Training For The Hypermobile

Oct 13

Takeaway Points:

Hypermobility is a condition where joints are unusually loose or unstable and often presents itself in people as excessively flexible bodies with poor proprioception (the sense of knowing what space your body is taking up and what it’s doing).
The risk of injury that comes with hypermobility means that clients should focus on stability rather than flexibility, avoid extreme ranges of motion, be careful with controlling movement and form, and be aware that their strength will grow slowly.
Personal trainers should familiarize themselves with common conditions like hypermobility in order to best support the wide range of individualization their clientele will need.

In a general sense, one of the expectations of a personal trainer is that they’re able to work with a variety of clients who have a variety of needs. When I got my first personal training certification, for example, this was a big emphasis in what I studied.

At the same time, however, a great deal of that energy was completely wasted. I was encouraged to spend a long time memorizing obscure contingencies and conditions which I have never since encountered as a personal trainer or online coach, and I was tested on it.

Efforts were not put, on the other hand, into teaching me how to work with clients with much more common conditions. In particular, I’ve worked with numerous clients who have to deal with PCOS, hypermobility, or Ehlers-Danlos syndrome, and in almost each and every case, clients have also expressed surprise and shock that I’ve even heard of these conditions. These clients recount issues getting even doctors to be aware of their conditions, much less fitness industry professionals.

I hope that in the future, we’ll be able to improve educational practices for personal trainers, and in the meantime, I’d like to share some of my thoughts on the topic of training for clients with hypermobility. Hypermobility is a surprisingly common condition that significantly changes the way that folks need to train, and knowledge of this condition should be much more common in the fitness professional population.

What Is hypermobility?

Hypermobility is a condition in which joints are unusually loose or unstable. Clients who are hypermobile often have excessive flexibility, and can train in very large ranges of motion. Conversely, they also tend to have difficulty with stabilizing their joints, and this leads to a greater risk of injury as well as often clumsiness or poor movement quality.

I’ve also found that many of my hypermobile clients tend to also have a bad sense of proprioception - a fancy word to explain our brain’s ability to effectively coordinate our body and have a proper sense of where all our body parts are as we move through space. A person with poor proprioception may have a hard time learning new movements, especially those that require a great deal of practice or skill, and may do things like lose track of their movements in space, leading to unexpected collisions with nearby objects.

Poor proprioception is a thing that does tend to happen naturally when people don’t get a lot of exercise, and as you exercise, your body does tend to get better at it. In essence, a part of learning any new lift is just the part where we learn the pattern of that movement, which gets drilled into our brain, and then our proprioception improves and we find it easier to complete that movement again in the future.

However, some folks do tend to naturally have poor proprioception. I’ve worked with elderly clients who have basically gone their entire lives without working out, and their proprioception as a result has deteriorated to the point that they often can’t tell different movements apart. For example, one woman that I’ve previously worked with had such poor proprioception that she needed to be constantly monitored and frequently corrected in order to keep her on track in terms of being able to complete all the reps of an exercise in a single set. You could start her off with a bicep curl, look away for a few seconds, and find that she was now doing a shoulder press - and wasn’t even aware that she was doing something different!

Hypermobile clients also tend to have poor proprioception in my experience in the same way, though it can vary from client to client.

Hypermobile clients can also have other issues related to their excessive flexibility - increased risk of sudden and frequent joint dislocations, recurring minor injuries and pain, and the ability to more easily accidentally overextend themselves when working out.

Working with hypermobile clients - flexibility versus stability

So what’s the best approach when working with hypermobile clients? That’s an interesting question, because at the end of the day, many hypermobile clients can present very differently. For example, I’ve worked with a hypermobile client who was generally hypermobile, but also had intensely tight calf muscles - for them, it was necessary to be careful, and there’s no one-size-fits-all approach that will work for all hypermobile clients without assessing their individual situation.

One important concept to understand, however, is the concept of flexibility and it’s contrast: stability.

In many cases, people believe that they need more flexibility in order to be better exercisers - they complain about tight hamstrings, difficulty getting deep into squats, not having the right wrist mobility to be able to do a proper front squat, and so on. In some cases, this is true - in other cases, the problem isn’t actually flexibility at all, but rather the opposite - stability.

Many people, for example, can actually squat deeper if they perform a short core activation exercise (a short plank of 10-30 seconds is a good example) beforehand - this isn’t a stretch, so how does this occur?

