Hey everyone: I’m so excited to announce that I’m kicking off a new series called How to Move With. In this (free!) series, I’ll interview experts about the ins and outs of exercise when you’re dealing with various conditions. (If you have a special request for a condition you’d like me to cover, please feel free to say so in the comments, reply to this email if you’re getting this in your inbox, or send me a DM on Substack.)
Before we get into it, a reminder that when I run interviews with experts, the optimal user experience tends to be audio — I will run an unedited and very messy transcript below, but the audio should be a little more enjoyable to digest. You can listen to it in the Substack app, or in your favorite podcast player: Here’s a link to learn more about making that happen.
So, the first edition of this series is How to Move with Hypermobility and Connective Tissue Disorders. Now, there are many topics that I wish were covered in personal training certification programs, but a big one is hyper-mobility spectrum disorders and connective tissue disorders like Ehlers-Danlos syndrome.
These conditions have a big impact on how people move, how they understand and experience movement, and just how they feel in their bodies every day. But trainers like me don’t typically get much, if any, information about them in our education programs. That’s why I was so excited to meet Estella Mejia.
Estella is a physical therapist here in New York City who specializes in the hypermobility spectrum and connective tissue disorders, and she is actually on that spectrum herself. Our conversation was a helpful overview of these disorders and how folks who have them should think about exercise. I know there’s so much more ground to cover here, so if you’d like to learn more, please don’t hesitate to leave a comment with your questions.
Here are some links to a few resources Estella shared with me:
Living Life to the Fullest with Ehlers-Danlos Syndrome (aka the Muldowney Protocol book) by Kevin Muldowney, PT, and Kathleen Muldowney, PT
The FibroManual by Ginevra Liptan, MD (though fibromyalgia is in a different category from hypermobility or EDS, they do have overlap in symptoms and treatments)
And a few Instagram accounts to follow:
I’ll also say that as usual, the content here is not meant to diagnose or treat a medical condition. If you have a condition like the ones we discuss here, or suspect you may have one, your best bet is always to consult one-on-one with a medical provider for guidance.
Okay, here’s Estella.
Estella: My name’s Estella Mejia.
I am a doctor of physical therapy. I. Am from Florida, so I did all my schooling in South Florida area. I went to Florida International University for undergrad, and then I went to University of Miami for grad school, and that’s when I really started learning a lot about hypermobility Ehlers-Danlos, and seeing a lot of different things with it that.
Uh, I feel like people often dismiss and they’re like, oh, you’re just double jointed. Oh, you just bruise easily. Oh, you’re just, uh, you’re just extra bendy, extra flexible. And then being in like, you know, a educational setting and then having lectures on hypermobility spectrum, Ehlers-Danlos, and then seeing all of the ways that it really affects the body got me very interested in all of it because I started seeing things of like, oh, I have this.
Oh, I also have this. Oh, I also have that. Oh, this makes sense now. Okay, got it. And when I was in school, at least, one of the other things that they would talk about is prevalence, right? They want to know like on average, how many people have this, how widespread is this? Will you be encountering this?
Because in school sometimes you hear about certain diagnosis and then they tell you, don’t worry you. I’ve only seen one or two in the clinic. Or, oh, don’t worry about that. But at least when it came to the numbers with EDS or hypermobility I was kind of surprised by some of the numbers and, and even with like follow up research, um, like the Ehlers-Danlos society, just like seeing different numbers and, and again, like reading the prevalence of it, I was like, oh, this is a lot bigger than what.
School kind of taught me to think about it. At least for hypermobility, it’s about one in every three to 5,000 people, which is a lot when you really think about, for example, just how many people are are in New York or in Florida. Um, so as I kept progressing through school and maybe like a lecture here, another one there, and just already having the knowledge that I did, I was like, you know what?
This is. This is a lot bigger than people see it as, and again, thinking of my own self, like because I’m hypermobile, I started seeing like, oh this, like I said, this makes sense now or I understand how this other system is tied in. And so that kind of all led me once I graduated into honing in like who and what population group I really wanted to treat or who would really benefit from the things that I had to.
