My joints do not fall out of their sockets. In fact, my shoulders are the least mobile shoulders I've ever seen.
As a young coach, I didn't think shoulder dislocations were common until I met Piotr.
Piotr was my client and during the initial consult, he mentioned not being able to do anything with the bar behind his head. So we didn't do anything with the bar behind his head.
Piotr was a hacker working for companies to protect them from being hacked. Cool AF.
He did a conditioning class featuring barbell back squats one day. He descended into the first squat and at the bottom, his shoulder fell out of its socket.
Lots of pain, screaming and trauma happened. Or at least it did in my head, as I wasn't there at the time.
This had happened to him numerous times, I wanted to understand why.
Piotr has localized hypermobility due to damage to the shoulder as a younger adult. The rest of his body isn't hypermobile.
Hypermobility is when a joint or number of joints have more laxity than normal.
I wondered if hypermobility could affect all joints and wondered whether training hypermobile people would be "worth the risk."
I decided I'd love to train hypermobile people and continually endeavor to improve my services to this population.
Today, I present a brief guide to training people with hypermobility.
Different Types of Hypermobility
The collective term for all the hypermobility syndromes is hypermobility spectrum disorders. The spectrum goes from asymptomatic hypermobility at one end to any of the hypermobile Ehlers Danlos-Syndrome types at the other.
Hypermobility syndrome is when hypermobility causes pain, injury, or illness.
General hypermobility: more than 5 joints affected
Localized hypermobility: less than 5 joints affected
Localized hypermobility is usually acquired via a genetically inherited unusual joint structure, injury or degenerative disease.
People are normally born with general hypermobility syndrome but some people do develop it later in life through training in a specific way or via chronic Inflammation or degenerative diseases.
Hypermobility is often assessed via the Beighton Mobility Score.
Women are more prone to hypermobility than men, but that doesn't mean you won't train hypermobile men. I have a hypermobile client named John, and he is the bendiest person I've ever met.
Hypermobility is common alongside Down's syndrome.
It's not known how many people have hypermobility as it is often overlooked and misdiagnosed.
As a coach, it isn't your job to diagnose anyone, but if it's obvious they are hypermobile, there is nothing wrong with adjusting your coaching strategies to accommodate their needs.
Hypermobility is the result of a few factors. One of the main factors theorized is genetically inherited changes to a protein called collagen. Collagen is highly important in ligaments, tendons, and joint capsules. When collagen is weakened, it makes it easier for sufferers' joints to fall out of their sockets.
Training Considerations
It's important to know some people have hypermobility with ZERO accompanying symptoms. In fact, in sports such as Olympic lifting and powerlifting, hypermobility can give you certain advantages. When symptoms are present, people can still compete successfully but training will need to constantly adapt to the needs of the individual.
Below is a selection of things to look out for when training people with hypermobility:
Hyperextending wrists and elbows while performing press ups
Strange ways of moving weights in an out of position
Knee hyperextension during squats and deadlifts
Subconscious stretching because they are good at it
Jelly ankles
Clumsiness
Dizziness/Fainting/Racing heart rate
Shoulders being more mobile during bench press
Crazy spinal mobility
Lower back hyperextension while planking and similar exercises
Shoulders being partial to dislocation during overhead movements
Hip pain/dislocation risk when performing any exercise lifting a leg or both legs while laying on your back
Training Trauma
Training can cause damage and micro damage to the structures of the body. Macrotrauma includes dislocations, and damage to muscle, ligaments, and tendons.
It is important to choose exercises the client can tolerate and remove what hurts them or exposes them to a high chance of injury. It's a constant learning process but over time you'll build a detailed picture of what your client can and can't do.
Microtrauma is tiny injuries that build up over time. This can lead to injury, pain, and loss of function.
Unfortunately, we can't avoid injury and trauma. With the best or worst form, injury can strike at any time.
As a coach, this means we are often relying on luck. With the hypermobile, it's easier to guess where injuries may occur, because you can see the hypermobile joints fairly easily. And this is where injury is most likely to occur.
It's good advice to avoid high-impact exercises on the hypermobile joints. Throws, jumps, and powerful movements will need adjusting to use less range of motion in an attempt to prevent dislocations.
To deter the long-term build-up of microtrauma, deloads may have to be a more regular occurrence for this population. You may need to cycle movements around more often to prevent too much wear and tear or you may have to stick to a few movements high to cause minimal discomfort.
