The Hypermobile Performer

Joint Hypermobility, facilitates movement, and therefore favours selection into dance. Great right? But what are the pitfalls?

 How did I get so interested in hypermobility syndrome? Back in 2015 I had a young professional performer come to see me in clinic. She had recurrent injuries, mainly affecting her knees and ankles, had seen numerous physios and trainers – been issued training plan upon training plan, where injury continued to outweigh progression. How did she feel? Anxious, tentative during training and powerless against another inevitable injury – WHY did this keep happening? We started by talking through her complex history; including not only joint pain, but chronic fatigue, gastrointestinal issues and cardiovascular symptoms, it was clear that there was something else going on. After a biomechanical assessment, identifying hypermobile joints was no surprise to either of us. To investigate the other symptoms outside of my remit to diagnose as a Physiotherapist I referred her to a good colleague of mine, an orthopaedic consultant with a keen interest in hypermobility and a cardiologist. A few tests and consultations later, our client was given the diagnosis of Hypermobility Syndrome, which is different to the more commonly known joint hypermobility. Hypermobility Syndrome includes symptoms including chronic fatigue, gastrointestinal issues and cardiovascular symptoms to name a few. With this diagnosis we were able to create a management plan that allowed her to continue to train, and more importantly progress. My client went from feeling lost, frustrated and somewhat unmotivated, to now having an in-depth understanding of what is going on within her body, why the symptoms present as they do, and how they can be managed to make way for optimal performance.

Joint hypermobility (JH) is a common connective tissue condition, and is marked as exceptional joint mobility. Individuals often present with recurrent dislocations, traumatic or overuse soft tissue injuries or low-grade inflammation. Although hypermobility in dancers is considered one of the factors associated with talent and highly desirable, it also increases the risk of injury and also lengthen the time it takes to recover from injury. Symptoms include decreased physical fitness and muscle strength and global fatigue. The injury risk is related to the structural reality that greater connective tissue (ligament, tendon and fascia) structural laxity increases the demand on muscles to provide  joint stability and absorb force, this is often extremely challenging for the individuals system to meet.

Within the hypermobility spectrum, there is Joint hypermobility Syndrome (JHS) which is a benign multi-system genetic condition also affecting the connective tissue. However it has widespread  features such as fatigue, uterine or rectal prolapse, chronic pain and GI dysmotility to name a few. As you can imagine this can often present as a complex clinical picture, and one which is commonly overlooked.

There is a hormonal aspect in both JH and JHS and this is because hyper lax joints are more symptomatic by progestogens, therefore symptoms can be exacerbated at the time of menstruation and times of chronic hormonal imbalances (for example, stress). Often it can be seen that polycystic ovaries and endometriosis can be diagnosed from symptomatic joints before diagnosis is made by a gynaecologist.

Rehabilitation should include strength, cardiovascular fitness, and trunk stability (commonly referred to as core stability) training. Although these areas of rehab are paramount for all performers, there is a greater need to include them  for the hypermobile performer. Other areas that need addressing are pacing, coping and behavioural strategies, avoiding resting in end range positions and improving joint proprioception.

Some common pitfalls which we are faced with hypermobility are that it is often overlooked (more notably the hypermobility syndrome patients). They can be misdiagnosed, and therefore, inappropriately treated with modalities such as drug therapy, surgery and overenthusiastic manipulation and manual therapy. However, slowly, awareness in this vast area is increasing.

This is just a little overview of Hypermobility; we will be delving deeper into this subject and sharing both strategies for those who are hypermobile and continuing the conversation to manage performers, so they can reduce injuries and optimise performance.

Thanks for your time

Sophie

@sophielanephysio