Is Your Athlete Hypermobile?

Is your athlete hypermobile? Can your athlete do any of the following things?

Edit: Replace Athlete with Child and it's still applicable - Dr. E

Hyperextend their elbows  > 10° on either side
Hyperextend their knees > 10° on either side
Flex their thumbs to contact their forearm on either side
Extend their pinky to a > 90° angle to the rest of the hand on either side
Place both palms flat on the floor without flexing the knees   

If so they may be hypermobile. Joint hypermobility is estimated to occur in 10-15% of children and is often a benign condition. Also known as double jointed or “loose joints,” these children may be at increased risk for joint subluxations/dislocations and ligament sprains.

The above scale is called the Beighton Hypermobility Scale and it is scored out of 9 points. If your athlete scores > 4 points, among other things, then they are most likely hypermobile and this should be taken into account when a coach, trainer, therapist, or physician assesses your athletes injury or writes their rehab or strength and conditioning program.

Just as joint hypomobility, decreased range of motion, may affect an athlete’s movement patterns and performance, joint hypermobility can also influence their program in a variety of ways which we will discuss.

I was recently speaking at a seminar and presented the audience with the following picture.

I followed this picture up with the question, Do you think this level of mobility is good or bad? One of the parents in the group answered good with several of those around her nodding in agreement. My response to her is that the above level of hypermobility is not necessarily a good thing and that it may actually be setting up her young athlete for injury and should certainly be taken into account when they are being assessed for an injury or prior to a strength or rehab program.

While you may think that being hypermobile may mean that you are more flexible, it doesn’t. Often hypermobility, certainly to the degrees of the above person, is more based in hypermobile joints as opposed to flexible muscles. These joints may be hypermobile for a variety reasons including but not limited to increased laxity and weakness through their ligaments, misaligned joints and abnormally shaped ends of bones.

Many times the “flexibility” is not due to muscle length changes, but increased joint mobility. As a result stretching these athletes who do not need to be stretched will only lead to further joint instability in turn placing your athlete at increased risk for ligamentous tears, sprains and arthritis further down the road. These athletes may still feel tight and have palpable knotting throughout their muscles or they may feel like they can never fully stretch their muscles even though they can touch their palms to the floor during a hamstring stretch. For these athletes foam rolling and other forms of soft tissue release may be more beneficial so that they can increase muscle extensibility for improved performance without further compromising joint stability.

Instead of stretching prior to a workout or competition another option may be to perform various band or joint stability circuits to promote more stable joints prior to competition. By using band exercises and circuits to “activate” your joint stabilizers they can prepare the muscles to stabilize a joint during exercise or competition helping to promote improved body mechanics with the goal to be to improve joint integrity and reduce the risk of injury. An example of a quick band circuit for the hips is below. This circuit is comprehensive in addressing hip movement through multiple movement patterns and all planes of motion. Addressing the hips prior to training or competition can also help to influence knee and ankle position during the activity in order to prevent injuries in these areas.  

Maintaining joint integrity is paramount especially if you play a contact sport or participate in dance and gymnastics related activities where you are routinely asked to perform movements or are forced into movements beyond normal joint ROM. A good general rule of thumb is to limit your time and the number of repetitions that you perform into joint hyperextended positions and to strengthen the opposing muscle groups that will help to counteract the stressful motion. For example gymnasts and dancers are often asked to routinely hyperextend their backs. These athletes may benefit from anterior core and trunk stabilizer activities prior to over-extending in order to help support their spine in these compromised positions. This way you may be able to help prevent common injuries including spondylolysis which is often too common in these athletes.

As described in the opening the below scale is used to asses joint hypermobility. If you suspect you or your child may be hypermobile you can use this test to confirm your suspicions. Overall a score of 4 or more and pain for greater than 3 months among other points can help to confirm.

Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

 1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

Please feel free to leave a comment below if you have any questions or suspect your athlete may be hypermobile. 

Contributed By Dr. Jon Herting