Over the course of last week, as my ankle and hip caused me all sorts of problems, one thing that became increasingly obvious to me is how my super loose joints can be contributing to all of these injuries that keep popping up. It had me thinking about hyper mobility and how it can lead to an increased injury risk for runners.
Hypermobility and Increased Injury Risk for Runners
Remember when I was told at the UVA Speed Clinic that I didn’t need to stretch?
Last year, when I was in PT, my SI joint was constantly out of alignment.
I have always been told that I have plenty of range of motion throughout my body (but that’s passive ROM, being able to use it while running is a different story) despite “feeling” tight in certain areas.
I always notice popping sounds coming from my joints. They don’t hurt, but are certainly noticeable.
I grew up dancing, and could easily do a split for most of my life (I can still come pretty close)
My PT and I got to discussing this a little more, and I was like “ok, so I should just always expect to get injured?” He put a positive spin on it by talking about the things I can do to prevent injuries, but the reality is, it may never be easy.
I started to do some of my own research about runners with hypermobile joints. There are a few tests you can do to determine if you are hypermobile. (I did these tests out of curiosity but not as a way to “diagnose” myself.)
The Beighton Score can be used as an indicator of widespread hypermobility:
- One point if while standing forward bending you can place palms on the ground with legs straight (not quite- but almost)
- One point for each elbow that bends backwards (not sure- maybe a little)
- One point for each knee that bends backwards (YES)
- One point for each thumb that touches the forearm when bent backwards (YES)
- One point for each little finger that bends backwards beyond 90 degrees. (YES)
I easily score a 6/9 on this.
The Brighton Criteria is used to diagnose joint hypermobility:
- A Beighton score of 4/9 or greater
- Joint pain for longer than 3 months in 4 or more joints
- A Beighton score of 1, 2 or 3 (or 0, 1, 2 or 3 if aged 50+)
- Joint pain (> 3 months) in one to three joints or back pain (> 3 months).
- Dislocation or subluxation (slipping of a joint) in more than one joint, or in one joint on more than one occasion.
- Soft tissue problems, more than 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
- Being tall, slim with an arm span/height ratio >1.03, or an upper: lower segment ratio less than 0.89, very long fingers compared to span of the palm
- Abnormal skin: striae (stretch marks), hyperextensibility, thin skin, papyraceous scarring (purple stretch marks).
- Eye signs: drooping eyelids or myopia (short sighted) or antimongoloid slant (downward slant of eyes).
- Varicose veins or hernia or uterine/rectal prolapse.
So if you have two major, or one major and two minor, or four minor criteria, you more than likely (93% certain) to have hypermobility syndrome (HMS).
I consider myself to have one major (a Beighton score of 4 or more) and two minor (joint pain and soft tissue problems)
After looking into some information about athletes with hypermobility, I felt a bit defeated. I wouldn’t say that the extent to which my joints are hypermobile is severe, but I think it affects my hips enough that it causes all sorts of problems around my pelvis and down the chain. However, this also confirmed the need for stability. I read in several articles that the best way to counteract hypermobility is with stability. Hypermobility really means the ligaments around the joints are very loose, but they are not supposed to support joints anyway- muscles should be doing that. So even though joints themselves can’t become more stable, they can be supported better by strong and functional muscles.
One part of this research that really hit home for me was that people with too much mobility are guilty of “cheating” exercises, and not firing the correct muscles. Apparently we have worse proprioception (ability to know where our bodies are in space) so less control over our bodies, especially when bringing ourselves into a great range on motion.
A few other pieces of advise I came across:
- Muscles may feel tight because they develop trigger points from needing to do extra work due to poor movement patterns related to mobile joints. Rather than stretching, its better to use foam rolling or other forms of myofascial release to relax those muscles.
- I haven’t noticed this, but for women our joints can become much more loose during certain times of the month related to hormones. A few years ago a PT brought this to me but I never noticed any patterns (maybe because it’s just a constant issue for me). I know Suzy mentioned that she was able to notice a pattern. I may try to see if I can figure out if there are certain times when my joints will be really loose and can maybe just focus on strengthening during those times and cut back on running.
- Rather that using full range of motion that can’t be controlled, work on partial range of motion movements with pre-defined depths (like squatting onto a chair).
- If you’re hips are too mobile and unstable, your back may need to try to take over–> this may mean SI joint problems including muscles around the low back developing imbalances (like my good ol’ friend the piriformis)
None of this information is really news to me, it just drills home the point of things I already knew. In a way I feel like I have been released from some of the blame for all of my injuries. I always try to figure out what I did wrong, and typically I feel like these problems “come out of nowhere”. It doesn’t mean that I can’t do anything about it; of course I will continue to work on getting and staying healthy. It just means that certain things may be out of my control, but improvement is always possible.
These are some of the informative articles that helped me to gather my thoughts for this post:
[Tweet “Hypermobility may be a runner’s worst enemy. via @milebymilerun “]
What is your Beighton Score?
Anyone else out there with too much joint mobility?
Any women notice more hip problems during certain times of the month?
For those of you out there who are personal trainers, physical therapists, or other related professionals, do you assess for hypermobility when you start working with a client? How does it affect the work you do with them?