Hypermobility-related problems and how the Alexander technique can help

Working with the Alexander technique can help people who have issues related to hypermobility.

What is hypermobility?

Hypermobility relates to hypermobile joints. Joints may be hypermobile because of their shape and how they articulate. They may also become hypermobile due to extensive training (eg, in gymnastics, athletics, sport, dance, or music). Sometimes, hypermobile joints are a result of certain medical conditions. For most people, hypermobile joints are the result of overly stretchy collagen in their body’s connective tissues.

This more loose and stretchy collagen makes joints more mobile and, sometimes, unstable. In turn, this can make the joints more prone to injury and slower to heal than normal.

Joint hypermobility is generally assessed using the Beighton score. For most people with hypermobility (c. 10–25% of the population worldwide[1]),their extra flexibility is not a problem.

What problems can be associated with hypermobility?

For some people, hypermobility is linked to joint and ligament injuries, pain, fatigue, and other symptoms. These problems are seen in the hypermobility-related disorders, which include hypermobility spectrum disorders (HSD) and the Ehlers–Danlos syndromes (EDS).

Briefly, common symptoms of hypermobility-related disorders include:

• joint instability and hyper-extension, sprains, strains, subluxations (partial or incomplete dislocations), and dislocations

• under-developed and unreliable proprioception (awareness of body position in space); alternatively proprioception can sometimes be super-sensitive and overwhelming

• stomach and digestive problems (eg, stomach reflux or slow stomach emptying)

• bladder and bowel problems

• dysfunction of the autonomic nervous system, including postural orthostatic tachycardia syndrome (POTS; ie, dizziness, light-headedness, fainting, and difficulty regulating temperature and blood pressure)

• easy bruising

• poor wound healing

• stretchy or soft skin

• chronic widespread pain and fibromyalgia

• chronic fatigue

• anxiety, depression, and other mental health issues.

Note: hypermobility-related disorders can overlap with neurodivergence (extra sensitivity and/or neurological differences from the norm). People with hypermobility-related disorders may also develop post-traumatic stress disorder. This can be an outcome of being told their pain, discomfort, and other symptoms are all ‘in their head’ as part of their often torturous journey to getting an accurate diagnosis.

What can be done to help?

To stabilise and protect hypermobile joints, the muscles and tendons around the joint need to be strong enough to do the job normally done by the ligaments. This makes exercise important for those with hypermobility. Exercise helps improve muscle tone and strength, which helps to reduce pain. While it may take increased time to initially build strength compared to someone without hypermobility, it does help to improve function.

What is the Alexander technique?

The Alexander technique is a mind–body mindfulness and re-educational method that identifies and changes habit and reaction patterns. It can be applied to all the activities in your life – to everything you do. The Alexander technique focuses on the how and gives us agency to improve. It focuses on:

• how you are moving

• how you are thinking and reacting

• how you are approaching your body and your whole mind–body self

• how you put what you learn into action.

(See my page ‘What is the Alexander technique?’ for more detail about the Alexander technique and what happens in sessions, or ‘lessons’.)

How can the Alexander technique help hypermobility-related issues?

Alexander technique can help problems linked to hypermobility by:

• calming generally overly activated and sensitised nervous systems – through applying the Alexander technique principle of inhibition (stopping)

  • this can help lower any centralised, nocioplastic pain, fatigue, and sensitisation in the central nervous system

• building and improving overall body awareness through:

  • applying the Alexander technique’s directions to the body and the related concepts of counter-direction and oppositions/opposing forces to ensure bodily connection

  • improvements to body schema (our unconscious, internal maps of the body used to guide movement and posture)

  • increased perception of three-dimensional volumes

  • ‘thinking in activity’ (mind–body awareness while in action)

• identifying habit patterns in how you use your body and how you are thinking about what you are doing – through applying the increased mindfulness and self-awareness taught by the Alexander technique

• retraining movement and providing you with more efficient, less harmful physical alternatives to your current behavioural choices

  • for example, while people with hypermobile joints may ‘lock’ their joints at the end of a range of movement to compensate for their hypermobility, this interferes with balance and may be causing pain

• helping to reduce pain and fatigue and helping to prevent injury through:

  • enabling less pressure on joints – through less joint ‘locking’, less compensatory weight being placed on the joint, and less unnecessary muscular tension and holding around the joint

  • activating appropriate whole-body postural tone and support – the Alexander technique aims for appropriate muscle tone throughout the body – this means loose and floppy body parts may need to work harder, while other parts need to work less; as a person’s deeper postural support system ‘wakes up’ through regular application of the Alexander directions, unneeded tension in the superficial muscles begins to let go

  • enabling stability without rigidity, better, more dynamic balance, and increased ease of movement

  • improving overall coordination of your body and your whole mind–body self – the Alexander technique looks at whole mind–body use and awareness rather than focusing on one problematic body part – we can see how one part of the body affects others and also how our thinking affects our body

  • working with related conditions that may also be causing pain and discomfort, such as scoliosis

• helping to develop proprioception and improve any other sensory processing issues

• providing strategies for better self-care and dealing with pain and stress, leading to greater confidence and self-efficacy

• offering support for those who are highly sensitive and/or neurodivergent

• providing support for those with hypervigilance (being extremely alert for potential danger) and post-traumatic stress who may have a long history of feeling unsafe in their bodies.

Interested in trying the Alexander technique?

If you have hypermobility-related problems, with lots of pain and discomfort, or a disorder like HSD and EDS, life can be difficult. If you would like to work with me, please do reach out. I would love to help.

Reference

[1] Garcia-Campayo J, Asso E, Alda M. Joint hypermobility and anxiety: the state of the art. Curr Psychiatry Rep 2011; 13: 18–25. doi: 10.1007/s11920-010-0164-0.