To the Hypermobile Athlete
In Motion with Morrison Blog
Written by Aubrey Morrison
MS Sports Medicine, CSCS, Licensed Massage Therapist #16763
You stretch, you foam roll, you do yoga, you do all the things “they” say to do as an active individual when you have muscle and joint pain… But you STILL hurt, maybe even worse after a stretching session. In fact, maybe you have excellent flexibility! So much flexibility that you feel a little unstable, and you can do cool things like pop your elbow or shoulder in and out of place (do not do that…). Maybe your knees hyperextend a little, your low back clicks around and hurts, or you have flat feet. We, at Coastal Massage and Wellness, see you and we have a rather good idea of what may be going on. It is something that is not discussed enough – HYPERMOBILITY! That is, excess mobility.
There is constantly all this talk about improving mobility, stretching more, increasing flexibility, and treating clients in a way so they have less pain with more freedom of movement in their joints. What if you are one of those semi-rare individuals who has plenty of movement in your joints, and are in pain because of that? You do not need stretching or traction or any other techniques to improve your movement, because your range of motion is already there, plus some. Treating this condition is ESPECIALLY important in athletes!! Since hypermobility isn’t very common and chances are there may only be one or two on a sports team, coaches should make sure to adjust training programs and warm-ups for them, as they will need a different approach than the others. So, what are you supposed to do for relief? Athletes who have joint and muscle pain are often told to “stretch more” – but stretching is not a cure-all, and it is downright counterproductive in this case. This article will discuss the degrees of severity that an athlete or any individual may have, and from there it will be decided how it is treated, whether improvement can be made in stabilizing loose joints, and when massage and bodywork is something that must be incorporated as a regular habit in managing hypermobility.
Hypermobility is basically joint laxity caused by loose ligaments and can present itself in various degrees of severity. Flat feet, swayback in the lumbar region of the spine, and hyperextended knees and elbows are typical with lax joints; it can be the cool party trick of popping your shoulder out of socket and back in (not recommended…), or it can be to the severity of being a chronic disease called Ehlers-Danlos Syndrome (EDS) that is very debilitating and goes further than just loose joints. I will be discussing both types of cases, and how it pertains specifically to treating athletes and active individuals who experience pain with hypermobility.
When it comes to competitive or recreational athletes, hypermobility will most likely be at a manageable level, but can still cause pain and discomfort at the very least. The thing with hypermobile athletes is that the muscle and joint pain isn’t caused by restrictions lack of flexibility; it is caused by muscles having to act as joint stabilizers in addition to their movement functions because the ligaments that are meant to hold joints stable are lax. Constantly having to work to stabilize a joint causes constant tension in the muscles and can create trigger points and pain just from the overstimulation. Not to mention the soreness felt in a joint and its ligaments that are always being jostled around! The extra work muscles must do can decrease overall exercise stamina and cause extra soreness after exercise. For example, a loose sacro-iliac (SI) joint can cause intense back pain and muscle tension because the ligaments cannot hold it stable, and the muscles of the low back and glutes must work overtime to stabilize, which is not meant to be their primary job. Further, when those muscles do have to help create a movement, it takes away from their ability to stabilize the SI joint, and that instability adds to the discomfort. With all those muscles are required to do, they soon tire out and then the joint is really struggling for stability!
For sports with repetitive movements, the antagonistic muscles (the one opposing whatever is being used, such as the tricep working in opposition to the bicep) can feel tight and knotted even though flexibility and mobility are fine, because they have to work to control the repetitive movement. An example of this would be a baseball player, as they throw at a high volume with the same arm. They use a lot of muscles in the front of the body like the chest, anterior shoulder, and internal rotators to throw (that’s not all that are used, but for simplicity’s sake we will keep it at that). The muscles in the back, like posterior shoulder and external rotators, are actually working very hard to provide opposing muscle control, and with hypermobile athletes they also are working to keep the shoulder in place during the forward movement of the throw. This repetitive “controlling” type of contraction creates trigger points and tension in the posterior shoulder. Tense and knotted up muscles from attempts at keeping a joint stable must be treated differently in a hypermobile person versus someone with just tight muscles. Instead of working to increase range of motion, we will keep the joint within its normal range while using deep tissue techniques to target the trigger points and neuromuscular techniques to get the muscle to relax and be able to recover. While massage treatment like this is necessary for healthy soft tissue in athletes, specific strength work needs to also be incorporated during training to keep stabilizing muscles strong enough to help keep joints in alignment during activity. To give you guidance on how to strengthen and stabilize muscles are two NEW SERVICES! The Functional Massage will combine a 45-minute massage to address the tightness and then you will be guided with some exercises to do at home to strengthen any hypermobility issues! If you need a quick service to address the hypermobility issue, then this stand-alone service is just for you! Exercise Prescription is an amazing 15-20-minute service that we have added to our menu to give you the education that you need at home to address your issues.
On a non-sports-related note, people with extreme hypermobility or EDS will typically need to avoid sports activities and would need to be treated at a more specialized level in addition to massage. EDS is beyond just being hypermobile; it involves excess elasticity throughout the body, including the skin. These individuals will likely have joint and muscle pain among other symptoms, but massage can absolutely be used as a pain management tool.
It could be that you do not even know you have some degree of hypermobility! If we do any stretching and find that there does not appear to be a mobility restriction that is causing an imbalance and pain, we will do some techniques that do not have the goal of increasing range of motion, but rather to calm trigger points and muscle tension. We may also have some exercises to recommend for strengthening those muscles surrounding joints to build stability, strength, and stamina to keep you active and pain free! If you know or feel that you fall into this hypermobile category, come see us for a Customized Massage session, Functional Massage, or the Exercise Prescription. We have talked a lot about our Mobility Maker session in previous posts, but someone who is hypermobile does not need that at all! We know hypermobility requires treatment, and our goal is to keep you active, balanced, and pain free.