This is a question that I received from one of my clients earlier this week. He is a personal trainer himself, and a great one at that, so I imagine many of you have had the same question at some point in time.
Working with someone with hypermobility can sometimes be a bit of a challenge, as they have probably seen physios who were very cautious when prescribing exercise. To me, they are the perfect example of why you can't just stretch your way away from pain/injury, and why more mobility/joint ROM isn't necessarily protective. Interestingly, joint hyper-mobility is neither protective nor harmful, as it seems that there is mixed evidence on whether or not injury risk
is increased, which should at least cause people to question the narrative that injury is caused by a lack of mobility/flexibility. If this was the case, we would expect there to be a pretty consistent trend of lower injury rates in these cohorts, which does not seem to be the case, although this may apply in certain specific circumstances, as "hypermobility" is a feature rather than a specific diagnosis.
So, where I would go from here with someone like this is beginning with some education. You can, of course, choose to explain your rationale in any way that you think would suit (if you are relaying this information onto someone), but this is how I would go about trying to gain some buy-in:
"One of the things we know you have got nailed is your mobility and flexibility. Since these components of fitness are not of concern to us, we have to ask ourselves what would be of most benefit to 1) help reduce future risk of injury, and 2) help you return to a high level of sports performance in any sport you wish to participate in. We can start to break this down by understanding that your joints already have lots of range of motion, so what should we do
with that? The answer is that we now want to take that range as it is, but begin to improve our ability to produce force/strength. Not only does this help with building muscle, but it will actually reduce your risk of injury going forward, as you will have a better ability to support your joints and control that range of motion that you have."
It obviously depends on one's current perspective, but that would be a typical starting point for the conversation that I would have with someone who has hypermobility. People who have lifelong conditions* like that often have more beliefs that may need to be challenged.
*it's important to note that one could be generally hypermobile without having a specific diagnosis (e.g. a connective tissue disorder, such as Marfan's Syndrome), so it's not necessarily something we need to view as pathological.
Well, actually, it can go one of two ways:
1) Some people will have developed very good coping strategies and will be the type of people who say "well, I have lived with this, found what helps me to be healthy, and now I am very in control".
2) Others (I imagine this is more relevant here, based on the information presented to me) get to the point where they are just frustrated by having to deal with this, when they just want to play sport and be injury-free like everyone else. They may be more cautious about the activities they participate in, since they have built up the experiences that tell them they may get injured, which may even have been reinforced by healthcare professionals, as it's not
uncommon for physios to discourage people like this from participating in sports/activities that they got injured in.
So, as we have discussed many times before in our articles, on the podcast, etc., challenging those beliefs may be an important part of this process. BUT, that does not mean that needs to happen through education/just telling him that your way is the right way. In fact, the more potent strategy here would be to show them what they are capable of. This is the beauty of getting an idea of what activities they may perceive to be threatening. For example, if
they have previously been shying away from squatting, deadlifting, running, or anything else, gradual exposure to those tasks is a fantastic way to build self-efficacy, which is more powerful than any amount of education.
With that in mind, it ends up being a fine balancing act between being too conservative and being too aggressive. If you are the former, that may rub off on them as a sense that they need to be really careful with what they do, which may perpetuate previous beliefs and make the process of building self-efficacy more challenging. If you are the latter, you may shoot yourself in the foot by causing too much discomfort too soon, which may make them feel
like they are failing, reinforcing those prior beliefs.
I hope you enjoyed this article, and would really appreciate your feedback/thoughts. This was designed to be a very general discussion of how I would approach this as a coach. Specific conditions do vary, as you may know someone with a specific diagnosis (e.g. Marfan's Syndrome, Ehlers-Danlos Syndrome), the conditions for which may vary beyond those who have general hypermobility that is benign. Therefore, this is simply a starting point, but if you do
have more questions about exercise in the context of those conditions, or others, I would be happy to discuss this in more detail, or at least point you in the direction of useful resources.
- Gary McGowan
