Considerations when working with clients (or yourself) with hyper mobility

Those clients that I see with hypermobility have some things in common. Some of my strategies are the same whether they have a diagnosis of Ehlers-Danlos Syndrome or not. 

The classic hypermobility presentation on my table tends to have more "nerve" symptoms like tingling, numbness, and burning. This can be in the pelvic floor, genitals, hands, feet, shins or "sciatica."

My objective joint assessment makes it feel like the hips, ankles, and shoulder girdles have excellent mobility on the first hit. At this point I usually ask them to show me what it looks like to straighten their elbow. Most of the time it hyperextends, like those who lock their knees when they stand and their knees look "overbent." We have all seen these people on the street.

What is happening? 

In the non hypermobile person, the body restricts motion at the muscle level, giving signs of tight muscles. If this strategy doesn't work, the body will limit the joints. With differences in collagen and elastin with hypermobility bodies, the next barrier that gets pushed is through the tension in the nerves. So more nerve symptoms are seen in this population.

When I assess these clients more deeply, I always find sacroiliac and hip joint restrictions. Still, when I engage the actual "joint space," the body makes a smoke-and-mirrors attempt by routing into the slippery muscle fascia. Deep, focused engagement of the bones will get you the unloading you are looking for as a practitioner. 

Remembering the hierarchy of protection that the body always provides, these clients of mine are then told to stop doing yoga. End range Yoga is an irritant to their system. If they are going to continue, I instruct them to do it for stability only, so about 60% of their available range of motion. These clients often enjoy practicing yoga because they are naturally "good" at it. Truthfully, they are better off in Pilates or weight training. When the why is explained, they always get on board with my suggestions.

When you do a postural assessment or watch the unwinding on the table, you will also note that the upper cervical spine, (like the cranial base to C3,) is gripping like mad! The nerve tension created down the arms and legs ultimately pulls on the spinal cord. Think of the nerve system as yarn; the tissue can not buffer tension like muscles. The reflexes in the body will not let you pull on your spinal cord at the level of the cranial base where the brainstem is, so it is giving you feedback (the tingling) to get you to stop.

When your client becomes a "trustable person" to their spinal cord reflexes by limiting yoga (spinal cord neural tension) and doing neutral alignment core strengthening while you, the practitioner, perform objective biomechanical corrections, you will reduce the symptoms.