Kind of share to a community. ‘cause there’s, there’s lots of PTs everywhere. There’s lots of different subspecialties and niches. And one thing that a mentor once told me when I was asking him like, how did you get into your field? Like, what brought you into this? He very simply was like, I saw a gap. I decided to fill it.
So that’s, that’s pretty similar with how I found myself treating individuals with hypermobility because I kind of saw that gap there. And then. Just started filling it in. Originally, I actually started, um, working at a solely pelvic floor private practice. Uh, and there’s, there’s a lot of overlap between pelvic floor dysfunction and having some form of hypermobility, whether it just be on like the hypermobility scale or a true like Ehlers-Danlos or EDS for short.
Um, and so from there, that’s kind of what. It got me into like the two of them, and then I jumped into also treating TMJ, so like jaw type issues because all of that is all connected with everything as well.
Anna: That’s so cool. I was gonna ask if you’re also a pelvic floor, therapist, because I have the basic understanding that there’s a lot of connections.
So I’m looking forward to getting into that. But I guess, um, to, zoom out, can you give the broad explanation of what are hypermobility disorders, what is Ehlers-Danlos and how does it fit in with that spectrum? Um, for those who aren’t familiar with. With what that all means.
Estella: Okay, so hypermobility and EDS as well, or Ehlers Danlos, both of them are a connective tissue issue. Um, if we’re just talking about hypermobility first, this one, same with EDS. They’re both on a spectrum. So what I mean by that is.
Your connective tissue is everywhere in the body. It’s like our building blocks. It makes up our muscles, our ligaments, our tendons. So it kind of all puts together and then you are a person. But connective tissue also makes up arteries, veins. It makes the channels that that blood and circulation is gonna flow through.
And so if that connective tissue, if those building blocks are. Not as solidified or a little bit more loosey goosey. This is where the connective tissue part comes in. Then it can start w wrecking havoc in lots of other systems. So for example, and the Ehlers-Danlos Society website does a really nice job of having different graphs and uh, things to really show everything but.
When we think about all the systems in our body, let’s think of our cardiovascular system, our GI system, our musculoskeletal system, just for like some, some big ones, if our building blocks, so our ligaments in particular are not as strong as an average or normal persons. Everything is a little off. So when it comes to moving something like pushing something, picking something up.
If our body doesn’t have the right amount of support, it starts needing to compensate in other places. So when we think about our muscular skeletal system and how hypermobility and also EDS Ehlers-Danlos affects it is the body is less stable. So when we think about one joint stacking on top of another joint and then on top of another one, there’s things surrounding that joint.
So. Let’s think about the elbow, for example. There is a joint capsule in this elbow. We’ve got ligaments, you’ve got tendons, you’ve got muscles that crossover. You’ve got some fluid in this capsule. So if everything that’s all the building blocks that are stacked up here are a little shifted or slanted, our body starts to need to compensate in some other way because our mind is confused.
It’s like, why can we move in this extra amount? When we know we’re not supposed to. So it starts confusing things and it makes the body start to need to compensate to help out. So what happens? The body can start to stiffen up a little bit or, or not, or it just freely starts moving through in that extra bit of a range, but then we start having some joint pain in that area.
Because for a couple of different reasons, and this is one of the tricky things with hypermobility, is that it really all depends on each person, how much on that spectrum they are, what systems are also involved with everything. But when we then just take a look at one joint and we start seeing, it’s moving in extra ways, so bending a little bit more, extending a little bit more, that starts putting more irritation and stress on that joint.
On the ligaments, on the capsule that’s there. And so a little bit, a little bit more at a time starts to either create micro tears, it starts to really stretch out that joint capsule. And again, it just confuses the body even more because our mind is like, wait, we can only move in this amount, so why are we going extra?
So it really starts to confuse everything. So one of the big things that hypermobility also affects is our interoception and our proprioception. So our interoception is our body’s awareness of where it is in relation to each other. So this is kind of with going with our like joint example of things stepped on top of each other.
So when people are moving around. And going to reach and grab something. This is where our muscles can get confused because if everything is slightly off of each other, we’re not activating the right muscles. We need things to be in that right alignment so that way we can activate and recruit all those muscles.
