Hypermobility Rehab: Why people get it wrong

Pretty much every hypermobile client we have ever worked with, has been told at some point either by their GP or multiple physiotherapists, that the solution to stopping joint dislocations is to build muscle around the joint.
And, if you don’t think too hard about it, it kind of makes sense: build muscle tissue to help stabilise a joint that’s lax.
On the surface it seems like a plausible way to go about rehab, but when you dig a little deeper, it starts to unravel fairly quickly.
Not sure what we mean?
Well, to actually grow muscle tissue a few requirements need to be met.
1. The first, being that muscle tissue needs to be sufficiently loaded to actually damage the tissue and initiate growth. You see people everyday in gyms all across the country, progressively using heavier and heavier dumbbells to grow their muscles.
However, to be able to put such load through a tissue to force growth, a joint first needs to be stable enough to actually manage the load.
If a joint is unstable, like in the case of hypermobility, then sufficient load cannot be put through a joint to actually increase muscle tissue, at least not to any noticeable degree without set back, after set back, because of healing times.
So, for those who have really unstable joints, building muscle tissue is just not going to work.
2. The second issue with this outdated thinking around hypermobility rehab is that we can only realistically add to our frame about 8-15lbs (depending on who you ask) of muscle tissue over the course of a year.
Keep in mind, that this is 8-15lbs distributed body-wide and not just isolated to one particular muscle.
There is also the issue that a large percentage of the population, through genetics and hormonal levels, will have significantly lower levels of testosterone, meaning they will add much less muscle tissue over the same time frame.
It also adds the question of how much muscle tissue do you need to build, if you can even handle the load needed to grow muscle without dislocating or getting injured in the first place?
Do you need 10lbs of muscle tissue to stabilise a subluxating knee?
Perhaps 5lbs for an unstable shoulder?
And how long do we need to build muscle for?
Are you expected to do rehab for 2 years to build 20lbs of muscle to stabilise your knee?
If you really think about it, you won’t have ever been told to pack on 10lbs, 5lbs, or any other specific amount of muscle tissue by your healthcare provider.
Because truth be told, they don’t know how much it takes.
And why do they not know?
Because the amount of muscle mass you have is the tiniest contributor to creating stable joints.
Look at our hypermobile clients. None of them come out jacked after their programme! In fact, when they finish their programmes, they do so with either the same amount of muscle tissue that they started with, or a very slight increase in muscle mass.
Far too much emphasis has been placed in the musculoskeletal factors for rehab, when it should have been placed neurologically.
Which leads us into the other area of rehab currently used for hypermobility “Proprioception exercises”.
This is a whole other rant, because the proprioception exercises that we have seen from physio’s, pilates instructors, and everyone else, are not proprioception exercises.
Proprioception is the effect, not the cause of the issues with hypermobility.
Think of it like being a good driver. Being a good driver is the direct effect of a number of skills working together: hazard awareness, timing, motor control, depth perception, judgement, and experience.
The same is true of proprioception. It is the effect of many systems working together.
Movement as a whole is unconscious, meaning it happens automatically. Stabilising joints is largely about the prediction of forces and being able to predict what force is incoming and how to react to it automatically.
If your proprioception training is consisting of you focusing on the joint and moving it, or waving your arms in the air supposedly “connecting to the tissue”, then you may get some short term benefits as you create a crude update to your mapping system, but it’s going to be temporary. As you are definitely not training proprioception. You are just being conscious of it.
Movement as a whole is unconscious, meaning it happens automatically. Stabilising joints is largely about the prediction of forces and being able to predict what force is incoming and how to react to it automatically.
Take it easy guys!
- The Fibro Guy Team -
www.thefibroguy.com

[@clairemckean2341]

What you say in the description box is so true also. People think they are doing proprioception exercise when they really arnt. I’m glad you guys are leading the way with rehab.
We need more of you, keep it up!