Introduction

The first thing that is surprising is just how complex it all is! 

There are 2 main categories of hypermobility:

1. Joint hypermobility - may affect one or more joints
2. A systemic, genetic condition called Ehlers-Danlos Syndrome (EDS) of which there are 14 different recognised types. According to which systems of the body are afffected. 

Hypermobile Ehlers-Danlos Syndrome (EDS) is a rare genetic connective tissue disorder that affects the body's collagen production. This condition can manifest in various ways, and while many people associate it with extreme flexibility, there are several surprising aspects of EDS that often go unnoticed. In this blog, we will explore five lesser-known features of EDS, shedding light on the challenges faced by those living with this condition.

1. Feeling Stiff Despite Being Hypermobile

One of the most puzzling aspects of hEDS is that some individuals may experience a paradoxical combination of extreme flexibility and stiffness. While their joints may exhibit a wide range of motion, they can also feel stiff and achy. This phenomenon is in part due to structural differences of the connective tissues. The collagen which makes up connective tissues is structurally different- so that it provides less support. This can cause instability & joints that easily slip out of place. The body's attempt to compensate for this instability may result in feelings of stiffness and discomfort, especially after physical activity. .This can be alleviated by strength work since our bodies are adaptable- hypermobile or not! 

2. Heightened Anxiety and Emotional Distress

Beyond the physical challenges, hEDS can significantly impact an individual's mental well-being. The uncertainty surrounding joint stability and the constant fear of dislocation or injury can lead to heightened anxiety levels. Moreover, chronic pain and the limitations imposed by the condition can also contribute to emotional distress. It is essential to provide comprehensive support to individuals with hEDS, addressing not only the physical aspects but also their emotional and mental health.

3. Giddiness- Low Blood Pressure and POTS (Autonomic nervous system dysfunction)

EDS is a systemic condition- it affects the structure fascia and forms a continuum through different systems of the body.  So it  affects more than the joints. Autonomic dysfunction can lead to low blood pressure due to the veins being less supported by the surrounding fascia. This can lead to feelings of giddiness, being spaced out and lethargic.

There is an additional and separate cause of giddiness that occurs when someone ALSO has POTS- postural tachycardia syndrome. This is a nervous system condition which is not well understood- but the effect is giddiness when moving from lying down- or low to the ground positions- to standing. Which can rule out many vinyasa style yoga classes. Here is a research blog with more info. More on alternatives later...

4. Chronic Fatigue and Exhaustion

Living with hEDS demands a tremendous amount of energy from the body. The constant joint instability and muscular effort required to maintain stability can lead to chronic fatigue and exhaustion. Additionally, individuals with hEDS may experience disrupted sleep patterns due to pain and discomfort, exacerbating their fatigue during the day. 

5. Limited Flexibility and Reduced Range of Motion

While hEDS is often associated with hypermobility and extreme flexibility, not all individuals with the condition exhibit these traits. Some may experience limited flexibility and reduced range of motion in certain joints due to the cumulative effects of joint damage and recurrent dislocations. This aspect can be surprising to those who expect hEDS patients to be "bendy" and flexible in every joint.

6. Anxiety 

When there is low blood pressure the neuro-endocrine system (nerve & hormones) might respond by sending adrenaline to help constrict blood vessels and to help the blood return to the heart. But this can also leave us feeling anxious. 

Hypermobility and yoga

What can we do as yoga teachers?

1. Offer plenty of supine poses for anyone with low blood pressure, gentle somatic type movements can work well to start to create some nervous system stimulus and to generate sensations to help feel the body and stimulate the nervous system. Being low to the ground also alleviates problems of giddiness/ exhaustion, but offer a slow transition to standing.
2. Tapping stimulates nerve endings & so helps us feel where we are. Also a somatic practice for anxiety. Diminished proprioception- sense of where the body is, can make us feel anxious.
3. Use props to help stabilise since there is less stability at the joints e.g. pressing into a brick with arms help's stabilise shoulder joints & pressing a block with legs- helps core engagement. This creates more co-contraction of muscles and trains us to maintain this feeling of stability even without the props.
4. Move away from end range and find a more centred placement for a joints- this helps the body to be ready for the next movement we take. This can help those for whom movement is more tiring. When movement is less efficient, the soft tissues- joints/ tendons/ ligaments tend to overwork. Holding the props helps train us to "find centre" so we can move more in mid range.
5. Its easy to rely on flexibility rather than work actively in poses. So avoiding so many passive and adding more active work helps.
6. Little adjustments/ movement and finding new ways of working can all support students to feel more at ease and find new neural pathways to support more strength & less pain. 
7. For POTS and giddiness instead of teaching a vinyasa class with lowering and lifting frequently consider structuring the same positional poses together. For a dynamic practice include some extra core work or dynamic rather than passive holds that do not require vinyasa. 

Watch my Instagram reel where I offer some tips on asana for hypermobility 6 ways

Conclusion

Often those with hypermobility are drawn to yoga so it's important to know how to support these folks too! Diagnosis is often difficult/ lacking but this approach works for many.

Disclaimer: not everyone with hyper mobility will suit all these movements. Medical advice should be sought and followed if in doubt. Hypermobile Ehlers-Danlos Syndrome is a complex and multi-faceted condition that goes far beyond the stereotypical notion of extreme flexibility. Alongside joint hypermobility, individuals with EDS may experience stiffness, anxiety, low blood pressure, chronic fatigue, headaches and limited flexibility. If you suspect you may have hypermobility it’s a good idea to seek medical support, even though diagnosis is notoriously difficult. But also you can follow the advice for someone with EDS and see if that helps you. Remember the body is always adaptable so there are ways to help yourself feel better.

Fascia & Hypermobility freebie! Get the video from our August masterclass on fascia - learn how connective tissues and hypermobility relate and enjoy some tips for teaching and practice for those with hypermobility. Sign up to download.

Advanced yoga teacher training

If you'd like to understand this better and feel confident with your hypermobile students, I cover this in more detail with practical techniques in my advanced yoga teacher training courses:

Fascia in Focus Live Yoga Intensive course

Understand Fascia and Hypermobility Online Anytime course

300hr Advanced Yoga Training

If you've got any questions or want to discuss what might suit you best book a call or join our next online open evening.