So what muscle is working? That one really depends. You have to see how the person is doing their movement pattern to see what might be cheating, what might be helping out in another way. And typically when our body lacks that stability, it’s gonna find it in one other way, shape, or form. So this is where individuals with hypermobility and EDS will mention that they feel very stiff and very tight, even though they’re putting their legs all the way up to the sky and being able to move in the most bendy and flexible positions that you’re like, well, your range of motion is fine.
So this is where it can get confusing because. Somebody will assess a person, they’re like, wow, you’re super flexible. You’re really bendy. Okay. Nothing is wrong in that sense, but the neuromuscular control isn’t there. People oftentimes either lean on their ligaments to really get that stretch, so we’re not stretching the muscle, we’re just stretching our ligament and adding more stress to our joint capsule.
Which, like I mentioned, can add to those micro tears, a little bit of inflammation in that joint space, and then make a person feel like, oh, I’m so tired, I’m so fatigued. Everything is hurting because they’re really trying to get that good stretch, but they’re leaning on ligaments and kind of stepping away from really getting that muscle to fire.
Uh, you can also have the opposite where somebody might have been really flexible when they were younger, but as they’ve started getting older, they can’t anymore. ‘cause our body started creating some stability and tightening everything up because it knew like, hmm, we’re not supposed to be moving in these big ranges or degrees, so let’s stiffen everything back up.
When it comes to not just the musculoskeletal worlds, but kind of how I mentioned like cardiovascularly or uh, GI Wise. I like to explain or describe to my patients, let’s think of your GI system. Kind of like some pipes, some tubing, getting some water to flow through, maybe some gas in a regular or normal person, you’ll have some solid pipes, some solid tubing, but in an individual with hypermobility, think of those pipes like some noodles.
It’s much softer. Because depending on how you cook, the pasta can be stiff. It can be much loosey goosey and kind of wiggly. So if those channels still need to help send blood flow, that oxygen, it can be problematic because, and this is where individuals can also start seeing some POTS dysautonomia type symptoms because those pipes, those tubings aren’t doing.
The best job to help circulate and move things around. This is also where you can see some individuals having GI issues as well. ‘cause our GI system is also a series of different tubes, all based on pressure, pressure needing to move, to adjust to change, which is also where you’ll see some hypermobile individuals have some pelvic floor dysfunction too with all of these channels, pipe.
Circulatory systems that kind of get stuck and don’t necessarily move around and or adjust. So yeah, I know a long-winded way of, of talking about hypermobility, but usually this is how it goes with my, my patients. During, uh, evals, we kind of bounce from one spot to another, hoping to really make things make sense in terms of why are all these things connected?
Why are you extra flexible? But you also have. Pots where you can’t stand up without feeling like you’re gonna pass out or why your GI system is just funky and flip flops between constipation, diarrhea, a series of the two, or where we start having like other systems play in.
Anna: It’s so interesting and , it sounds so complex.
It doesn’t necessarily surprise me that you. You didn’t put it together for yourself until you were actually studying, um, and learning about these things. For a lay person with one of these, disorders, is there sort of a typical tell? How do people figure out that they might have this going on?
Estella: That’s a good question. Um, so one of the tricky things with hypermobility too is. It’s really hard to diagnose in particular, since oftentimes you need genetic testing to really confirm. So this is where the differentiation between hypermobility, so HEDS versus uh, Ehlers-Danlos, EDS comes in, is based on genetic variance.
So there are certain genetic variants that will classify you into the true like EDS category. Whereas for hypermobility, something that can be really good screening for any person to do and or check out is called the Beighton Scale. So I believe on the Ehlers-Danlos Society website, they, they do provide the Beighton scale with a couple of other different, uh, tests to also kind of add into.
You know if you are or not, hypermobile. Uh, and so just some, some of the things are on that, uh, bait and scale is checking out certain joint movements. So if when you stand up, you can touch your, uh, touch your hands to the floor without having to bend your knees. If when you bring your elbows up, they kind of do an extra bend.
