Here’s how I explain what hypermobility really means in simple terms to my hypermobile patients👇
Hypermobility Is Not Flexibility!
- HYPERMOBILITY refers to joint-based excessive movement beyond normal limits due to hypermobile connective tissue. Hypermobility is something you are born with (think of it as any other characteristic like having brown eyes, or being tall), as it is an innate quality of your connective tissue. For example, if your knees hyperextend you didn’t have to work to achieve that range of motion. It’s just how your knees are.
- FLEXIBILITY refers to muscle-based ability for joints to move through an unrestricted range of motion that does not result in pain or injury. Flexibility is acquired through stretching and developing the ability to move a joint in a greater range of motion due to neuromuscular adaptation of the soft tissue structures within and around the joint. For example, if you are someone who could never touch your toes and you worked consistently over time on hamstring stretches and then developed the ability to touch your toes, that would be an example of increasing your flexibility
There Are Different Types of Hypermobility
Hypermobile connective tissue can be local, regional, or throughout the whole body depending on how the person is affected. A fourth type of hypermobility called Historical Hypermobility refers to when a hypermobile person has experienced joint stiffening due to age-related changes or cumulative injuries over time and consequently their joints do not appear to be hypermobile in the same way as they would have done if they were assessed at a younger age. This is why taking age into account when assessing patients for Generalised Joint Hypermobility (GJH) is critical, as the way in which hypermobility presents in a person’s joints will change over their lifetime.
TYPES OF HYPERMOBILITY
Local Hypermobility: a singular joint/group of joints is hypermobile. For example, someone might just have hypermobile knees (and not be hypermobile anywhere else in their body). I don’t see this very often in patients, but it does occasionally happen.
Regional Hypermobility: sometimes joints are grouped in different ways in the body, and these are referred to as “bodily regions.” Some examples of regions include the upper extremities (your hands, arms and shoulder blades), your lower extremities (your feet, legs, and hips), and your axial skeleton (your sacroilliac joints, your pelvis, your spine, your jaw, and your skull). Some patients will present with hypermobile joints in one region of their body, without having hypermobile joints in another region of their body. Commonly patients who are only hypermobile in their lower extremities (hips, feet, knees, ankles etc.) are not identified as being hypermobile by healthcare providers, as the most common hypermobility assessment (the Beighton Scale) neglects to adequately asses the lower extremities.
The Beighton Scale In Brief:
The Beighton Scale is a 9-point movement scale used to assess patients for Generalised Joint Hypermobility. Of the 9 possible points, 6 are located in the upper extremities. This means that the Beighton Scale is not a reliable tool in isolation to assess patients for hypermobility, and it’s particularly not reliable for patients who are hypermobile in their hips, knees, ankles, and feet.
Generalised Joint Hypermobility (GJH): sometimes people will have hypermobile connective tissue in joints throughout their body. This is referred to as Generalised Joint Hypermobility (GJH). GJH is typically assessed using the Beighton Scale, with people who score 5 or more on the 9 point scale given the label of GJH. Although the Beighton Scale is commonly used, it is far from perfect. You can listen to my Help! I’m Hypermobile podcast episode by clicking here where I do an in-depth discussion and analysis of the Beighton Scale, and please also be sure to check out The Beighton Score as a measure of generalised joint hypermobility by Sabeeha Malek et al. (2021) which reaches the conclusion that:
“As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH.” (Malek, Reinhold and Pearce, 2021)
Historical Hypermobility: when someone was hypermobile in their youth, but in adulthood their tissue has stiffened so that they now present as someone with seemingly normal mobility or even joint stiffness. It’s important to note that in addition to natural consequences of aging, their tissue likely will have stiffened due to cumulative injury over time and tissue scarring. These patients are in no way less affected than younger patients where joint hypermobility is more obvious, and it is critical that patients with Historical Hypermobility are not overlooked when assessed by healthcare providers.
HYPERMOBILITY SUMMARY
If you’re still with me by now, here’s what you should know so far:
- Hypermobility is an innate quality that someone either has or does not have due to their connective tissue makeup.
- Hypermobility can be local, regional, or general (throughout the body). And it can be historical!
- Although the Beighton Scale is used to assess individuals for GJH, it is flawed and should be used as part of a comprehensive assessment by a hypermobility-informed healthcare provider. The Beighton Scale should never be used in isolation to exclude GJH!
