In this age of semi-private and bootcamp training, we have to go out of our way to make sure certain clients don't get lost in the shuffle. Joint hypermobility—also known as "loose joints"—is perhaps the most important scenario that this could happen.

We're all born with varying degrees of congenital laxity, meaning some of us have less ligamentous "give" than others do.

Just like an individual might make more or less or a certain hormone, certain individuals are more efficient at synthesizing collagen. People with congenital laxity really aren't super proficient this regard, so they wind up with a lot more joint range of motion (ROM).

In certain cases, this can be really advantageous; swimmers, throwers, and gymnasts can use this natural predisposition toward freaky ROM to be more successful in their sporting disciplines. However, it also opens these individuals up to other musculoskeletal issues ranging from ankle sprains, to shoulder subluxations, to stress fractures, to hernias and early osteoarthritis.

These folks are also more likely to have detached retinas and gastrointestinal reflux disorder (and a host of other issues), because collagen deficiency affects not just skeletal muscles, tendons, and ligaments, but also visceral organs (smooth muscle), skin, blood vessels, and the tissues of the eye.

According to Dr. Alan Pocinki, a renowned expert in this field:

"To compensate for stretchy blood vessels and increased venous pooling (too much blood collecting in over-stretched veins) most people with hypermobility appear to make extra adrenaline, which may account for the high-energy, always-on-the-go lifestyles of many hypermobile people."

This is one reason why it's not uncommon for hypermobile individuals to have anxiety issues and panic attacks; they are in chronic sympathetic nervous system overload.  Poor sleep quality and impaired recovery can also be present in this population.

Further, Pocinki notes, "Because too much blood is pooling instead of circulating, people with JHS typically have cold hands and feet and low or low-normal blood pressure, in addition to lightheadedness on standing."

We can appreciate that it's absolutely imperative to identify the most hypermobile clients we have before starting their exercise programs. Here are three quick tips on this front:

1. Be cognizant of gender, age, and ethnicity. Laxity is higher in females than males, and becomes less prevalent as we age. Additionally, you'll see hypermobility more commonly in those of African, Asian, and Arab origin than in Caucasians.
2. Take note of a handshake. You'll typically feel a lot of "give" in these individuals' handshakes, and their hands will often be cold - even when it's really warm in the environment at hand.
3. Run a Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9; a higher score is indicative of greater hypermobility:

Now, in light of our more sedentary population, many trainers assume all individuals are incredibly tight and need to stretch until the cows come home. Here's a great example of an athlete who—at 6-4, 240 pounds—wouldn't appear to be hypermobile to the naked eye. However, when you run a Beighton score, you quickly see that he's actually got a lot of laxity, and his programs need to focus on building stability first and foremost.

Stretch him, and he'll get worse. Build stability, and he'll thrive - all because you ran some simple tests ahead of time.

If we've got these hypermobile people under our care, we don't want to be stretching them. What do we do when they always feel "tight?" And they absolutely will say this is the case all the time.

Why hypermobile people feel tight, and what to do

The reason they feel "tight" is because their bodies will lay down trigger points to protectively lay down stability where they otherwise lack it. If you just stretch them, you destroy their joints and just continue the painful cycle.

Instead, these individuals need to work on building stability within the ROM they already have with quality strength training. For the trigger points, they can do some extra foam rolling or get massage work done, especially if it helps them to wind down and shut off the sympathetic nervous system (fight or flight) for a bit.

In terms of training them, most things are fair game, but you just need to make sure that they aren't exaggerating the ROM on exercises; they need to stop short of where their end-range is. A great example is elbow hyperextension on push-ups; this is no bueno!

Finally, monitor what they do between sets. A lot of hypermobile individuals will stretch while they're resting without even thinking about it. We like to do what we're good at doing, so you need to go out of your way to coach these individuals out of those habits.

As you can see, identifying and managing hypermobile individuals can be a bit more time consuming and challenging, but it can also be tremendously rewarding, as these folks are often chronically mismanaged by inattentive or unprepared trainers and therapists.  This population is an outstanding opportunity to really make a difference in someone's life because of your unique expertise.

References

1. Pocinki, AG, 2010. http://www.cfids.org/pdf/joint-hypermobility-guide.pdf