Same thing with your knees when you stand. Um, there’s some. Things that you can check out with your thumbs, like if they can move all the way back here if like the pinky can come further back, the 90 degrees. Um, another one is if your thumb touches your pinky, and if you can do that on both, uh, some other ones are if you bruise easily, really easily or.
Have very, like soft or velvety skin. So there’s a couple of like external type of criteria that you can sort of check out to give you an indicator of, am am I likely to be hypermobile? And then same thing with if you, if you start noticing, hey, I have some GI stuff that nobody can really tie in, maybe some cardio things that a cardiologist and a neurologist are really unsure about.
Chances are if you don’t have answers for certain things and you’re a little bit extra flexible and, and have some of these high scoring Beighton scales, then you can lean into the idea of, okay, I’m hypermobile From there, then I think that’s kind of the next step of, okay, what type of hypermobility is it?
Is just the. Standard hypermobility or do I now, uh, dip into the EDS category? But like I mentioned, that one’s a little tricky ‘cause you need some genetic testing to, to really confirm that one.
Anna: Got it. , And as a PT who specializes here, , what are you typically treating? Like what are you working with patients on most of the time?
Is it injuries? Is it. Pelvic floor issues like, or is it just a huge range?
Estella: It, it’s really a huge range and it really depends per person, uh, because this is a spectrum. So I have some pretty low symptomatic hypermobile patients, but I also have some very symptomatic, uh, EDS patients. , And it really depends on per person, what we’re working on, what their goals are.
, For example, some individuals have come in with , just one joint that’s bothering them, let’s just say the knee and then maybe every once in a while, the hips or the back. But pretty commonly it’s, it’s joint pain, joint pain, having a difficult time, really activating muscles, uh, feeling a stretch.
So, so for those patients, a lot of it is one, let’s educate, let’s make sure you know, kind of what is happening to your body. What are things that can help out with it. And then really assessing, let’s see, movement patterns, let’s see how you’re moving. Let’s see what muscle’s working, and start to kind of build from there.
For some of my patients who are a little bit more symptomatic, they’ll have crossovers in other systems, so maybe more of the pots, the dysautonomia, maybe more of like the GI upsets and flares. So for them also depends on what they’re coming in for. Uh, management of pain and symptoms is a really big one, which can be really beneficial from movement and exercise, but all at a gentle and tolerable load.
So let’s say somebody’s coming in for some neck pain. And shoulder pain and headaches as well. So like lots of other stuff. And maybe those headaches are also contributing to their constipation. So again, first, just let’s see how everything is moving, how everything is going, what’s working, what’s not, where are our deficits?
And again, let’s get into the education. Let’s make sure we’re supporting your body in the right way. And starting to use gentle movements to either help bring down that inflammation, get systems moving, and again, just helping you understand all the things that are going on versus somebody who might be really, really flared or symptomatic.
In that case, we really want to help bring pains down first. Again, make sure everything feels okay before then we really start building up into everything. Uh, there’s, there’s different. Schools of thoughts in terms of what joint to start with first, where to kind of build up from. But I kind of take it with case by case and what patient is in front of me too, to kind of depend on how we’re gonna treat, how we’re going to, or what we’re really gonna focus on.
Anna: You mentioned exercise. I definitely wanna get into movement specifically. . How do recommendations and guidelines for exercise kind of vary based on, you know, where you are on sort of the hypermobility spectrum or your type of disorder?
Estella: So depending on what individual I have in front of me, exercise will definitely vary. So, for example, if I have one of my less symptomatic individuals. It really is making sure that your form is good, that you feel what muscles are actually activating and can differentiate.
Are you cheating? Are you not cheating? So when it comes to that, it, it’s really breaking it down. Oftentimes my hypermobile individuals, they wanna do a hundred percent, they wanna do a hundred percent, like they wanna go through the movement pattern. And then when I’m observing it or when I ask them, what’d you feel?
I don’t know. I, I think I fell it here. I’m not sure. Chances are when I see them doing the exercise or movement pattern or whatever screening that I want to see, they’re not breathing. Something is over recruited and something in form is a little off, so we gotta break it down, not doing as much. So that way everything is.
