Hypermobility has begun to garner attention in the yoga community—and for good reason. With social media full of images of yoga influencers twisting themselves into highly contorted positions, yoga can appear to be about ever-increasing and near-superhuman flexibility. With its focus on end-range mobility, asanas tend to attract exceptionally flexible individuals. While most yoga practitioners would surely agree that yoga is for everyone, being good at yoga can sometimes be construed with getting oneself into poses that resemble human pretzels. It is worthwhile to ask: Do yoga asanas promote an unhealthful level of flexibility and should hypermobile individuals practice yoga?
Read on to find out more, in an exclusive excerpt from The Physiology of Yoga.
Joint hypermobility, commonly known as double-jointedness (though that term is not anatomically or biomechanically accurate), describes joints that can move beyond what is considered normal ranges of motion. While the definition of normal range of motion varies from one textbook to another, a few indicators of hypermobility are the ability to touch your thumb backward to your wrist or the ability to put your foot behind your head. The latter is a position that, on the one hand, is considered abnormal by the medical community and is, on the other hand, known as Eka Pada Sirsasana and found in the intermediate series of the Ashtanga Vinyasa system.
Eka Pada Sirsasana
While it is possible to be hypermobile in just one joint, hypermobility is usually seen in multiple joints or even all joints as a hypermobile individual has highly compliant (meaning stretchy) connective tissue. Joint hypermobility is relatively common, occurring in about 10 to 25% of the population, with no problems presenting in most cases (Garcia-Campayo, Asso, and Alda 2011). If no symptoms are present, there appears to be no harm in being hypermobile.
A minority of hypermobile people, however, can experience pain and other issues. Hypermobility spectrum disorder (HSD) describes the pain and other symptoms that can come with being overly mobile. The term was coined in 2017 to replace joint hypermobility syndrome, which lacked differentiation from other syndromes (Tinkle et al. 2017). Symptoms of HSD can include pain in affected areas and the inability to walk properly or for long distances. Some people with HSD have hypersensitive nerves and a weak immune system. It can also cause severe fatigue and, in some cases, is associated with depressive episodes or anxiety disorder. It is similar to other genetic connective tissue disorders such as Ehlers-Danlos syndrome. In fact, some experts recommend the two should be recognized as the same condition until further research is conducted, because no genetic test can identify or separate the conditions and the diagnostic criteria and recommended treatments for them are similar.
Hypermobile people might be more drawn to the practice of yoga than hypomobile (very stiff) people as they find they can access the advanced postures with relative ease. But should a hypermobile person, especially one who experiences pain as a result of their increased flexibility, really be trying to increase their flexibility through yoga?
I believe yoga can be appropriate for hypermobile people, whether diagnosed with HSD or not. The intricacies of adapting yoga to hypermobile populations create a complex topic, and what works for one hypermobile person may not work for another. Furthermore, yoga teachers do not have the authority to diagnose HSD—or any condition for that matter.
However, with those caveats, here are a few common-sense guidelines for hypermobile people practicing asana:
• Maintain a slight bend in joints, particularly weight-bearing ones. Hypermobile people are more likely to have joints that can hyperextend (one of the marks from the Beighton test is hyperextended elbows), and it is easy to disengage muscles around hyperextended joints, which usually translates as greater force through ligaments and joint capsules. In addition to maintaining a microbend in the elbows during High Plank, try microbending the knee in straight-legged poses such as Triangle (Trikonasana) and Pyramid Pose (Parsvottanasana). Also, press into the ball of the foot (metatarsals) while driving the shin forward slightly. This will require more effort but can contribute to building strength in the asana.
• Prioritize stability over flexibility. While passive stretching can feel great and can complement a balanced movement practice, hypermobile people should probably focus on increasing strength and stability over increasing range of motion. Knowing that hypermobile people usually have decreased muscle strength and muscle mass (Pacey et al. 2010), training for strength should be an important part of their practice. In any given pose, instead of focusing on going deeper into the stretch, consider how easily you could be knocked over if someone bumped into you and focus on creating more stability in your practice rather than flexibility. In making strength a priority, one might consider adding a session of resistance training with weights or resistance bands to their weekly yoga practice.
• Aim for 80% of your full range. Pulling back from your end range will make your muscles recruit to support the pose and may assist in building your body’s inner awareness, or proprioception, something that tends to be compromised in hypermobile people.
• Seek ideal individual alignment rather than ideal universal alignment. Notice how the traditional cues for an asana (which can vary from one style to another) feel in your body. If the teacher is telling you to keep the heels in one line in Warrior II while squaring off your hips to the front of your mat, but you find that these cues do not work for your body (for example, they cause pain in the lower back), be confident in adapting the pose to your body’s needs. Sometimes, a slightly wider foot stance or shift in the hips can make all the difference between a pose feeling uncomfortable or comfortably challenging.
• Practice humility. Just because you can get your foot behind your head does not mean you should. While there are no poses that are specifically contraindicated for hypermobility, hypermobile people should consider the following question before trying to get into some contortionist-looking advanced posture: Am I attempting this pose because I genuinely believe it would benefit my body, or am I attempting it merely out of ego?
References:
Garcia-Campayo, J., E. Asso, and M. Alda. 2011. “Joint Hypermobility and Anxiety: The State of the Art.” Current Psychiatry Reports 13 (1): 18-25. https://doi.org/10.1007/s11920-010-0164-0.
Pacey, V., L.L. Nicholson, R.D. Adams, J. Munn, and C.F. Munns. 2010. “Generalized Joint Hypermobility and Risk of Lower Limb Joint Injury During Sport: A Systematic Review With Meta-Analysis.” The American Journal of Sports Medicine 38 (7): 1487-1497. https://doi.org/10.1177/0363546510364838.
Tinkle, B., M. Castori, B. Berglund, H. Cohen, R. Grahame, H. Kazkaz, and H. Levy. 2017. “Hypermobile Ehlers-Danlos Syndrome (a.k.a. Ehlers-Danlos Syndrome Type III and Ehlers-Danlos Syndrome Hypermobility Type): Clinical Description and Natural History.” American Journal of Medical Genetics C Seminars in Medical Genetics 175 (1): 48-69. https://doi.org/10.1002/ajmg.c.31538.