beneath the heels: This may preserve a mild knee bend, therefore removing tension on the hamstrings.

Forward walk of hands: This would transfer some weight forward and perhaps ease the stretching in the hamstrings.

Example of Hyper-mobility in Triangle Pose (Trikonasana)

In Triangle Pose, hyper mobile people can bend into the sides, but because of this action, it does overstretch out the side of the body; therefore, causing compression in the spine.

Correction of Hyper-mobility in Triangle Pose (Trikonasana)

Block under the hand: This also enables maintaining someone in a slightly more upright position and avoids overstretching in the torso sides.

Activate the core: Activation of the core muscles helps stabilize the spine and prevents extreme bending.

Example of Hyper-mobility in Plank Pose

In Plank Pose, the hypermobile can lower their hips to the floor but it stretches out the shoulders and lower back excessively.

Solution for Hyper-Mobility in Plank Pose

Contract the core: Activate these muscles to maintain a solid, stable plank.

Bend the elbows slightly: This can reduce some of the load on the shoulders.

Example of Hyper-mobility in Low Lunge

In Low Lunge, the hypermobile person will be able to drop down a long way into the front hip, which may overstretch the hip flexors and potentially compress the knee.

Solution for Hyper-mobility in Low Lunge

• A block is placed under the front knee to keep the knee slightly bent and to limit the stretch of the hip flexors.

• Quadriceps of the front leg are activated to keep the knee stable and prevent its sinking.

Example of Hyper-mobility in Upward-Facing Bow Pose (Urdhva Dhanurasana) 

In Upward-Facing Bow Pose, individuals with joint hypermobility may arch excessively in the torso, causing uneven tension in the spine.

Solution for Hyper-Mobility in  Upward-Facing Bow Pose

• Use a block under the pelvis: this can be helpful when stabilizing your lower back while preventing the pelvis from arching.

• Activation of the deep core muscles may help stabilize your spine and even prevent movement from occurring.

A Yoga Sequence to Build Lower Body Strength 

Here is an example of a yoga sequence that will help build strength and stability in the lower body:

1. Warrior II (Virabhadrasana II): Hold for 5-10 breaths, focusing on engaging the legs and core.

2. High Lunge (Alanasana): Hold for 5-10 breaths, focusing on engaging the quadriceps of the front leg.

3. Chair Pose (Utkatasana): Hold for 5-10 breaths, focusing on engaging the quads and glutes.

4. Tree Pose (Vrksasana): Hold for 5-10 breaths on each side, focusing on balance and core engagement.

5. Setu Bandha Sarvangasana (Bridge Pose): Do 5-10 breaths holding the bridge up, getting the hips up as high as you can to focus on what's happening in your glutes.

How to Teach Yoga for Hypermobility: 5 Tips for a Safe Class

As a matter of fact, hypermobile practitioners are more prone to injury because of how they always try to extend over the joint hence the muscles, tendons, and ligaments are strained.

This, however, doesn't mean that yoga is inappropriate for the hypermobile individual. Rather, it means that the yoga teacher has to approach the hypermobile student with caution. Here are five tips to help you guide the hypermobile student safely, as a teacher:

1. Avoid over-praising hypermobility in yoga

Hypermobility often marks students who will excel in asanas whereas others may take months or years to master. For this reason, it is tempting to use these students as examples to show flexibility or the ease with which they can align their bodies perfectly. While praise for efforts is important, there are two reasons why hypermobile students should not be overly praised:

• This could deter other students from practicing because they do not possess the same degree of flexibility.

• This could encourage the hypermobile student to use their mobility to excess, where there is potential for long-term damage.

2. Bring Awareness to Joints

Hypermobile students should be aware of how to remain safe and healthy in terms of joints. Hyper-extended knees, for instance, are damaging when standing, walking, or exercising. Damage may be caused due to the weight of the body that is exerted on the locked knees as regards the ligaments cartilage and menisci. Locked knees also may interfere with the pelvis's alignment.

Emphasize them to always be conscious of their joints. The golden rule of thumb is, if the joint extension or flexion feels comfortable, then reduce it by some degree. Look for:

• Locked knees in standing balances like Mountain Pose, Dancer's Pose, and others that require a straight leg

• Locked elbows in support-bearing balance like Downward-Facing Dog and Incline Plane

3. Mindful movement

Teach the hypermobile student to listen to his/her limitations and not overstretch in any asana. When one moves into extreme ranges of motion, his/her muscles are at their weakest points and most susceptible to injury. Most hypermobile people unknowingly harm themselves by being overly aggressive or trying to prove themselves through difficult asanas. Keep the pace of class slow and focus the attention on minute movements.

4. Building Strength

A hypermobile student needs to strengthen the muscles so that he would not rely on flexibility alone to ensure safety and effectiveness in the practice of yoga. Strengthening the muscles in the vicinity of joints may not abolish hypermobility, but there is a considerable reduction in sprains and strains because the risks are minimized if the joints are stabilized.

5. Constructive Criticism

Just as with any student, verbal corrections and subtle body adjustments can make a hypermobile student align properly and practice more safely. Instructions should be designed to the specific needs of each hypermobile student. For example, whereas most students pay attention to depth in backbends, thus stretching the anterior part of their body, a hypermobile student may be instructed to engage the core and reduce their range of movement.

By adopting these techniques, you ensure that such students suffering from the hypermobility condition can comfortably participate in the yoga classes and, in turn, avail of its benefits without the probable risk of suffering from injury.

Living with Hypermobility: A Holistic Approach

Living with hypermobility requires a holistic approach that addresses not only the physical aspects but also the emotional and psychological well-being.

• Prioritize self-care: Make time for activities that bring you joy and relaxation.

• Connect with others: Join a support group or connect with others who understand your condition.

• Seek professional guidance: If you're struggling with pain or other symptoms, consult a healthcare professional.

Final Thoughts

For a person with hypermobility, yoga can be an excellent resource; however, it must be approached with awareness and caution, and the building of strength and stability kept in mind. It is, in fact, self-care and guidance from a qualified teacher with a mindful approach to practice, creating a supportive yoga practice that addresses your unique needs and brings better overall well-being. The journey is not about being perfect; it is about finding your balance, honoring your body's limits, and deepening your connection to yourself.

Disclaimer: This article is for informational purposes only and is not intended as medical advice. Always consult a healthcare professional before embarking on any new exercise program.