Stability and Strength Training for Managing Joint Hypermobility

Are you struggling with joint hypermobility? You’re not alone!

Hypermobility, characterized by an above-normal range of motion in your joints, can be accompanied by chronic pain, instability, fatigue, and very tight/tender muscles. For some individuals, joint hypermobility is just one symptom of a genetic connective tissue disorder, such Ehlers-Danlos Syndrome (EDS) or Marfan Syndrome. Other folks, particularly "aesthetic athletes" such as gymnasts, dancers, figure skaters, and circus artists, develop hypermobility in certain joints as a result of frequent training and stretching in extreme ranges of motion (e.g. splits and deep backbends). While most individuals with mild to moderate joint hypermobility do not experience major issues, some people who experience recurring pain and/or instability in multiple joints may be diagnosed with a Hypermobility Spectrum Disorder (HSD) by a clinician after ruling out other conditions.

For anyone with symptomatic joint hypermobility, managing symptoms and preventing instability injuries is crucial for staying active and engaged with the activities that bring us joy. Supportive tools such as braces, splints, Kinesio Tape, and orthotics can be profoundly helpful for managing flare-ups and easing pain during our daily activities. However, while these tools are useful for mitigating symptoms, they usually insufficient for improving our joint stability, posture, and movement quality.

...The good news? Stability and strength training can play a key role in supporting our joints, decreasing chronic pain, and helping us maintain active and independent lives.

In this post, we'll break down the vital role of stability and strengthening exercises for managing symptoms, as well as share some important tips for hypermobile folks starting a new movement practice.

Understanding Joint Hypermobility

Joint hypermobility occurs when the ligaments (connective tissue) that support your joints are more "stretchy" than normal, enabling a greater range of motion. For individuals with a genetic connective tissue disorder, these "loose ligaments" may be attributed to structural differences in collagen (a protein that comprises connective tissue throughout the body).

Chronic pain affects a significant proportion of individuals with joint hypermobility; however, the types of pain that effect this population can be quite complex. According to a 2017 literature review in The American Journal of Medicine (DOI 10.1016/j.amjmed.2017.02.013), people with joint hypermobility are particularly prone to generalized musculoskeletal pain, severe fatigue, dysautonomia (impaired autonomic nervous system reflexes), headaches, and pelvic and abdominal pain. Additionally, folks with hypermobility are more 4 times more likely to present with clinical depression and/or anxiety than the general population (both of which can impact our experience and perception of pain).

Hypermobility can result in joint instability, increasing the likelihood of injuries and related consequences. Repeated joint dislocations and subluxations are not only painful and disruptive; they can make us fearful of movement and diminish our confidence in our own bodies. Chronic instability contributes to chronic pain and fatigue, which can make simple daily tasks, such as climbing stairs or carrying groceries, challenging.

The Role of Stability Training

Stability training aims to strengthen the muscles that support the joints, as well as our deep core and postural muscles. This training is a game-changer for individuals with joint hypermobility, as it helps counterbalance excessive joint motion (picking up the slack for those loose ligaments!), decrease postural fatigue, and improve our proprioception and coordination.

Activities such as balance exercises on unstable surfaces, core strength workouts, and proprioceptive drills can significantly enhance our joint stability, body awareness, and movement quality. For hypermobile athletes, integrating some stability drills into a warm-up can significantly improve our power, coordination, and overall performance.

Strength Training for Joint Support

Strength training goes hand-in-hand with stability work for people with joint hypermobility -- I consider stability training to be our foundation, while strength training enables us to move with greater efficiency, resilience, and power. By building muscle strength around the joints, our risk of injury diminishes and overall function improves...and lifting heavy things makes us feel strong and confident, too!

Contrary to popular belief, many hypermobile folks can safely participate in heavy weight lifting for strength and power...with the right training, coaching, and preparation. According to a 2022 case series (DOI 10.1155/2022/8367134), 16 hypermobile women with knee pain who underwent a supervised heavy resistance training program saw significant improvement in their knee pain, fear of movement, proprioception, and measured lower body strength and function. While most of the published research on hypermobility is limited to lower-resistance exercises, many savvy clinicians and coaches report similar outcomes with their clients (as do I!).

I always recommend starting any strength training program gradually, and prioritizing good form

(even if that means decreasing resistance or moving within a smaller range of motion). While non-hypermobile folks can often get away with a few "ugly lifts", those of us with bendy joints tend to be more prone to pain flares and muscle spasms if we lift with poor motor control.