More synchronized together. So in terms of how is your form, how is your breathing with this form? Are we doing really, really heavy weight? Because you can do it just for the sake of doing it, but are we feeling those muscles activating? Are you, you feeling things actually moving around? So oftentimes with, let’s say a less flared individual, I want to use bands.
I want to use mirrors. I want to use anything that can be an external cue. Since with, uh, hypermobile individuals, their interoception is a little off, and also the proprioception. So proprioception being your body’s place in space. So let’s say I’m doing a squat. Do I know that I’m coming all the way down in that squat, or am I like halfway?
Am I coming all the way down? But I think I’m only halfway. So this is where mirrors or bands or all sorts of different cues can be really helpful to provide that stability that the body so desperately needs. And now that we have that stability, now we can start actually really feeling those muscles move, feeling what you really want to activate.
To help you. So with, with that, that can just be really nice for somebody to feel, oh, okay, I’m actually feeling my muscles, as opposed to just, you know, hiking things around and just pushing stuff and, and not really knowing what’s moving.
Anna: Do you have any favorite.
Kind of tricks for helping. I mean, once you get the form right, but if people are still having a little trouble kind of connecting with like, where am I supposed to be feeling this? If that’s not something that comes as naturally to them, how do you help them tune into that?
Estella: Great question. One of my favorite things to go to is tapping.
So quite literally tapping of her muscle holding over the muscle. It’s a great way to prime the muscle, um, in. Individuals who have had strokes or any sort of neurological condition studies and research show that tapping is a great way for neuromuscular facilitation. It’s a great way to just get that part engaged.
‘cause you’re quite literally waking it up a little bit. You’re like, Hey, I wanna use you. Can we, can we join in the party? So it already primes the body to react a little bit more. So that’s one of my go-tos. I just tell patients like, all right, tap over the muscle. You know what? It’s supposed to feel like maybe the other side is doing it.
Maybe you’ve done it a couple of times, but you lost it. So tap over the area, wiggle it out, move around, get outta that form, find it once more. So this is where mirrors can also be really, really helpful to see, okay, this is, this is where my body is going. If maybe while they’re doing a squat pattern, they’re always leaning towards one side, that mirror is gonna help them find that alignment.
Again, same thing with bands, foam rollers, cables, anything that. Grounds a person can also be really, really helpful to figure, okay, where am I? Where’s my body? How far is this moving? So those are, those are some things that I like to, to give my, my hypermobile people to feel the muscles a little bit more.
Anna: I love that. I mean, I think there’s so many people who could benefit from those types of tools, even if they aren’t hypermobile, but sort of have trouble. Connecting with, with the right spot. So what about on the other end of the spectrum when folks , are experiencing a lot of symptoms, , what does movement look like for them?
Estella: So movement definitely looks smaller. There are a lot of small accessory muscles and stabilizing muscles that we really can’t see ‘cause they’re so much smaller and and hidden behind some other layers. So oftentimes the big movers. Are overworked and the small ones, the stabilizers are a little more offline.
So oftentimes with a very symptomatic individual, we gotta get those small stabilizers, those small accessory muscles to tune beckin. So just thinking of a lot of individuals will come in with either back pain, neck pain, hip pain. So we really wanna make sure, okay, is your core. Your back, your abdominal muscles, your diaphragm, and your pelvic floor.
Are they all, are they all working together to help stabilize and protect your core and your spine? A lot of times it’s some breathing, some core activation, moving around gently with that. Since oftentimes the individuals that I see that are a bit more flared or symptomatic, they also have some other.
Either diagnosis involved with it, or lots of crossovers in these other systems. So I’m kind of thinking more so of the pots and like dysautonomia or a lot of like GI type flares where just everything in the abdomen is gonna feel either bloated, stiff, tense. So if those muscles or just that system is more extended and expanded.
It’s gonna be a little harder and more challenging to get the muscles to contract to help support the body. So gentle education or reeducation of your stabilizers, those core muscles as they’re gonna help you as you’re sitting, as you’re standing and walking. So once that piece starts getting a little bit more under control and they have.