Already taken the Officially Unofficial Hypermobility Quiz? If so, you’ve likely received your personalised results and now have a clearer idea of whether your hypermobility is more focused in your upper body, lower body, or throughout.
Not taken the quiz yet? No worries! It’s quick, fun, and could give you valuable insight into your body. Plus, it’s just 10 questions. Click here to get started!
Hypermobility and Health Consequences
Although many healthcare providers and researchers argue that hypermobile joints on their own can be harmless (and they often cite examples of various Olympians and pop stars), I disagree. Here’s why:
Why There’s No Such Thing as Truly Benign Hypermobility
- Hypermobile connective tissue allows joints to move beyond their typical range of motion, even if only slightly. This extra movement, while not always dramatic, still exceeds the normal capacity of the joint’s supportive structures.
- When a joint moves outside its normal range, particularly without sufficient muscular support or repeated over time, it places strain on the joint surfaces, which are not designed to handle such stress.
- Movement at the extreme end of a joint’s range is inherently more difficult to control, especially if proper movement patterns are not consistently maintained or the joint lacks adequate muscular support.
- While not every case of uncontrolled movement results in injury, it significantly increases the likelihood of joint damage, as abnormal movement can compromise the integrity of the joint’s supportive tissues over time.
CONCLUSION: Therefore, even individuals with localised hypermobility face a greater risk of joint injury at their affect joint(s). Although some people may not experience symptoms until later in life, hypermobility increases the overall likelihood of developing arthritis and other joint-related conditions, particularly if preventative measures aren’t taken early on.
And as for the visibly hypermobile Olympians and pop stars, it’s well-known by anyone who has spent any amount of time working with professional athletes and performing artists that a lot of them are plagued by chronic injuries and joint pain that they don’t publicly disclose due to fear of losing sponsorships or as being seen as vulnerable or weak by their competition. So just because your favourite Olympian or pop star can do something impressive with their body it does not necessarily mean that they are in good health and feeling well.
Generalised Joint Hypermobility and Health Conditions
GJH is a feature of numerous connective tissue disorders, including Hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), and Marfan’s Syndrome to name a few. Each diagnosable connective tissue disorder has its own set of diagnostic criteria (for example, at the time of writing this hEDS is currently diagnosed using the 2017 hEDS Diagnostic Criteria). However, it’s important to note that due to a general lack of understanding and awareness in both the healthcare providers and the general population regarding connective tissue disorders that although they are relatively common (for example, hEDS/HSD occur in at least 1 in 500 people, which makes it more common than other relatively well known conditions such as Sickle Cell Anaemia and Inherited Familial Hypercholesterolaemia) they are frequently not diagnosed.
In her commentary on hEDS and HSD in midwifery patients, Dr. Sally Pezaro powerfully summarises the current diagnostic reality of hEDS and HSD by stating that: “[hEDS/HSD] should no longer be considered rare, only rarely diagnosed.”
This is why I’m so passionate about my work with people who are hypermobile: because it’s common(!), and it affects the lives of countless people across the globe. And although hopefully one day there will be greater awareness in healthcare as a whole regarding hypermobile connective tissue, for now unfortunately most patients have to learn about hypermobility and related conditions independently in order to be able to access care. The healthcare needs of people who are hypermobile are further complicated by the fact that hypermobile connective tissue (especially in people who are hypermobile throughout their body) is often not just limited to muscles and joints.
Connective Tissue is Everywhere (Literally)
Did you know that your gut is essentially a long tube of connective tissue?
And your eyes are connective tissue. And your teeth. And your skin. And your bones. Even your blood is technically connective tissue!
Connective tissue is everywhere.
Although some people who are hypermobile do not experience symptoms outside of those relating to their muscles and joints, anecdotally I can say with certainty that most of the patients who I see experience symptoms in at least a few other bodily systems. Common ones include:
- an unexplained IBS diagnosis (you can listen to my podcast episode where I discuss hypermobility and gut health here, and you can check out the research paper Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know by Phoebe Thwaites, Peter Gibson, and Rebecca Burgell)
- unexplained period issues (for example: serious muscle and joint pain before/during menstruation, excessive bleeding, cycle-related headaches)
- unexplained skin rashes that seem to come and go, and which often get labelled simply as “sensitive skin”
- unexplained dental issues (the classic example is the patient who tries their best to brush and floss their teeth and eat healthily and who still gets cavities)
- unexplained lightheadedness when transitioning from sitting to standing, or an unexplained chronically low or otherwise abnormal blood-pressure (for many patients this ultimately relates to conditions such as Postural Orthostatic Tachycardia Syndrome aka POTS or other forms of Orthostatic Intolerance, including Orthostatic Hypotension)
Please note that although connective tissue will affect each of the above listed symptoms/conditions from a mechanical perspective (for example: it’s common sense that if the connective tissue of your gut is too stretchy then it won’t move food through it at a normal rate due to an altered ability to exert tension on its contents), it’s important to be aware that each of the listed items will also be affected by other related health issues seen in people who are hypermobile, the most important of which are mast cell and histamine related issues.