Cuing, visual and tactile feedback, and skilled coaching are essential for learning to lift. Unfortunately, many of my movement clients who have had adverse responses to strength training and PT exercises were not provided with sufficient training or appropriate progressions for their bodies...so, it's completely understandable for people who have had such experiences to feel apprehensive about picking up the weights again!

Practical Tips for Starting a Training Program

Getting started with stability and strength training can feel overwhelming, especially if you have had some negative prior experiences with injuries or unsafe coaching practices.

Here are some practical tips:

1. Consult a Hypermobility-Aware Professional: If you have (or suspect that you may have) a connective tissue disorder, I highly recommend getting screened and cleared by your medical provider before starting any new program. Some individuals with issues such as craniocervical instability or dysautonomia may need to take some special precautions as they train. If possible, seek out a hypermobility-aware movement professional to help you pinpoint any important areas of focus (e.g. shoulder stability) and establish a training plan in line with your unique needs and goals.

   NOTE: When I refer to any professional as being "hypermobility-aware", this goes beyond just knowing what hypermobility is; it's being educated on the unique needs and best clinical practices for working with this population.

   
   

2. Start Slow: Training for function and longevity is a marathon, not a sprint! Start gently, building your foundation of stability first. As your balance, posture, and body awareness improve, then you can start to integrate more complex movements and heavier resistance training. This is especially important for folks who deal with Post-Exertional Malaise (PEM) -- pacing is your best tool for getting out of the boom/bust cycle.

   
   

3. Focus on Form: Yep, I'll say it again: training proper technique is essential for hypermobile folks. Invest the time in learning the correct form, and consider working with a specialized coach or PT to develop and reinforce safe movement patterns. A skilled movement professional should be able to effectively cue you through a movement, as well as help you develop your own landmarks and form checks to assist you in building confidence and independence as you progress.

   
   

4. Face your Fear: Kinesiophobia (fear of movement) is a very common learned behavior among folks with an injury history...and it's a totally valid and understandable protective response. The thing is, sometimes the things that have kept us safe are the same things that keep us from growing and evolving. We don't need to gaslight ourselves (or allow ourselves to be gaslit by well-meaning professionals) into doing things that don't feel right for our bodies, but sometimes it can be worthwhile to spend a little time exploring the barrier of discomfort. This work can feel very vulnerable, which is why it is particularly important to establish a collaborative relationship with a movement professional you trust.

   
   

5. Listen to Your Body: Always pay attention to your body's signals, even if they don't always seem to make perfect sense ("why does that movement feel painful/scary?"). If a particular exercise causes pain or discomfort, you may be able to modify the movement by using props, reducing the range of motion, or changing the amount of resistance. If you are unsure of how to do that, this is another way working with a hypermobility-informed professional can help! A skilled movement professional may be able to help you interpret different types of sensations that arise during training (i.e. a warning signal for injury, vs. "safe, but expanding my comfort zone"), as well as help you find ways to modify your routine when you're experiencing a "flare-up".

   
   

Final Thoughts

Stability and strength training are essential for managing symptomatic joint hypermobility. By focusing on these areas, you can achieve better joint stability, lower your risk of injury (and rebound faster), and enhance your overall quality of life.

Recognizing the significance of these exercises and committing to a regular routine can lead to tangible improvements in how you manage conditions like EDS and HSD. With the right approach, you can reclaim control over your body and enjoy a more active, fulfilling life.

Embracing stability and strength training means prioritizing your health and empowering yourself despite the challenges posed by joint hypermobility.

Ready to Get Started?

Whether you're wanting to join a group movement class or work one-on-one with a hypermobility-informed coach, Root & Branch Bodywork has you covered!

Our Zebra Strong and Architectural Movement classes are both led by hypermobility-informed practitioners with a focus on stability and functional strength. For folks seeking relief from chronic pain and strengthening their postural muscles, we enthusiastically recommend Foundation Training. And for individuals with an existing training practice who are looking for ways to safely push themselves with a highly experienced coach, our Small Group Strength Training and Handstand classes are solid choices.

For individualized training, private training sessions with Kaitlin and Noah are available, both of whom have extensive experience helping hypermobile individuals manage symptoms and achieve their movement goals.

See you in the studio!