Whether you are aware or unaware of hypermobility, you may not know that it is a disorder that can result in severe long-term implications. For many years, I knew that I had hypermobile joints and understood that it was associated with injury risk. However, I was never treated differently by any allied healthcare professional, nor was it ever considered in my medical history.

Now I understand that it has links to autoimmune conditions (which I have), neurodivergence (which I have), gut issues (another tick), and many more comorbidities. Today, I want to dive deeper and provide the information I was unaware of, hoping that you can help someone identify any associated risk factors and potentially avoid severe injury.

First Up: What Does Hypermobility Mean?

Hypermobility means that someone's joints can have a greater range of motion than expected. Many people as kids would describe themselves as bendy, flexible, or 'double-jointed'. This can be seen as an advantage in many sports, such as dance or gymnastics, which require a large range of motion and flexibility. However, with this additional range comes joint instability, one of the biggest issues that can increase injury prevalence.

Hypermobility is a connective tissue disorder that can be present in a few joints, all joints, or anywhere there is connective tissue in the body. I will give you a hint: connective tissue is everywhere. It binds and separates your muscles from bones, nerves from muscles, blood vessels around it all, and all your organs where they are meant to be.

This is where it gets tricky. Let's dive deeper

Hypermobility Spectrum Disorder

Hypermobility has now been reclassified as a spectrum disorder. However, it is only a disorder if it disrupts your normal physical and mental functions, meaning it is possible to have asymptomatic hypermobility. A spectrum disorder is a condition with a wide variation in the type and severity of symptoms people experience. Each person's experience with this disorder is a combination of the different symptoms that affect them. Now, as you remember back to my introduction, you can see some of those comorbidities I mentioned and perhaps start to understand why they may be associated with hypermobility.

Symptoms and Comorbidities

Unfortunately, there is a long list of symptoms and comorbidities associated with this disorder, as well as genetic variants such as Ehlers-Danlos Syndrome (EDS).

Hypermobility Spectrum Disorder (HSD) is not well understood or researched and is currently more prevalent in females. We will now explore some of the main symptoms and issues associated with this disorder so that you can help yourself and your clients seek further information and begin taking action to reduce their injury risk.

Hypermobility: What to Look For

The main symptoms and issues coaches and trainers should consider for their clients are extra joint range of motion and joint instability. Some people know they have this extra range; others may not know, but you will be able to see it, and in some, it can be disguised. We will go through each of these scenarios to help you spot any clients with HSD.

Personal Experience

I was the person who knew I was bendy, flexible, and double-jointed. From an early age, I could split, throw my legs over my shoulders, and had so many 'party tricks' that I could muster without so much as looking at a warm-up. All of this extra range has also given me eight knee dislocations, several shoulder subluxations, multiple ankle 'sprains', countless rib facet joint issues, SI joint pain, cervical spine instability, pelvic floor hypertonicity, and jaw issues.

Dislocations, repeated sprains, and subluxations are some of the most common injuries associated with HSD. When you are going through the injury history with your clients and see these types of injuries, that is your warning to dive a little deeper, and you can start with the Beighton Score.

The Beighton Score

Currently, the Beighton Score is one of the only ways to measure joint hypermobility, and it could be more robust and thorough. It only measures five joints from one joint angle. However, it is a simple and easy protocol to follow, and it may give you some hints to see if someone is hypermobile. However, there is more to the story.

Visibly Hypermobile Clients

Why must we be careful with someone who is visibly hypermobile but may not know they are? In my experience, these clients are at the highest risk of injury, particularly if they like to exercise often. Some of the challenging aspects of hypermobility and instability are that on a day-to-day basis, anyone with this condition goes through a substantial amount of micro-trauma and additional muscular loading.

If they are unstable through their joints and are lifting heavy, the likelihood that they will eventually exceed their body's capability to maintain stability during a movement is very high. This might happen in an overhead press as the client can extend their arm past their head or at the base of a deadlift where the load on the SI joints and lumbar is at its highest. Even making these clients aware of their hypermobility so they can be vigilant of their end ranges during exercise can be extremely helpful.

Disguised Hypermobility

As we delve a little deeper into the effects of micro-trauma and how that changes the relationship between global and stabilizing muscles, we introduce our last case study: the disguised hypermobile. This person may have what we call 'historical hypermobility'; they used to be bendy and flexible, but now, they have become stiff through injury, pain, or reduced movement. In my experience, these clients are very easily missed as the Beighton Score may not work for them due to their stiffness.

The body is very good at adapting to what it needs. In the case of hypermobile humans, they need stability. After the body has gone through micro or macro trauma, it adds tension and more connective tissue to the sites it's trying to protect. This mechanism can create a lot of muscle tension and stiffness, so the person no longer presents as visibly hypermobile. These people can present with large amounts of pain and often get passed around from allied professionals to medical professionals trying to find the cause and solution to their problems.

Action Points

I wish I had more solutions to help you with your hypermobile clients, but we don't have the research to support any clinical guidelines at this stage.

However, I want to leave you with action points; these are some excellent places to start.

• Check out The Ehlers-Danlos Society for comprehensive information about HSD and EDS and a directory of professionals to look for.

• Test all your clients with the Beighton Score: Include this in your regular client screening.

• Focus on stability and strength: For suspected HSD clients, work on stability and strength more than mobility.

• Continue to search for information: Stay informed and spread the word about HSD, as we suspect many more people have this condition than initially thought!

Vanessa Leone is a seasoned Movement Therapist and Exercise Scientist with a vast array of skills and experiences in the industry. She is known as a hybrid trainer, delivering a quality presenting experience in both group fitness and personal training streams. Attaining betterment drives her knowledge and pursuit for further education for herself and everyone she encounters. Vanessa continues training clients and trainers all over the world and presenting at International Fitness Conferences. Vanessa’s ethos is doing things BETTER. Vanessa is the founder of the education brand, The Movement Faculty, co-founder of Exercise to Experience and a Master Trainer and Educator for Technogym.