F both more autonomy and awareness of, okay, what’s a good form? What’s a good posture? And when symptoms are starting to calm down a little bit, that’s where, depending on the area that they feel more symptoms or more discomfort, we kind of start dipping into those. But having that foundation piece already established of, okay, let’s make sure everything is coordinating well together.
Uh, one of the things I like to often tell my patients, whether it be hypermobility or EDS, is I do not want you doing a hundred percent. ‘cause if you’re doing a hundred percent, that means you’re probably not breathing. Your form is probably gonna fall. You might be cheating at some point, but you don’t notice ‘cause you’re just thinking, all right, let me do a hundred percent with this exercise.
So I like to kind of reel it back. Less is more. So, alright, gimme, gimme 50% with your core bracing. Give me 20% thinking about your breathing in coordination with all this, another 10%. Let’s make sure you’re checking out where you’re at, that your form isn’t faltering somewhere else. So that way you know, okay, what is doing what?
And going back to the mental component with it too. Your, your mind, your nervous system, your brain, which is in charge of all of these functions and actions. It’s in charge of telling you, bend your knee, extend your elbow. Take a breath so that way we’re not overloading it with too many things. Okay. Just need to do a little bit here, a little bit there, a little bit there.
And, okay. So oftentimes I feel like with the exercise, the misconception can be okay. You need to be sweating buckets. You need to be having the heaviest weights. You need to be always pushing yourself to, to pr and, and hit the next best thing. But when it comes to hypermobility and EDS, a lot of it is, is management of symptoms helping support the body.
And so we don’t need to do a hundred percent with that. We just need to kind of fine tune and, and figure out, okay, what has an easier time and what doesn’t, so that way we can start accommodating and adjusting that way.
Anna: And what about stretching? Should people with hypermobility be stretching?
Estella: Good question. I tell my individuals we have to find the balance between stretching, so that way, yeah, you give your body that mobility that it needs and that it’s craving. But we don’t wanna overstretch, we don’t wanna get to the point where you’re leaning on your ligaments, where you’re just hanging out there in a stretch passively.
We wanna make sure that the mobility is controlled. So oftentimes here, this is where the mirrors, the bands, all those things are really, really helpful to gauge how much are we stretching? Because like I mentioned, I do want my hypermobile people to stretch. ‘cause oftentimes some of the muscles are really stiff and guarded.
So we gotta give that muscle some extensibility, make it pliable so that way it can recognize that, hey, I can move. I like to compare muscles and muscle’s ability to perform to taffy. So if there’s a piece of taffy that’s super, super stiff and rigid, yeah, we gotta, we gotta warm it up a little bit. We gotta make it pliable.
So that way when you want to move that taffy, it has the ability to go through that range. Then this is where that controlled mobility part comes in. We wanna make sure that from the start of that range and the start of that stretch, you know what’s happening. That you’re not just like flinging into it, that you’re actively controlling it through.
And even through some of these, uh, controlled mobility or dynamic stretches, I’ve had individuals be exhausted and tired because they’re so used to just flinging into it, to just leaning into a certain spot as opposed to warming up the muscle and really getting it extensible through that way. So this is where it, it’s good to have an eye on a person, make sure that they understand, okay, this is overstretching.
This is, this is what I’m looking for and feeling. So sometimes I, I tell my people, do it wrong. Do it wrong. So that way you and your body know, okay, this is what I don’t want. So that way you have a marker of, okay, this is what is correct. This is what I wanna aim for. Alright, this is the opposite. This is what I don’t wanna really find or feel.
Anna: What about, , things like walking, running, hiking, kind of more of a cardio element.
Estella: So also a great question and one that really depends too. If, for example, somebody is really, really flared or has some more of the dysautonomia pots type symptoms, sometimes excessive walking and or running to is not gonna be their best friend.
It might add more inflammation or just stressors to the body. Whereas maybe somebody else who is a little less flared, I do want them to walk. I do want them to be mobile since walking is a great way to just get a whole body workout in. But this is where, again, we wanna gauge it. Since maybe an individual who has more symptoms or is a little bit more flared, their cardiovascular system might not be able to adapt to some of those stressors.
