Does Hypermobility Make You More Prone to Sports Injuries?

This article originally appeared on Outside

At age 18, Kate Badgett was your typical young runner. She clocked about 20 miles a week, usually on the road, and took spin classes and did basic core work to cross-train. However, like other dedicated athletes, she soon experienced a femoral stress fracture, a hairline fracture of the thigh bone.

This type of injury is typically the result of overuse, but Badgett's weekly mileage didn't seem high enough for the two to be correlated. She started experiencing other pain, including partial dislocations of her shoulder. Badgett's case suddenly felt anything but typical. Her physical therapist began to wonder if joint hypermobility, a greater-than-average range of motion in your joints, was at the root of the problem. Turns out, he was right.

Badgett has hypermobile joints due to Ehlers-Danlos syndrome, a connective tissue disorder that causes the ligaments to become looser and stretchier. She experienced two more femoral stress fractures over the next six years. (She later discovered that they were caused by extensive hypermobility and instability through her feet and ankles that placed too much pressure and strain on her bones.)

Research shows that some people with joint hypermobility may be more at risk of things like joint and ligament injuries, instability, and knee and shoulder dislocations. Badgett’s still able to run these days, but she had to change the way she trains. She goes to physical therapy regularly, cross-trains, runs on trails more than she used to, and does a specific yoga practice that's designed to help the body rewire more effective movement patterns.

What Is Hypermobility?

Normally, your ligaments help keep your joints stable. But if you have joint hypermobility, your ligaments and other connective tissue can be loose, so your body has to work harder to keep the joints stable. As a result, the joints of hypermobile people may frequently subluxate or dislocate, says Linda Bluestein, MD, an integrated medicine physician who treats hypermobility.

"Hypermobility is really common, and it’s a different body type that requires a lot of maintenance--and if treated well, will perform well," explains Jacques Courseault, MD, a sports medicine physician and medical director of the Tulane Hypermobility & EDS Clinic and the Tulane Fascia Institute and Treatment Center.

Doctors measure joint hypermobility using a screening test called the Beighton score, which looks at the range of motion of various joints, including your spine, thumbs, elbows, and knees. The higher the score, the more likely someone has joint hypermobility. But physicians also look at other factors, like how flexible or hypermobile someone may have been in the past. Some people with hypermobility can become more stiff as they age, due to arthritis and other physical changes.

Joint hypermobility occurs on a spectrum and can manifest in different ways. Some people may only have one hypermobile joint in their body, whereas others, like Badgett, may experience hypermobility as one symptom of a broader genetic connective tissue disorder. And hypermobility doesn't always equal flexibility. If you're hypermobile, your body may compensate for joints that move past the normal range of motion by tightening muscles around the joint to hold it in place. In these cases, you may feel stiff and inflexible.

How Might Hypermobility Affect Someone Who Lives an Active Lifestyle?

Having hypermobile joints definitely doesn't mean you need to ditch your active lifestyle. In fact, it may work to your advantage in your athletic pursuits. For a swimmer, spine and shoulder hypermobility can offer increased range of motion, torque, and efficiency. And a hypermobile pitcher may have greater range of motion in their shoulders or elbows that allows them to throw a faster and more forceful pitch.

"In general, hypermobility probably offers a mechanical advantage when it comes to cycling, running, and hiking, and it certainly offers a mechanical advantage with anyone who throws anything, like pitchers, javelin, and quarterbacks," Courseault says.

But hypermobility can also be problematic in some cases. "For people who have problems with their kneecap tracking, hiking can actually be really tough and so can bicycling," says Alissa Zingman, MD, a board-certified physician and founder of P.R.I.S.M. Spine and Joint, a clinic that treats patients with hypermobility and connective tissue disorders. "When you have kneecap tracking problems, that midrange of knee mobility is actually where you have the most pressure on your kneecap."

For someone with a hypermobile spine or shoulders, she says, cycling may put a lot of pressure on the thoracic spine or overstretch the muscles in your back, causing pain.

Does Hypermobility Lead to More Injuries?

Not necessarily. Some studies show that hypermobility doesn't always lead to more injuries. In fact, many high-performing and even professional athletes are hypermobile, Courseault says. But the care and maintenance required to keep a hypermobile body well-functioning and injury-free through things like strength and balance work is a bit higher than for someone without hypermobility.

For example, a strong, hypermobile climber who has well-supported joints may actually benefit from increased range of motion in her joints that allows her to move her body in ways that makes it easier to reach and grab holds. "You can make the argument that hypermobile bodies are less prone to injury because they can stretch in ways that a non-hyper mobile body can't," Courseault says.

But if an athlete's joints become too loose, they could get injured in settings where others wouldn't. People who are hypermobile are more likely to dislocate a joint, as well as get tendinopathies, tendonitis, and tendinosis, Bluestein says. It also may take them longer to recover from these injuries.

How to Deal With Hypermobility

If you're hypermobile, the most critical thing you can do is listen to the signals your body sends your way--and respect that your anatomy may change over time. Some people with hypermobility can engage in all the activities they love without any issues. But if you're experiencing a lot of injuries, Bluestein recommends taking a close look at what activities you can participate in without problem (green light activities), which cause your symptoms to flare up a bit (yellow light activities), and which cause lots of pain and injuries (red light activities).

"Over the course of your lifetime, those things are of course going to change, but you want to get to where you're as active as you can be, but in a zone that is appropriate for your body at that point in time," she says.

Here are some ways to manage hypermobility--but keep in mind that managing hypermobility is highly individual.

11 Ways to Manage Hypermobility

1. Wear supportive shoes that offer stability.
2. Work with a physical therapist who is knowledgeable about hypermobility.
3. Strengthen your body with isometric exercises and Pilates.
4. Work on stabilizing exercises that maintain space in the joints.
5. Move your body and exercise regularly, but stick to activities that don't cause pain.
6. Avoid repetitive physical activities if they cause pain or irritation.
7. Keep proper form and biomechanics when engaging in physical activities.
8. Try to maintain correct posture and alignment in your body, even when you're not being physically active.
9. Stay hydrated, including with electrolyte drinks.
10. See a doctor who specializes in or is knowledgeable about hypermobility.
11. Speak with your doctor about the benefits of prolotherapy and other forms of regenerative injections.

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