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Are you super flexible? Physiotherapist answers hypermobility FAQ’s

Are you super flexible Physiotherapist answers hypermobility FAQ's MAIN

Are you way more flexible than all your friends? You may have hypermobility. Physiotherapist & Healthista Collective Expert Finola Burrell answers FAQ’s on hypermobile joints

Joint hypermobility is defined as a condition where most of an individual’s joints move beyond the normal range.

You can have a hypermobile joint but if several joints are involved, it is considered generalised hypermobility.

a condition where most of an individual’s joints move beyond the normal range

Generalised hypermobility is thought to be due to an abnormal ratio of Type III to Type I collagen. Type I collagen is very stiff and strong, whereas Type III is less so and it may there are more Type III collagen fibres than Type I.

Hypermobility may not cause any issues, but in some it can result in a variety of injuries such as increased risk of ankle sprains, joint dislocations, general joint aches and pains and arthritis.

What causes hypermobolity?

Hypermobility can be classified as an inherited condition, and includes the less severe symptoms associated with the more serious hypermobility conditions Marfan’s Syndrome, Ehlers–Danlos Syndrome and Osteogenesis Imperfecta.

It may also be acquired through years of training and stretching in certain sports and activities. It may also develop as a result of changes in connective tissue from other underlying diseases.


How do you know you have hypermobility?

There are a couple of ways you can check if you have it.

The major criteria for recognising someone may well have hypermobility  syndrome is: a Beighton score of 4/9 or greater (either currently or historically) and arthralgia (joint pain) for longer than three months in four or more joints.

The Beighton scoring system is also used by health professionals, with a score four or more out of nine suggesting hypermobility syndrome.

  • Being able to bend back the little finger more than 90 degrees (one point for each hand).
  • Bringing the back thumb against the forearm (one point for each thumb).
  • Hyperextension of the elbow above 10 degrees (one point for each elbow)
  • Hyperextension of the knee above 10 degrees (one point for each knee)
  • Flexion of the trunk, with knees straight and the palms flat on the ground (one point)

The 5 point hypermobility questionnaire has also been referenced as a tool to help diagnosis hypermobility syndrome (Hakim and Grahame 2003):

#1 Can you now (or could you ever) place your hands flat on the floor without bending your knees?

#2 Can you now (or could you ever) bend your thumb to touch your forearm?

#3 As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?

#4 As a child or teenager, did your kneecap or shoulder dislocate on more than one occasion?

#5 Do you consider yourself ‘double-jointed’?

Answering yes to two or more of these questions suggests hypermobility. It’s always advisable to seek a professional opinion and diagnosis.

Remember this does not mean you will definitely have symptoms or need to seek medical help for it, and this is also not a diagnosis for any symptoms you may have.

Does it hurt?

The main complaint of hypermobility syndrome is pain.

Other symptoms can include a feeling of stiffness, multiple joints clicking, clunking, popping, dislocations, a feeling of joint instability (the joints feel ‘vulnerable’) as well as symptoms such as tiredness, feeling unwell, bruising, IBS and flu-like symptoms. It’s even been linked to anxiety and depression.

hypermobility woman with both hands on floor

How can you help it?

Physiotherapy, particularly exercise, is a mainstay of treatment for hypermobility. Including regular strengthening, proprioceptive and stability exercises is the main form of treatment.

This includes using a swiss ball to improve your stability and proprioception (awareness of where your joint is positioned), and the use of resistance bands and resistance machines to strengthen the muscles around your joints.

using a swiss ball to improve your stability

If we strengthen the muscles around the joints, it helps to compensate for the ligaments and other soft tissue laxity which is a result of hypermobility syndrome.

This prevents the joints moving outside their normal range of movement and so reduces the risks of the joint and surrounding parts of the body becoming irritated and painful.

Can it cause problems when working out?

It may increase the risk of pain after workouts or the risk of ligament sprain and joint dislocations if the strengthening and stability exercises aren’t included and if modifications aren’t implemented.

When working out, those with hypermobility would benefit from being a bit more mindful of their form. In general, reduce the range of movement in the joint/exercise/yoga pose/stretch to approximately 70-80% of what you feel your maximum range is.

those with hypermobility would benefit from being a bit more mindful of their form

This can then help to keep your joints within the actual normal range and so reduce the risk of pain during exercise. Exercises should in general not be painful whilst carrying them out, they should only be challenging and tiring.

In yoga and ballet, it can sometimes feel advantageous to have hypermobility for the aesthetic feel of the movement or pose.

However, long term this may cause symptoms and so it’s best to still modify your practice to keep within the normal range of movement as mentioned above, and to include regular strengthening exercises 2-3 times per week.

Finola Burrell Physiotherapist

Finola Burrell is a physiotherapist based in London who is passionate about giving people the knowledge and tools to help them lead the life they want, without pain or injury stopping them.

Since graduating from King’s College London, Finola has gained additional qualifications as a Pilates teacher, in women’s health physiotherapy, acupuncture and in psychological therapies for pain.

Together with yoga specialist Hannah Barrett, she has co written a postnatal yoga based fitness guide, Strength Through Yoga, to inspire and help women regain strength in both body and mind after having a baby.

Follow Finola on Instagram @finolaphysio

You can find Strength Through Yoga guides here, including their most recent Mindfulness and Anxiety Toolkit guide. 

More from Finola:

5 easy steps to help sciatica – the physio’s guide

5 back stretches to help relieve desk hunch

More Healthista content:

8 sciatica treatments that don’t involve drugs

Got back pain? This hand reflexology can help quickly

Got back pain? This 10-minute yoga sequence will help

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