Joint Mobility & Stability, Hyperextension, Hypermobility, and How Yoga Can Help

Vocabulary

hyperextension, hypermobility / hypermobile joints, joint congruency, joint hypermobility syndrome

1. HYPEREXTENSION — The joint range in extension is greater than average, causing bones to be out of alignment; in asana practice, this “misdirects the forces that create the form of the asana” (Ray Long MD)
2. HYPERMOBILITY / HYPERMOBILE JOINTS — One or more joints with a greater than average range of motion; also known as “generalized ligamentous laxity,” it refers to a laxness (looseness) in the ligaments that stabilize joints; this laxity can range from mild “loose joints” and “double jointedness” to systemic pathological conditions
3. JOINT CONGRUENCY — Joint surfaces maintaining their natural curvature when in contact with one another (Ray Long MD); the contact might be due to body weight or due to the forces of muscles surrounding the joint when practicing a pose or during a pose adjustment, for example
4. JOINT HYPERMOBILITY SYNDROME — A condition affecting 3% of the population (PubMed) “typified by the presence of hyperflexibility of multiple joints (usually four or more, but this varies), joint pain (especially in the knees and ankles), and fatigue” (Baxter Bell MD)

Joint Mobility & Stability

Here we focus on joint and muscular health. See also:

• Connective Tissue Health — Fascia & Connective Tissue
• Bone Health — Bones, Strengthening Practices, Osteoporosis & Osteopenia, 5 Ways to Reverse Biological Age.

Health of the musculoskeletal system displays as a balance in stability and mobility.

When joints are functioning optimally, moving through their healthy range of motion, they are, of course, helping us to move pain-free with fluidity and grace, power and strength. But there is more going on in the body than we can see and even feel. As Ray Long MD explains here, in addition to their more obvious functions, healthy synovial joints also secrete a fluid that:

• Lubricates the joint surfaces, reducing friction during movement and acting as a shock absorber through fluid pressurization
• Carries oxygen and nutrients to the cartilage
• Removes carbon dioxide

Moving oxygen, nutrients and carbon dioxide! The body is a truly wondrous orchestration, is it not?

When healthy and functioning optimally within the great harmony of the body’s physiology, joints display both mobility and stability.

Ray Long MD explains here that joint mobility and stability are determined by these factors:

1. The shape of the bones at the joint (ball and socket, hinge, etc.)
2. Soft tissue stabilizers around the joint (ligaments, capsule, labrum, meniscus)
3. Muscular stabilizers that surround a joint

CORRECTING IMBALANCE IN ALL THINGS, INCLUDING JOINT MOBILITY & STABILITY

A central concept in all healing arts is that of correcting imbalances within the body. The principle of re-establishing balance can be found across all cultures from Navajo sand paintings, Ayurveda, Traditional Chinese Medicine to modern allopathy. And anything with true healing power also has the capacity to cause injury when practiced without balance. For example, joint mobility is beneficial for a number of reasons — provided it is balanced with joint stability.  – Ray Long MD 

Musculoskeletal Issues

Introduction

Musculoskeletal issues include:

• Pain
• Postural issues
• An imbalance in mobility and stability of joints (in general)
• Hypermobility (specifically) which is associated with an increased incidence of musculoskeletal injuries (Ray Long MD)

See Also

• In cases where there is pain, please begin with those lessons.
• See the related 3-lesson series on the anatomy and physiology of flexibility and stretching.
• In the case of postural issues, combine the following foundational knowledge with the posture lessons.

A JOINT IS ONLY AS HEALTHY AS MUSCLES SURROUNDING IT

While a few joints in the body are immovable or slightly movable, most of the joints are “freely movable” and have elaborate structures. Their complexity is one reason they’re particularly vulnerable to injury. A joint is only as healthy as the muscles surrounding it. Relaxed, flexible muscles lead to a more mobile joint. – Larry Payne 

Diminished Mobility

When inactivity or poor posture causes diminished range of motion, “the resulting rigidity in the joints and… muscles supporting it places more stress on neighboring joints and muscles.” (Mukunda Stiles)

Excessive Mobility

When healthy range of motion is exceeded, “the joint becomes hyperextended, less stable and potentially more vulnerable to injury.” (Mukunda Stiles) Healthy ROM may be exceeded by:

1. Overstretching
2. Postural issues
3. Injury
4. Skeletal issues
5. Joint hypermobility (see below)

While some medical practitioners (and even some inexperienced yoga teachers) may equate yoga with stretching, Leslie Kaminoff corrects that misperception in this 5-min video, explaining why hypermobile students can indeed practice yoga.

After explaining the proper balancing role of well-chosen yoga asana, he goes on to explain that the consequences of overstretching can be significant for those with hypermobility. If a stiff person overstretches, he could experience a pull or strain that is likely to fully heal relatively quickly while a person with hypermobility is more likely to experience chronic degenerative joint changes from overstretching.

See Also

• Stretching Issues & Techniques
• Jill Miller: How I Ended Up with a Total Hip Replacement at Age 45

HYPERMOBILITY MAY BE MISUNDERSTOOD AS “BEING GOOD AT YOGA”

I had a student in one of my classes who was hypermobile, and I often caught my other students asking her how she got so good at yoga — there’s just a sense that more flexible is better when it comes to yoga. Unfortunately, hypermobility is a real problem that can lead to joint instability, chronic pain, and sometimes even costly and painful joint repairs. – Bridget Frederick 

DECREASE IN A JOINT’S STABILITY

As you get “looser” or more limber in a particular joint, less support is given to the joint by its surrounding muscles. Excessive flexibility can be just as bad as not enough because both increase your risk of injury. Once a muscle has reached its absolute maximum length, attempting to stretch the muscle further only serves to stretch the ligaments and put undue stress upon the tendons (two things that you do not want to stretch). Ligaments will tear when stretched more than 6% of their normal length. Tendons are not even supposed to be able to lengthen. Even when stretched ligaments and tendons do not tear, loose joints and/or a decrease in the joint’s stability can occur (thus vastly increasing your risk of injury). Once you have achieved the desired level of flexibility for a muscle or set of muscles and have maintained that level for a solid week, you should discontinue any isometric or PNF stretching of that muscle until some of its flexibility is lost. – Massachusetts Institute of Technology (MIT), Flexibility