It occurs because the limiting factor here isn’t actually your flexibility, but your stability. If a joint is not effectively stable during a movement due to an inability to activate muscle and tendon fibers properly, then it won’t be able to generate an optimal amount of force. If it can’t generate an optimal amount of force, then, intuitively knowing that your body isn’t really capable of doing that movement properly, your brain will subtly inhibit your muscles a bit, preventing you from exerting a full effort or going through a full range of motion.

A similar effect occurs when you try to pick up a barbell in a deadlift with poor grip - your muscles may be able to actually physically move the weight, but because your brain already knows that there’s a weak link that will fail first (your grip), it struggles to fully activate all your muscle mass and continue moving the weight. The end result is that you could try and power through it, but instead you quickly give up and drop the weight. If you then took your grip strength out of the equation (for example, by applying grip chalk or using lifting straps) then you’d find that you can then easily lift a weight that your muscles refused to activate for just a few minutes prior.

In the same way, your body is good about protecting itself when it knows that it’s not up for the demands you try to impose on it, and this is why you see things like shaking or instability in planks or other movements when you’re not used to them - your body is inhibiting itself purposefully to prevent you from overdoing yourself.

So, for the average exerciser, stretching CAN be a way to help increase your range of motion, but so can building stability in that greater range of motion, which can be developed simply by practicing the motion under load anyway. A part of getting stronger is about the act of building up the stabilizing skill needed to enable your muscles to exert their optimal effort.

This balance is VERY different for the hypermobile exerciser. Because the hypermobile exerciser has an excess of flexibility, this means that they should basically NEVER do any flexibility focused exercises, as this is far more likely to risk injury. Instead, when it comes to working with hypermobile clients, a greater emphasis must be placed on stability.

Interestingly, it’s also important to recognize that some clients who are not normally hypermobile, can also experience transient hypermobility throughout their lives. A pregnant client, for example, has a vastly different hormone profile which may impact their mobility or susceptibility to injury or back pain. A client who broke his arm at one point recently noticed hypermobility only in that arm after his recovery, necessitating some changes to his program.

Guidelines for training

With that in mind, here are some of the guidelines for training that I’ve developed as a result of working with a variety of hypermobile clients:

No stretching - This should be self-evident. Stretching protocols for hypermobile clients are likely to lead to further injury, and the risk to reward ratio in hypermobile clients is simply not worth it.
Careful with movement - Hypermobile clients may have worse proprioception, and thus should be more carefully screened for proper form in order to keep them on track with their movements.
Avoid extreme end ranges of motion - Certain movements rely heavily on pushing the exerciser towards an extreme end range of motion in order to stimulate adaptation - for example, chest flies, romanian deadlifts, good mornings, deep pushups, deficit deadlifts, ass to grass squats, and so on. Such exercises should be modified to use a reduced range of motion and avoid the extreme end range.
Reduced range of motion - In general, working with purposefully reduced ranges of motion isn’t a good thing in terms of overall strength and muscle gains, but should be considered as an approach with hypermobile clients as a way of protecting joints and limiting injury risk.
Controlled movement - Movements should be slower and more controlled, and not done with excessive speed. This helps to build stability and avoids the risk of accidentally pushing into excessive ranges of motion.
Avoiding jumps and high impact activity - High impact activity is already risky in terms of the risk to reward - anything with lots of jumps, running, or plyometrics should be exceptionally avoided with hypermobile clients due to their increased injury risk.
Be careful on balance - Hypermobile clients will often have compromised balance, and so when working with exercises that can be demanding on balance (lunges or calf raises, for example), care should be taken to ensure that the client has objects nearby to hold onto and stabilize with.
Strength develops slowly - Hypermobile clients struggle to build strength in part because the process of building stability is much harder for them. However, doing so will have massive benefits, provided that they can stick it out. For this reason, greater caution, slower progressions, and an emphasis on process over concrete strength gains will be much more helpful. Focus on ways you can tangibly improve movement quality in the client’s life, over things like the amount of weight on the bar.

About Adam Fisher

Adam is an experienced fitness coach and blogger who's been blogging and coaching since 2012, and lifting since 2006. He's written for numerous major health publications, including Personal Trainer Development Center, T-Nation, Bodybuilding.com, Fitocracy, and Juggernaut Training Systems.

During that time he has coached hundreds of individuals of all levels of fitness, including competitive powerlifters and older exercisers regaining the strength to walk up a flight of stairs. His own training revolves around bodybuilding and powerlifting, in which he’s competed.

Adam writes about fitness, health, science, philosophy, personal finance, self-improvement, productivity, the good life, and everything else that interests him. When he's not writing or lifting, he's usually hanging out with his cats or feeding his video game addiction.

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