I won’t go into detail mast cells and histamine in this blog post but the key to successfully managing symptoms in most patients who are hypermobile is appreciating how hypermobile connective tissue AND dysregulated chronic inflammatory processes (which are often mast cell/histamine related) affect each other.
And finally: this is not to say that every health issue relates to hypermobile connective tissue. In fact, there are MANY other ways that people can have symptoms, and it’s critical that caution is taken before ascribing everything to being related to a connective tissue disorder. But many other healthcare conditions occur at greater rates in people with hEDS/HSD, and it’s important to be aware of them so that they are properly diagnosed and managed.
Incurable Does Not Mean Untreatable!
Although as of right now there’s no way to make anyone’s connective tissue less hypermobile (just like we can’t make my eyes any less brown), there are treatment options available for many of the symptoms that hypermobile people deal with. And the more you learn about this stuff, the better able you will be to make informed decisions (ideally in collaboration with good healthcare providers) about treatment options for your uniquely hypermobile body.
If you’re eager to dive deeper into hypermobility and related topics, be sure to check out my Officially Unofficial Hypermobility Quiz and sign up for my newsletters. There’s plenty more to explore on my blog, podcast Help! I’m Hypermobile, or through my content on TikTok and Instagram.
And of course, if you’d like to inquire about booking a consultation with me, I’d love to hear from you (you can get in touch by filling in the form here).
Remember, while we can’t change the fact that hypermobile connective tissue isn’t “curable,”many of the challenges hypermobile people face are treatable or manageable. Once you really grasp what hypermobility is and how it affects you, you may be surprised at how many ways you can improve or at least feel more in control of your health.
Wishing you all the best in health—and everything else!
Alex
P.S. If you haven’t taken the quiz yet, now’s the time! Click here to start. It’s fun, and you’ll also receive freebies like my Hypermobility Travel Guide (2nd Edition) and Salt Supplementation Strategy Guide—plus lots more hypermobility tips!
Accessibility Information
Both of my clinic offices at The Light Centre Marylebone and The Light Centre Monument are fully accessible, with elevator access and gender-neutral bathroom facilities. If you have specific accessibility needs, please reach out before booking an appointment to discuss how I can accommodate you.
About Alex
Alex is a highly sought-after Hypermobility Specialist Osteopath based in London, known for her extensive experience in treating chronic pain and injuries related to hypermobile connective tissue in both athletes and everyday individuals. She holds two four-year university degrees, including a Master’s in Osteopathy, and has completed numerous postgraduate certifications, such as Active Release Techniques®.
Alex began her career working with elite athletes, including two-time CrossFit Games Champion Annie Thorisdottir, before focusing on hypermobility-related injuries. She provides holistic, scientifically informed care for patients with Hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), and other connective tissue disorders. While hypermobility is her specialty, she also treats patients with complex, chronic, and treatment-resistant injuries who are not hypermobile.
Learn more at hypermobilityhq.com/about.
Works Cited
Malek, S., Reinhold, E.J. and Pearce, G.S., 2021. The Beighton Score as a measure of generalised joint hypermobility. Rheumatology International, 41(10), pp.1707–1716. Available at: https://doi.org/10.1007/s00296-021-04832-4 [Accessed 15 Oct. 2024].
Pezaro, S., Pearce, G. and Reinhold, E., 2021. A clinical update on hypermobile Ehlers-Danlos syndrome during pregnancy, birth and beyond. British Journal of Midwifery, 29(9). Available at: https://www.britishjournalofmidwifery.com/content/clinical-practice/a-clinical-update-on-hypermobile-ehlers-danlos-syndrome-during-pregnancy-birth-and-beyond/ [Accessed 15 Oct. 2024].
Thwaites, P.A., Gibson, P.R. and Burgell, R.E., 2022. Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know. Journal of Gastroenterology and Hepatology, 37(9), pp.1693–1709. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9544979/ [Accessed 15 Oct. 2024].
