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:
Major Criteria
- A Beighton score of 4/9 or greater
- Joint pain for longer than 3 months in 4 or more joints
Minor Criteria
- 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.
More resources:
These are some of the informative articles that helped me to gather my thoughts for this post:
Are you Gumby? Hypermobility, Joint Laxity and What’s Bad about too much Flexibility
Coaching the Hypermobile Athlete
Runners’ Guide to Hypermobility
Mobility’s Dark Side: Why Being Super Bendy Isn’t All That
[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?
this is so very interesting! and I notice so many things at various times of the month but nothing on my joints. except maybe after childbirth since that throws everything off and loosens a whole lot but I wasn’t exercising then so I have no idea lol.
I have heard it only gets worse after having kids so whenever that day comes I will be in real trouble!
I do not have this problem by and large (and especially not now after my back injury), but I know a few people who do and damn, girl, it is hard! This explains a lot, though. I do have a bit too much mobility in my shoulders, though, and that poses a problem for lifts above my head.
It doesn’t seem like many people recognize this to be a problem but it seems really important when figuring out how to address an injury. Its interesting that you have been able to figure that out about your shoulders!
Oh wow, I never thought about hyper-mobility but I definitely meet the criteria for the first 3 items in the Beighton test you listed. I also hear clicking noises sometimes when I am getting ready to stretch after sitting still for a while. This definitely adds another reason to why my Piriformis really acted up last year. Bookmarking this post so I can read all of the articles you linked to!
Definitely check out the articles! And as an example, if your ankles aren’t stable your calves may have to tighten up to provide support. Not that it’s definitely what causes your tight calves, but could be something to consider. Maybe try working on ankle stability by standing on one leg while barefoot whenever you think about it throughout the day?
I have 0 points! I’m not flexible at all, and I have started a daily stretching routine. I’m not focused enough to keep up with yoga, but a stretching routine seems easier to do.
I think there are downsides to both ends of the spectrum. At least you know that about yourself and how to address it!
Yeah, you know what? This makes a lot of sense. So like you, I have hip issues but I am not flexible in the slightest bit, however, I think the fact that I’ve had four babies makes my hips all loosey goosey. My eldest son Jake has hyperextension in his elbow joints, and he’s broken his arm three times. Too much flexibility is not a good thing, except on Friday night date nights! Ha ha. 😛
Ha!
There has to be a happy medium, right? But it definitely makes sense that if your joints are too loose that you aren’t going to be able to run as well or something else will have to overcompensate.
Interesting! I’m not hyper mobile at all it seems with a score of zero but I can totally picture people who are with knees and elbows bending the wrong way. My girls dance and are not naturally flexible – they have to stretch a lot – but are always jealous of the kids who are so I’ll have to tell them it’s actually a good thing in the long term.
So from what I have read it seems like kids who dance or do gymnastics are encouraged to pull their bodies past their normal ranges of motion (which I probably did) and can lead to problems later. I would definitely tell them not too toke it too far! In fact all the years of dancing is what most likely led to my labral tear that required surgery. Not something I ever thought about when I was growing up!
Really interesting post. I am definitely not hypermobile – I’m not stretchy at all, which causes all kinds of different problems. At least you’re figuring it out and finding out what you can do to support your super flexible self!
There are definitely problems with being at both ends of the spectrum! But its just important that we know how to best work with the bodies we were given.
This is really interesting and may explain some of my nagging running injuries! I was once told by a podiatrist that my feet were “very malleable”. I also meet several of the minor criteria and two of the major ones. Like you, this makes me feel a little better knowing that it really is out of my control. Thanks for the research!
It’s really interesting, right? Have you ever tried to strengthen your feet? The best hope I got from all the research I did was that we can always work on making our muscles stronger:)
This is so interesting! I’m practically the opposite of hypermobile. I can’t even do yoga easily because of how much hip and shoulder mobility I lack. I only meet one criteria – touching toes – and that’s probably because I am a runner stuck in a swimmer’s body.
I think that I can usually pass the hands on the floor test but from all the sitting I do my hamstrings are kind of a mess. But for never stretching or doing any yoga I come really close!
Yoga is probably better for people like you than people like me- my PT even said that I may be good and yoga but would just end up taking it too far and getting hurt.
This is so so interesting! I don’t think I’m hypermobile (maybe the opposite? haha!) but it’s so interesting how all of these things interlink!
It’s really crazy right?
I have hypermobility too and basically had the same conversation with my PT. Am I destined for injuries for life? She said no and that I should work on stability too. I use the BOSU for a ton of ankle and balance training. It’s helping so far!
I love using the bosu to work on balance and hip/ankle stability! I am also a big fan of doing my exercises barefoot and I think thats helped alot with the foot and ankle strength, although it was tricky to figure out how much of that I could do with a post tib injury. I am glad to hear that the bosu is helping you! I would love to hear any other tips that you learn from your experience with this.
I don’t really know anything about hypermobility but this was really interesting!
It’s like a runner can’t win! You’re hypermobile and I’m completely inflexible (hypomobile?)! Geez. This was really interesting. I had no idea that being too flexible was a problem.
You are so right- it’s like we can’t win! I had started piecing this together over the past year but it’s all starting to make more sense to me now, although I think I will continue to need to learn about how to manage this.
This is very interesting! I’ve had a few of these symptoms myself over the years, especially the ones you described about joints popping and elbows that can bend slightly backwards.
If you are generally injury free than it probably isn’t too much of a problem, but it never hurts to add in a little extra strength training! I also think its important to be mindful of not pushing too far when stretching or doing yoga.
This is really interesting, I never heard of hypermobility. Based on the test I think I’m in the clear…I can’t even imagine my knees or elbows going backwards. Hopefully you’ll be able to find that stability that you need!
Thank you! It’s a problem that doesn’t seem to be talked about very often!
Wow, this is fascinating. I’ve never thought about the hormones affecting joints, but I’ll try to be more mindful of it now. I am not hypermobile at all, but I’ve heard certain joints crack before.
The joints popping and cracking occasionally is probably normal, but I feel like for me it happens way too much. Like when the PT is assessing my mobility and I start popping, he just looks at me like, uhh, what did I do? But it doesn’t hurt and I am just used to it I guess!
This is interesting! My score was better than I thought it’d be. Guess I have pretty good joint mobility.
That’s good! You want enough mobility, just not too much.
I know alllll about this from a personal place. I’ve written about it before, but I have Ehlers-Danlos Syndrome (hypermobility type), and have like an 8-9 Beighton Score. Basically, all my joints and other connective tissues are loose and weird and ANNOYING. It’s the reason I pick a spot by the mirror in yoga, so I can see where my body is and if it’s doing the right things, because otherwise I have no idea. When I’m doing physical therapy, or any new exercise, I always ask what muscles should be firing/where I should be feeling something so I know what corrections I need to make. It’s why I have trigger points everywhere that cause me to be in a lot of pain all the time. And it’s why, despite the fact that strength training sometimes feels like it just tightens me up, I do it anyway – because I know I have to strengthen the muscles so they can stabilize the joints.
All that said, I love being active and I’ve found that it is helpful for the pain, so even though I have to be extra cautious, I do it. It sounds like you have it all sorted out, but if you ever want to chat, feel free to reach out!
Thank you so much for your comment! I am so sorry that you have to go through all of that, but it sounds very much in line with what I have read. I am planning to go check out what you have written about this. Thanks for sharing!