The Trouble with Bendy Joints
“The trouble with you Julia is that you’re knock kneed, bow legged and flat footed.” Sixteen years ago, this was the blunt conclusion of Jeanette Thomson, a highly experienced osteopath. When I told a student osteopath friend, he said: “it’s impossible to be both knock kneed and bow-legged.” However, Jeanette was spot on. Hypermobile people can go too far in the range of motion of their joints. This means hypermobile knees can turn both in and out and even extend backwards further than is usual. In fact, I didn’t (as yet) have any pain in my knees. That’s another story! Yet, my neck had seized up entirely, partly due to the stress of completing my university dissertation. Looseness in my joints and weakness in my lower body was creating stiffness and tension in my upper body muscles. Hence, I found myself completely unable to turn my head from side to side.
The Downside of Bendiness
Although I’ve never been formally diagnosed, I am (like many yoga practitioners) hypermobile. This means I’m overly bendy, in certain areas (and woefully stiff in others). As a child, I totally dislocated an elbow (a very surreal experience). Only a few years ago in my early forties, I partially dislocated a shoulder (this helped me understand shoulder joints a lot more). I have “interesting” sacroiliac joints, that have given me a lot of pain over the years, but are now behaving. Hypermobile people need to work hard to connect with their body, if only to reduce pain and bring some control to otherwise wayward joints.
Yoga Can Help or Hinder
If I didn’t have this condition, I probably wouldn’t be a yoga teacher. So for that, I am thankful. Hypermobile people have less proprioceptive awareness, which means they are prone to poor posture and can be awkward, erratic and clumsy in their movement. Yoga helps with posture, cultivating grace, awareness and flow. Yoga can also help to relieve aches and pains associated with hypermobility, which is why I got hooked on yoga in my teens. However, the last thing a hypermobile person needs is more stretching. Going to a yoga teacher who has no idea about the needs of a hypermobile person can create more pain and difficulty. If you are verbally encouraged to stretch in pose, don’t listen. If the teacher gives you an assisted stretch, without careful assessment of your joint mobility, back away. This is not the class for you!!
Bendiness is Overrated
To those stiffer, naturally stronger students of yoga who long to touch their toes or put their foot behind their head (why is this even a goal?) I say: “don’t covert the overly bendy.” There is a price to pay for being a human pretzel. If flexibility is not carefully balanced with strength, then it can become a real drag.
What is Hypermobility?
Doctors tend to regard hypermobility as a very rare condition. Ehler’s Danlos Syndrome is the little known medical name for moderate to severe hypermobility syndrome. In addition, people do get confused between flexibility and hypermobility. Joint flexibility (ideal range of motion) is certainly beneficial. It is associated with better range of motion and resilience in older age. However, joint hypermobility (going beyond normal range) is associated with arthritis and joint problems. Before you worry too much about this, be aware that hypermobility is a spectrum disorder. This means that being a little bit hypermobile may be entirely manageable, you can prevent adverse symptoms by strengthening and becoming aware of your movement. However, people who have more severe forms of hypermobility should seek medical support and treatment. Current research is connecting the dots between hypermobility, fibromyalgia and chronic pain. Top specialist doctors and researchers now see that the links between these conditions could provide clues to better management and treatment.
Hypermobility, Fatigue and Pain
Hypermobility can cause constant nagging pain, in joints and muscles. It can be hard to find the root cause of the pain, therefore dignosis and treatment is difficult. When hypermobility is severe or unmanaged it is also associated with sleep problems; gastrointestinal problems; dizziness, nausea and headaches There are various different kinds of hypermobility, as it can affect different tissues. In serious cases it can adversely affect the cardiovascular and reproductive systems and severely restrict mobility. Please be clear, that I’m a yoga teacher, not a doctor, so my approach to hypermobility is non-medical and simplified. Please refer to the reading list below if you’d like more detailed medical explanation
What causes hypermoblility?
It is an inherited condition that means the connective tissue (think tendons, ligaments, joint capsules) is much more stretchy than in the average person. Women are more prone to hypermobility than men. This may be due to prolactin, a hormone that increases during pregnancy and breastfeeding, to increase the stretchiness of connective tissue, which enables easier childbirth. Perhaps this is why more women are more attracted to yoga than men, as it’s easier for them to attain the more challenging poses. People from particular ethic backgrounds are also more likely to have stretchy connective tissue. Yoga originated in Asia, and where flexible hips and joints are the norm.