But this, it really goes kind of case by case per person. Uh, some things that I do like to recommend if individuals are very big into walking, running, hiking, all all of those different things, big cardio events. I encourage the use of compression garments, so whether it be compression socks, uh, the sleeves, anything that is going to give the body, again, that stability that it’s so desperately craving.
It’s a little bit of. Some support. What I try to tell people to avoid is something that’s really gonna cut into the abdominal area. So if it’s like one of those high wasted leggings, just make sure, okay, it feels comfortable and you can move around that. It’s not just gonna like cut through the middle.
Um, it’s gonna be really helpful to help support the blood flow. And circulation back, so that way there’s not just like a lot of pooling maybe in the legs or in the feet, just where you can kind of see like some swelling towards the end of the day or in the middle of the day. Um, I also recommend being hydrated not just with plain water, but adding in electrolytes.
There have been studies that show that individuals with hypermobility lose hydration much quicker compared to a average individual. Based on kind of what we’re thinking about, your body is working so much harder at baseline to keep itself stable, to know where it’s at, to remind itself that, Hey, we don’t need to move this much, or maybe we do need to move this much.
There’s lots of confusion and work, mental work that’s always happening and that’s gonna deplete our. Our hydration levels and in particular our electrolytes, so those small little mineral that we don’t really think about all the time. That’s something that I want my hypermobile or EDS people to be a little bit more on the hydrated side with homemade electrolytes or the electrolyte packets, especially if they know that they’re going to be out in the sun more or doing some more cardio activities.
All right, that’s fine. Just make sure that you and your body feel supported through it.
Anna: That’s so interesting. It almost reminds me of like guidance that we see around pregnancy and just remembering that your body is already doing a lot, it already has a lot of demand on it and your brain. Um, and, and we need more hydration during that time as well.
Um, and just not to feel like we have to take things to a hundred percent all the time because. A lot of effort is already being expended.
Estella: No, that’s a really good comparison. ‘cause yeah, it really is true. There’s, I’ve, I’ve had some individuals do very gentle, like core bracing stuff or you know, some standing up and sitting down using that and they’re like, I’m wiped out.
I’m so exhausted. And it’s like, yeah, we don’t, we don’t need to, to do so much to really get the body what it needs.
Anna: Can exercise improve symptoms for folks with hypermobility?
Estella: It definitely can. When we think about the benefits from exercise, there’s lots of research that shows it can help with pain management. But this kind of goes back to what we were talking about with exercise in the beginning of how much to do.
When I recommend an individual with hypermobility to start exercising again, I don’t need them to start pring after every time. I want them to just kind of go through some gentle movement patterns, start getting your muscles to actually activate and get those muscle pumps to start working. So that way, one, your body starts to build up that stability.
‘cause if we can build up that muscle tone and strength. That takes less stress and pressure off of those ligaments, off of that joint capsule, so can really help with reducing that chronic joint pain. But the same way that it took some time to get there, it’s gonna take some time to get out of it too.
For building up muscle strength, it takes anywhere from on the lighter side, three weeks up to about eight weeks to really start building the strength and that neuromuscular control. So this is where. Small, steady, and consistent can be a really good thought to go into exercise with. So that way one, again, you start getting that neuromuscular control of what muscle is working when, where already that is gonna be tiring and exhausting enough as it is.
So just adding that on little by little can be a great way to take off all that stress and extra pressure on those joint capsules. And ultimately the inflammation in the body as well. So I always recommend exercise for people who are in pain or who have this chronic joint pain and discomfort. It can feel a little intuitive or counterintuitive at first because it hurts to move, so why am I gonna move?
But this is where again, we gotta scale it back, find what’s working, what’s not, and start incorporating it that way so that way we can build it up to the bigger things.
Anna: I love that. I actually wanna touch on, approaches to strength training just a little bit. Mm-hmm. I think,, in a more typical population, we’re looking to try to at least lift heavier or, or load ourselves to a point where we’re getting close to muscle failure after.
You know, usually eight to 10 to 12 maybe reps, depending on the weight that we’re moving. Do those guidelines differ for folks with hypermobility? Are we, are we looking to stay a little farther from that close to failure point, or does it kind of depend on where you are symptomatically?
