Hypermobility – how regular exercise can ease the pain and give you your life back

KTB’s Director Katie Ballard has had hypermobility all her life so in the past when patients came to her with the condition, she understood, sometimes like others didn’t.
How it affected their life…not just daily, but by the minute.
Here, she gives an insight into treatment and how regular self-care can ease the pain.

I am a sufferer of joint hypermobility, and have experienced first-hand the turbulent path of management to improve my life and reduce my pain. I understand only too well the importance of a regular, manageable exercise routine.
I am tall, slim and an ex-competitive swimmer and athlete to national level. Returning to exercise should be easy for me, I love exercise and I want to do it.
But it’s hard, because after exercise I am too often left feeling frustrated, disappointed and in pain.

Have I pushed myself too hard? Probably; but that is what is expected of me. I am yet to find a fitness instructor, (or friend for that matter!) who understands the reality of pacing with hypermobility and to what extent you need to take things slower.

Your ligaments are like an elastic band
Imagine a piece of elastic that is constantly stretched beyond where it should be – of course, it will weaken over time. This is exactly what happens to the ligaments, because every day they are being worked to an extended range.

The ligaments that attach bone to bone are the body’s first point of protection for joints.
If the ligaments cannot do their job adequately because they are stretched and weak, then the body relies too much on the deep musculature to do this job.
And then the same thing happens to these over-worked muscles – they are having to do more and will also weaken.
The body then brings in the big guns – it’s larger muscles, which normally have to work only to move parts of the body, but now have to play a stabilising role in addition to a mobilising role…and no-one likes doing someone else’s job!

And they react badly to this extra pressure – they spasm and cause pain. If you’re exercising, they want to have a real meltdown because they’re already tired from the day. Half-way into your exercise they start to go on strike and hand back the workload to the rest of the body – and that’s when you get the aches and strains, maybe even a dislocation or misalignment of the vertebrae.
And so exercise becomes a non-starter for the hypermobile person – or does it?

Hypermobility doesn’t prevent exercise
The good news is, that hypermobility won’t prevent you from exercising – you’ll just need to find a way to do it that doesn’t make your body protest.
Finding a baseline for safe exercise is essential and I can’t stress enough how important it is to establish what you can do that doesn’t aggravate pain or affect other symptoms.
This will vary greatly with every person, and even in every individual at different times – listen to your body is a good thing to say here.
Once the baseline has been identified, then a very gentle and controlled progression can be applied. A lifelong commitment to exercise is only then realistic, with maintenance of good general fitness.

Take control of your hypermobile joints
Pilates is perfect – but make sure your instructor knows and understands hypermobility and its effects on the body. Ask before you book the class, or come to one of ours – all of my therapists understand it and have me as their primary resource for both patient empathy and treatment should they need any guidance or deeper understanding.
Our classes, whilst they are group exercise, are also individually-tailored too. The Pilates teacher will look carefully at everyone, offering advice on different stretches and positions if the one they are teaching will aggravate pain, cause discomfort or not be right for them. We know people’s body weaknesses ahead of the class and make adjustments so they get the most out of the exercise without doing too much, over-challenging and causing more pain.
We make sure the adjustments we make not only prevent pain elsewhere through compensation, but still work the core – essential for hypermobility as it acts as a pillar for the whole body.

No pain, no gain
This phrase really ought out to be banished, because if people at a class are in pain trying to copy the core stability instructor’s moves thinking it’s good for them (and I’ve seen this happen!) then all they will be left with is pain – and absolutely no gain!

Pain in the back and neck is simply unsafe and if you’re hypermobile and hobbling out of a class, you’ll know it’s done you no good!
Our Pilates classes will give you all the same benefits but within a safe range for you, with adjustments that still make the exercise or stretch beneficial.

We won’t overwork you, leave you in pain or regretting coming – I know that feeling all too well of really looking forward to it and then getting to the end and thinking I never want to do it again. Any many hypermobile people don’t go back, so the cycle of pain continues because we need the exercise but are scared of it.
Here at KTB, we must have our hypermobile clients feeling good after a class and know that exercise is OK and safe for them.

A massage is what’s needed – but only in the right hands
Loose joints mean that the rest of the body has to work harder to support the and these are the areas that need the stretching, mobilisation and in some cases, correction too.

The muscles react to the over-working by being tight and going into spasm. They attempt to limit the range of a joint that wants to run free and it all ends in pain.
At the end of most days, the muscles in the top of my back are screaming out – like my head is too heavy for my neck.
My muscles will be in spasm from the effort of being upright all day and I long to lie down!
A massage would be good but when you’re hypermobile, you can’t just book a massage – it needs to be with someone who understands the condition and knows that my body will respond differently.
Our therapists know that pressing too hard during a massage will leave us hypermobile people in pain, with a longer recovery than others – and who goes into a massage knowing they’ll need a recovery period after?!
We won’t leave you bruised, or tender or in more pain – we will use a different technique that suits you and that concentrates on the areas you need; the areas your hypermobility leaves you in pain from.
And don’t get me started on back cracking – it’s a lovely sense of relief for some people but for me as hypermobile, no thanks – guaranteed agony and a month-long recovery.

What we offer our clients is time – to get to know you and how the condition affects you, what makes it worse and work towards what can ease the pain and create long-term improvements for you.
It’s a commitment from you and us, to work together regularly and consistently to understand how it affects you and what treatment will be affective.

Unfortunately, there’s a lack of regulation in this area where fitness meets complimentary therapy. There’s also a lack of understanding throughout the medical profession, so for many hypermobile people, it becomes easier to ignore the pain, plus you’re nervous of referrals for treatment. You become over-protective of your body and of letting anyone get too close.

Why we’re different and what we offer:
Physiotherapists who understand how the hypermobile patient can react to treatment and exercise.
Time: We take our time working with you to find your boundaries and what you can tolerate.
Commitment: We’ll work with you for as long as you need us.
Goals: Specific to you, so that our therapy enhances your life.
Support: We’ll support you and give you reassurance that any exercise is a great start.
Routine: We’ll help you to establish a routine that’s sustainable.
Progress: We’ll build distances or speed from our established routine.
Updates:  We’ll reassure you that you’re doing OK and making progress; we keep notes so we can look back to recognise the changes you’re experiencing.
Variety: We will use a range of treatments including gentle mobilisation of your stiff joints, releasing tight soft tissues through gentle pressure and the use of heat.
Tailor-made: Pressure and treatment will be given according to how your body responds on any given day.
Education: We’ll teach you about the condition and about how your lifestyle affects it, asking you to make some changes at home – posture, movements, recognising limits.
Reminders: We’ll keep reminding you of the education, to stand taller, keep your chin tucked in, home exercises, small changes – because you won’t remember it all in one go.

We know our patients want to learn more about the condition and to manage it themselves but they will need our support – and will get it.