Problems with Associated with Hypermobility
Connective tissue (AKA fascia) supports, surrounds, joins and separates our muscles, bones, viscera (organs) and blood vessels. Connective tissue literally holds us up and holds us together. Hence people with loose fascia are more likely to slump and to “lean into” or “hang off” their joints. This causes further instability in joints, leading to joint pain, “wear and tear,” and dislocations of the joints. Hypermobile people are also more likely to have low blood pressure; flat feet; prolapses; hernias; varicose veins; and urinary stress incontinence. Whilst there is no cure for hypermobility, it can be managed with appropriate exercise (like yoga, pilates and physiotherapy). In my own experience, and that of my hypermobile students, proper hydration, nutritional supplementation and eating more healthfully (more green vegetables, high quality protein and good fats) can help lessen some symptoms enormously.
Are you a Viking or A Temple Dancer?
Tom Myers, an anatomist who has made a life long study of connective tissue, suggested that people can be classified broadly into two types. The Viking: sturdy, strong, inflexible – possessing tough connective tissue. The Temple Dancer: less stable, weaker, flexible – having loose connective tissue. Interestingly as the connective tissue surrounds our blood vessels as well as our joints, the Viking is has a tendency towards higher blood pressure; the Temple Dancer towards lower blood pressure. The Viking likes a yang style yoga practice: her favourites will be plank pose, boat pose, balancing postures and long holds of standing poses. As for the Temple Dancer, well flexibility is her forte. She will enjoy a more yin practice: sitting and standing forward bends, hip openers and pretzel type poses. Putting her foot behind her ear seems more attainable than it does for the Viking. This flexibility sets the Temple Dancer up for problems such as hamstring attachment injuries; knee problems; rotator cuff (shoulder muscle) problems; sacroiliac joint (SIJ) dysfunction and lower back strain, to name a few.
Yoga for Resilience
Hatha Yoga (the postural part of yoga practice) is the art of bringing opposing forces into balance. Although Temple Dancers may be drawn to yoga because they find it easy and enjoyable to do the postures that demand flexibility; strength needs to become a part of the practice in order to protect vulnerable joints. Temple Dancers need to learn not to go to the end range of their joints (which is often beyond the norm already). They need to forgo that stretchy sensation (we are often overly attached to the sensations of stretch, and crave it) and find a quieter, stronger expression of the pose. As for the Viking, well the yoga postures provide a delicious way of increasing or maintaining their flexibility as they age. They will feel the stretchy sensation pretty easily, as a strong type of discomfort, that is hard to learn to love. By using the breath, awareness, gravity and time, they will gradually unravel the some of tightness that binds them. Regular yoga practice maintains a conscious connection to how the body feels on a day to day; week to week basis. It is the ultimate age-reversing movement practice. Regular yoga practitioners find they cultivate flexibility as well as strength; balance and equanimity (calmness and composure, especially in difficult situations). These qualities are enormously important for developing resilience, vitality and energy as we age.
Where are You in Space?
Hypermobile people are drawn to yoga like moths to a flame. Thankfully, awareness of hypermobility is growing in the yoga community. Teachers are less likely to encourage hypermobile students to bend excessively in mobile areas of their spine or without engaging their bandhas (core strength muscles). The problem is that hypermobile students have less proprioceptive awareness (less idea of where they are in space, due to less feedback messages coming from their muscles). After years of self correcting and training myself to move back to centre, I still benefit from using a mirror or having a teacher let me know I’m over bending. However, in the larger studio classes, such details can be missed. Especially as many of these overly bendy yogis are put forward as the ideal and their pretzel like poses are viewed as something for everyone to aspire to. This must stop – yoga is so much more than a bending competition!! We all have different fascia, different skeletons, allowing for vastly different ranges of mobility. We cannot all be super bendy, nor should be aspire to be.
Bendy Yoga Injuries
As a new mum and Astanga yoga practitioner in 2002 I was encouraged by my teacher to go stretch deeply. This further destabilised by joints and led to three yoga injuries. An out of whack SIJ (sacroilliac joint, the bony plate at the base of the spine, between the hips). Two busted knees (torn meniscus and anterior cruciate ligaments). And a “clicky-cluncky” hip. These all caused me a huge amount of pain and misery. I walked with a stick, when I was at my worst. I felt elderly, depressed and exhausted. It was quite common for both of my knees to go red, hot and puff up like squishy puddings.
