Occasionally in a physiotherapy practice we will get a patient walk through the door and tell us how extremely 'tight and stiff' they are. They're the ones you see in the gym who are constantly stretching, to then head over to the exercise bike for 5 minutes before heading back to the mat for some more aggressive stretching. Despite the fact that they move more freely than a zen yogi, they continually feel 'tight'.
When this patient eagerly shows us how limited their movement is, we observe as they flawlessly bend forwards and put their hands flat on the floor with their knees straight. They return to the upright position, exclaiming; 'See, i told you I am inflexible and tight.' A quick glance at their elbows reveals a hyperextended elbow, which straightens beyond neutral territory. We ask them to bend their thumb back to try and touch their thumb to forearm. Three out of three ticks so far. After some thorough assessment, the patient scores very highly on a scale called the 'Beighton Hypermobility Scale'. This patient is not tight or inflexible at all, in fact they are the opposite. They are hypermobile.
Our joints are surrounded by ligaments which restrict and limit our range of movement. Some peoples' ligaments are tight and stiff, while others have loose or 'lax' ligaments. Now this is neither good nor bad, just a variation from the norm.
Is hypermobility an issue?
Not necessarily, but anecdotally it can lead to pain and discomfort.
When we have more range of movement, we are more likely to take our joints to this end of range, potentially making us more prone to joint dislocations, joint pain and muscle fatigue.
Why does a hypermobile individual often feel 'tight'?
It's quite the irony really; the flexibile nature of our joint is actually the cause of our perceived tightness. You see, when we have a joint that moves a lot, we require our muscles to stabilise and control movement a lot around this highly moveable joint. These muscles are constantly working to control and limit this excessive motion. A hip joint that doesn't move much doesn't require much muscle control through that limited range. A hip joint that moves A LOT requires A LOT of muscle control through the excessive range. This renders the muscle more likely to become fatigued. When a muscle becomes fatigued, it develops tight spots or trigger points - leaving our hypermobile patient with a feeling of 'tightness.' The key here is that it is a feeling of tightness, not a barrier to movement tightness or restriction to movement.
What can we do about it?
The best thing we can do is to stop our excessive stretching! There are exceptions here; dancers, gymnasts and some sportspeople NEED large ranges of motion, but Joe or Julie Bloggs from Ocean Grove doesn't need huge flexibility to make it through their day to day lives.
Instead of excessive stretching, it's time for our patient to start focussing on stability, strength and control. We need the hypermobile individual to gain more control of the excessive joint movement that they have available. There are several ways to do this, some including;
- An individualised pilates type program.
- A structured strength and conditioning program.
Both would potentially lead to good results if the focus was on muscle control and stability, as opposed to increasing joint movement.
So there you have it. If you score high on Beighton's Scale, and have joint, muscle or instability problems, it's time to seek out some professional advice to start on a structured rehab program.