With single-joint hypermobilers, it's a little easier to reduce injury risk because the coach needs to not be a dickhead with the affected joint. This means avoiding certain movements, reducing the range of motion of certain movements, and creatively working around the hypermobile joint.
Chronic Pain
Hypermobile often suffer from chronic pain which is described as pain that lasts longer than 12 weeks.
Chronic pain is debilitating, ridiculously tiring, and changes how people move as they try to void using the painful area .
Chronic pain reduces people's decision-making abilities and sufferers can be prone to saying "screw it" and going for a big lift they have no business going for. Look for opportunities to navigate these behaviors.
I thoroughly believe you should train hypermobile, chronic pain sufferers around the pain. I recommend planning a series of programs around their pain spectrum so they can always do something, and they are given some power over their pain by being able to decide which training to do.
I've written about this before. You can read about it HERE.
Pain is incredibly complex. The chronic pain a hypermobile person feels may have no obvious cause. You can't see the pain and this can be debilitating in itself. Be patient, work around what your client can tolerate. You could be the difference between a hypermobile person not being able to train and them creating a lifelong lifting habit because of the adaptability you've built as a team.
Proprioception/Coordination
Proprioception is the sense of registering where parts of our body are and how much effort it takes to do things. This can make new movements take longer to master.
This means the style of coaching cues you use on people without impaired proprioception may not work with people with hypermobility.
As I discussed in my podcast with Nick Winkelman, coaching cues tend to work best when the focus is on the outside, or on an action, or on anything but thinking about what muscles you should be using. This means you can teach people to move with sentences like "throw your knuckles towards the ceiling" and they'll perform a dumbbell snatch better.
This often isn't the case with hypermobile lifters. It could be because of heightened anxiety, it could be due to being prone to falling over, or could be to do with struggling to visualize certain things because of an autistic spectrum disorder.
It could be to do with a substantial removal of a 'stretch' feeling, which is such important feedback for movement.
My theory is hypermobile people have less data to work with as they don't feel a stretch in many movements. You can't have good proprioception when there is nothing to feel!
If you have a hypermobile client who struggles with proprioception, be careful with throwing, catching, and things moving at high speed.
With hypermobile people, I tend to use more internal cues (getting someone to think about something in their body as they move), slower tempos, and starting from the most difficult portion of the lift to help the person build context and familiarity with the positions I want them in.
Hypermobile people are usually very coachable, but you will have to be patient, adaptable, and have great communication skills to coach them effectively, especially if you want them to move well away from your prying coach eyes.
Over time, you'll learn what your client struggles with and what they nail quickly, and how to train them effectively.
A lack of coordination/proprioception is usually present with general hypermobility not single-joint hypermobility, but it's possible a single-joint hypermobile person doesn't have a good awareness of how their body is moving.
Other Fun Bendy Things
As hypermobile people grow, forces like gravity impact them differently from the rest of the population.
You might see:
Flat feet
Misaligned bones in the elbow and big toes (as with one of Coach V's big toes)
Scoliosis of the spine
Kyphosis of the spine or rounding of the upper back, perhaps looking like a hump
Lordosis (excessive lower back arching)
You may see reduced bone mass
Muscle weakness
Hernias
Dislocations
Associated Issues
Anxiety disorders
Orthostatic tachycardia (abnormal increase in heart rate when standing or sitting)
Low blood pressure
Gastrointestinal disorders
Pelvic and bladder dysfunction
Autism and ADHD traits
These additional issues can affect training and health in a myriad of ways. Anxiety disorders can affect, well, everything. If you feel dizzy each time you stand up from sitting or vice versa this should affect exercise selection as will low blood pressure.
Pelvic and bladder dysfunction influences exercise selection strongly and should be talked about openly, especially if issues such as urine leakage during certain exercises are present.
Your clients may experience stiffness in their joints. This is a protective mechanism the body uses to protect the area. It's important to use sensible recovery strategies and appropriate programming changes when these issues present themselves.
ADHD and autistic people are more likely than neurotypical people to present with hypermobility. Often, if you have an ADHD or autistic client, it's worth checking for hypermobility symptoms.
Some Good News
Hypermobility often improves with age. Not many things get better with age apart from general happiness and getting less bendy. While aging is no guaranteed cure for hypermobility, you could see a reduction in your hypermobility as the years pass by.
Further Reading
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