We Need Stability and Awareness
The combination of even more softening in my connective tissue (due to my recent pregnancy and breastfeeding) and my pre-existing hypermobility meant that I could not stabilise myself. The lack of stability I had in every day life, was taken to new levels in my Astanga yoga practice. As my muscles didn’t realise they had to participate, a lot of stress went into my joints. Sadly, during this time, no teacher spotted that I wasn’t working my muscles. Instead, they saw the overall bendiness and celebrated and encouraged still more of it.
During my three year teacher training, starting in 2003, I realised that this over enthusiastic yoga practice had caused my injuries. Thankfully, I also saw that a more considered practice was the way to sort them out. My knees responded well and I avoided the surgery that my physiotherapist recommended.
Scaravelli Yoga Solutions
After my teacher training I was recommended to go to a wonderful teacher called Sophy Hoare, who had been taught by Vanda Scaravelli. Sophy had an incredible way of communicating somatic experience within the body. Her language was very precise and descriptive, using a host of playful visual imagery. She was the first person who helped me to locate my gravitational centre and connect it in a powerful way to the ground. Finally, I became aware of how to create strength and stability in a “whole body” manner. In her classes, I was surprised and delighted that I could turn the pain in my joints off (and on again) by connecting from spine to earth (or not). From this point on, my joint pain became understandable and manageable.
Over-stretching already long weak muscles, can create further instability, muscle attachment tears and pain for hypermobile students. However, an intelligent practice can help to relieve many symptoms. Paradoxically, hypermobile students can be very tight in some muscles groups in order to compensate for the lack of tightness elsewhere. One thing I see quite regularly in class is tight hips and mobile knees (or ankles); or tight shoulders and neck and loose elbows, wrists and fingers. Working with yoga to balance out all these relative tensions can be quite specific and detailed. It demands cultivation of inner body awareness, in yoga terminology this is called pratayahara.
And this cultivation of inner awareness leads us to the difference between yoga and many other movement practices. In sports, personal training or even Pilates there is little or no philosophical or spiritual underpinning to the work in hand. With many movement practices (including, sadly some yoga styles) there is a goal, or an agenda. With yoga there is no goal to strive towards. In fact by striving to “do” yoga, we are misunderstanding what yoga is all about! Working hard to become more or less bendy, really is missing the point. Aiming to fix ourselves or to become better in any way is also not understanding the true purpose of our practice.
Yoga is a journey of self discovery. We learn to respect our limits on some days, we learn when we can go safely beyond them on others. More importantly, we learn to accept being where we are, maybe stuck in limited in some ways, but not in others. Breathing with the discomfort can help to alleviate it, it can also simply help us to bear with it, gracefully. With regular practice, we learn how we feel on a day to day basis; we notice the changes. We accept the changes with equanimity, we don’t wish for something else, we work with what is here today.
Through our practice we become more attuned to the effect that our moods, the weather, injury and exertion, have on our body and mind. We learn to laugh at ourselves (not take ourselves too seriously) and to be kinder to ourselves (and therefore to others). We learn the art of non-doing, slowing down, deep restoration and stillness. It is these more subtle and mental aspects of yoga, that help the hypermobile student, (or indeed any student) to come to terms with restriction, pain, tiredness, stress, tension, flare ups and set backs. We meet ourselves each day (or week) on the mat, with kindness, patience and awareness. We learn to bring our awareness to our movement, breathing slowly and steadily and feeling the ground beneath us. This kind of practice has a habit of seeping into our every day lives inviting us to live with more acceptance, grace and gentle humour.
Isobel Knight, A Guide to Living with Ehlers-Danlos Syndrome (Hypermobility Type) Bending without Breaking
This is a book written by a sufferer, full of information and tips for dealing with hypermobility syndrome.
Alan J. Hakim et al, Hypermobility, Fibromyalgia and Chronic Pain
This book is written by the leading hypermobility specialist in the UK who works in the leading London Hypermobility Unit (this is a private clinic) There is an NHS Hypermobility Clinic at UCLH