Hypermobility and the Alexander Technique -July 2019

gymnast-1958324_1920What is hypermobility? It’s when a joint can move beyond the ‘normal’ range of movement (ROM). When we were children, we may have known or been someone who was ‘double jointed’. Someone that could perform great ‘party pieces’, for example, demonstrate weird shaped elbows that seemed to bend the wrong way, be able to get their feet behind their head or push their thumbs down to touch the inside of their wrist. My husband is hypermobile, and until recently his party piece was dropping into the box splits!

Hypermobility can be present in a some joints and can be caused by specific training, for example, dancing and gymnastics, but these activities and disciplines, like yoga, also attract people with Hypermobility Syndrome (HMS) as they naturally more flexible. Hypermobility Syndrome is a specific condition affecting some or all joints and its often associated with other symptoms *. HMS is a spectrum disorder with most people only mildly affected and often asymptomatic, but a small proportion can be more severely affected. (There are also other conditions such as Ehlers-Danlos syndromes (EDS), a group of connective tissue disorders that can be inherited and are varied both in how they affect the body and in their genetic causes. They are generally characterised by joint hypermobility, skin hyperextensibility (skin that can be more stretchy than normal), and tissue fragility. There is substantial symptom overlap between the EDS subtypes and HMS disorders, which often makes diagnosis tricky.)

To stress, the majority of people with HMS are asymptomatic the condition can be an advantage for some. For example, many top athletes and performers are hypermobile including dance professionals as seen on Strictly Come Dancing, Wimbledon tennis campion Novak Djokovic, retired Olympic swimmer, Michael Phelps and even violinist and composer Paganini, who may have had an advantage from having HMS, as he was able to play wider fingerings than normal violinists.

As an Alexander Technique teacher with a background as a personal trainer I can help pupils in two ways:
1) Improve proprioception (awareness of the position and movement of the body) and body awareness.
2) Workshop exercises and activities so they learn to perform them in a safe and effective way.

Poor proprioception may make pupils more vulnerable to injury. It’s useful for anyone to have an accurate sense of where they are in space and how they are moving and using their joints, but its especially so if they have HMS. Understanding what a normal ROM is and generally using the joint within this range has a protective effect. In AT we help improve proprioception through a combination of body mapping and ‘hands-on’ teaching.

As people with HMS have more stretchy connective tissue (e.g. tendons and ligaments), the muscles around joints are having to perform more joint stabilisation, as a result muscles can become very tight. AT is often seen as helping release excess tension, pupils with HMS however, need to balance this release with a sense of ‘connection’ within their body. We only want release of excess tension, but keep appropriate tone to aid joint stability.

When pupils with HMS have active lifestyles, they tend to have stronger muscles and this is helpful when learning the Alexander Technique. There needs to be sufficient muscle strength present, or it can be difficult to sit or stand in a poised way for any length of time without ‘collapsing’ or slouching. Alexander Technique is a useful self-care tool for people with HMS, but strength work or specialist physiotherapy is also important, especially when people have had a sedentary lifestyle. Philip Bull, Consultant Rheumatologist, specialist with HMS and an advocate of Alexander Technique explains in an article “Working with a local Alexander Technique teacher I was able to help more people and found that patients with hypermobility found it particularly helpful; some even life changing. I then concluded that an individual programme combining specialist physiotherapy usually followed by Alexander Technique lessons often worked really well, allowing patients to self-manage their symptoms more easily. This approach became part of my standard practice.
Physiotherapists and the Alexander Technique teachers are quite different in their approach. I often say to my patients that if they think of themselves as a car, then the physiotherapist could be seen as the mechanic, i.e. the person who optimises the joints and builds up core stability. In contrast the Alexander Technique teacher can be likened to the driving instructor, teaching them how to drive their body with more skill.”

Muscle strengthening can be achieved in a number of ways, as Philip Bull states specialist physio maybe helpful, but once a level of stability is obtained pilates, resistance (weight) training, swimming or something similar maybe useful to maintain and develop strength. It’s important however, to (1) perform any exercise well and know you are not using joints outside of their normal ROM. (2) build up very slowly so as not to suddenly put undue strain through any joints.

The most important foundation for successful exercising with HMS is to have good body awareness which AT will teach. I encourage my AT pupils to workshop their pilates, gym or physio exercises with me using their new Alexander embodied awareness and principles, so they feel confident to perform them well when in exercises classes, the gym or at home. I also suggest pupils with HMS make their exercise instructor aware of their condition and preferably work with professionals that are experienced with HMS. I have recently found a pilates instructor Jeannie Di Bon on FaceBook that has EDS and has modified the way she works especially for herself and her hypermobile clients. In her book “Hypermobility without Tears” she writes about the importance of good proprioception, body awareness and breath, all of which are taught and improved by Alexander Technique. I recommend looking her up online as the way she teaches compliments the approach in AT. She also highlights other important differences in approach for people with HMS, such as stretching differently.

When I work with children with HMS, once the basic AT principles have been attended to and greater proprioception and body awareness achieved, I often work with them on simple but important tasks that make everyday life easier. For example; how to wear a school ruck sack well, how to hold a book and use a smart tablet, hand-writing (hypermobile finger joints can make writing hard work, causing excess tension), using scissors and workshop PE exercises and sports. After working on handwriting in a lesson with one of my young pupils with HMS they reported it had really helped at school. Before, writing had made their hand and wrist ache and writing was slow. It was proving tricky to keep up with note taking in class. After our session and some practice writing became easier, faster and their hand no longer ached. All, while sitting with a soft and tall body! – Gratifying feedback.

So if you are hypermobile, the Alexander Technique can prove a useful tool for self-care.

To read more go to www.atfriends.org/Hypermobility.htm where Julie Barber, Alexander Technique Teacher and specialist in working with HMS writes about her experience of getting an HMS diagnosis for her daughter and presents greater detail of the condition.

To find out more about lessons call or email me using the links at the top of the page.

Note: Alexander Technique Teachers are not doctors or therapist and do not engage in medical diagnosis or administer any disease specific remedy.

* other symptoms may include; autonomic dysfunction, proprioceptive impairment, intestinal dysfunction, anxiety and chronic pain.

Author: Esther Miltiadous

Alexander Technique Teacher, North London, U.K.

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