Generalised joint hypermobility is a condition in which a person has a range of movement beyond what would be considered normal; in everyday language, hypermobile people are often described as ‘double jointed’. Although hypermobility is usually asymptomatic, the symptoms of the connective tissue disorder Ehlers-Danlos Syndrome (EDS) can be severe. In Ehlers-Danlos/Hypermobility Type, or Hypermobility Syndrome (HMS), the hypermobility causes joint pain. According to A Guide to Living with Hypermobility (2011) by Isobel Knight, a dancer, Bowen Therapist and lecturer on hypermobility, the list of symptoms of EDS can be huge; just some of them are extreme tiredness, soft tissue trauma, slow healing, overuse injuries, bruising, subluxations, clicky joints, hip dysplasia, arthritis, fallen arches, increased risk of sprains, strained ligaments due to an excessive range of movement, plantar fascitis, cramp, spasms, difficulties with proprioception, headaches, coordination difficulties, poor reflexes, numbness, IBS, weakened bladder, uterine prolapse, anxiety, memory loss, difficulty concentrating and many more. Because there are so many possible symptoms, EDS often goes undiagnosed. To manage HMS, techniques including mindfulness, physiotherapy and Pilates are used.
Jessica Moolenaar, a Pilates Foundation teacher and Director of Mindful Pilates, is hypermobile. She contributed a chapter on Pilates and EDS to Isobel Knight’s newest book, Managing EDS (Type III)-Hypermobility Syndrome (2013). Jessica and Isobel are presenting a workshop on Pilates and hypermobility in Edinburgh on 22 June. ‘I have been working with dancers at Laban for so many years,’ explains Jessica. ‘Seventy percent of female dancers have hypermobility. Hypermobility Type makes people’s bodies unstable, and also makes them have less proprioception. Pilates can help with that enormously. Proprioception is an important part of the whole process of building awareness and embodiment. From a technical point of view, strengthening the joints is the most important part, so that we get a body that is a whole rather than a body that just does its own thing. Not only can the body be hypermobile, but there is a lot of bracing because it has to become stable.’
EDS brings its own particular problems. ‘With EDS, there is pain in the body that jumps around,’ Jessica says. ‘One day it’s the traps, the next it’s the hips. Pilates helps to make the joints more stable so they move in coordination.’
Gentle movement is helpful for people with EDS, but static work and repetitive movement are tiring and often lead to pain. Pilates helps by taking clients through gentle movements into smooth, coordinated recruitment patterns of the muscles. Not only does Pilates build stabilisation by strengthening around the joints, it increases the proprioception, working on balance, relaxation and breathing to combat fatigue and anxiety.
Pilates Foundation teachers understand fascially how to coordinate the body so that hypermobile clients get the distribution of force through the whole system instead of hanging in certain areas and locking in others. ‘You don’t push into the end range of movement ever because that’s just not beneficial,’ says Jessica. ‘But very good Pilates practice never pushes into the end range or locks any joints. There’s always the flow of the in and out breath so you never stop moving or lock into position or push beyond your capabilities.’
Clients with the condition need to direct their movements consciously in order to build new body-mind patterns in the brain, thereby overriding faulty patterns. They start to feel their ‘inner alignment’ by scanning body positions and sensations, and with the help of mirrors and the hands of the teacher, rather than collapsing in an excessive range of movement, they create new neural pathways by being mindful of the difference.
Jessica explains, ‘Rather than just strengthening with a set of Pilates exercises, we as teachers work on a one-to-one basis, designing a person-centred programme to balance the soft tissues using imagery and releasing local areas of muscle and myofascia in spasm through small and gentle movements and breathing exercises and then integrating new patterns, slowly building a new organisation of the body-mind.’
For more information:
Ehlers-Danlos Support UK www.ehlers-danlos.org
Hypermobility Syndromes Association http://hypermobility.org/
Hypermobility Unit, Hospital of St. John and St. Elizabeth www.thehypermobilityunit.org.uk
Hypermobility and Pilates workshop, 22 June, Edinburgh http://www.pilatesfoundation.com/workshops/show/hypermobility-and-pilates-2/