Estella: Definitely.
Really good question. I do say they kind of vary a little bit, mainly in, let’s say somebody’s getting into exercise for the first time and they’re just trying to figure out all the things. I would want them to start off with a lighter weight and do more repetitions. So kind of getting a little higher from the eight to 12 range.
Bring it to like 12 to 20, but again, lower weight. So that way this is how you start fatiguing out that muscle. ‘cause oftentimes when we bring in a bigger weight, other parts of the body are gonna start cheating. Those big movers, the bigger muscles that are always used to. Having to take over as opposed to the smaller ones.
So this is where keeping the weight lighter, but just doing more reps can get that muscle burn or fatigue that people look for to really make sure, okay, I, I did this. My, my muscles were working. So I, I recommend individuals start that way once they feel good with finding the muscles. Making sure that it felt pretty consistent all throughout those last reps, right?
Then pretty similar to standard guidelines of exercise. Okay, then let’s bump it up. Now let’s go to the next weight. But still keeping it the same. Let’s try to get those more repetitions and then kind of progress. So I feel like once an individual has better control of their muscles of finding it. Then maybe those types of recommendations can be better suited for their warmup.
And then once they feel more comfortable, okay, let’s start increasing the weight. Going back to anywhere from like eight to 12 type repetitions, but always trying to be mindful of what was working. Did I cheat while I was doing that or did I actually really feel each part contributing to everything?
Anna: That’s so helpful. Thank you. Um, I guess just to kind of wrap things up, is there anything else that you wish people knew about exercising with hypermobility?
Estella: To not be scared of it and that exercise doesn’t have to look like the stereotypical gym exercises. Where you’re thinking of deadlifting and squatting and your lap pull downs and your bench presses, it can, it can be totally different.
‘cause your body moves in all sorts of different ways, has all sorts of different muscle groups. So sometimes exercise can just be some postural control and then letting it go. Maybe it can be minimal small movements. One of the other things that I like to tell my individuals with hypermobility is. Again with the don’t go a hundred percent.
Sometimes I don’t need you to do a hundred percent in that full range. Let’s just start small. Let’s say if we’re working a squat pattern, okay? Do a half squat and then come up. Make sure that your body feels the control all the way through, because sometimes with these big movement patterns, you’ll see people just doing it again.
Okay, I did it. I wasn’t sure what. Once we make the range smaller. It makes people work much more consciously and a little harder through each step of it too. So I would tell people, don’t freak out. Don’t get scared. Your body exercises and moves every single day. It’s a matter of how are we dosing it? Are you doing it continuously?
Are you doing a little bite size here and there? The other thing too, a little bite size. Here and there, especially when it comes to getting some of our small movers, those accessory muscles to engage and turn on. We need them throughout day to day stuff. So maybe if kind of bringing the shoulder blades back a little bit, a couple of times throughout the day, maybe doing some, some gentle chin tucks if, if somebody is a little bit more head, neck, cervical region involved.
Okay. Let’s, let’s make sure that you’re finding these guys throughout the day. And then relaxing. So little bite sizes of exercises or mobility tips can also be really, really helpful for the body. And I going back to the a hundred percent, we don’t need to spend an hour in the gym every day to get those, uh, improvements or help manage the pain.
Sometimes it’s gimme five minutes, three to four times a day. So that way we just start helping the body, getting everything recoordinate. ‘cause a lot of it’s that neuromuscular reeducation. Let’s make sure that the mind, the body and each component of it knows what’s happening and who needs to support what.
So that way everything can flow through.
Anna: Well, this has been so helpful. I feel like I could probably ask you 20,000 more questions about this, but just a really great overview and I know it’s gonna be super helpful for folks, um, to hear you. So thank you for taking the time. I really appreciate it.
Estella: Of course. Thank you so much. Seriously.
I hope you enjoyed this conversation. If you’re interested in a deeper dive into how to navigate exercise with a specific condition, please let me know. I’ll add it to my list for a future installment of how to move with. Thanks for listening!
xo
Anna
