I've also loved exercise, even training as a fitness instructor when I was in my early twenties while on summer break at university. But then all my medical conditions entered my life, or became recognised, including hypermobilie EDS. So I was super nervous about exercising, or didn't have the energy to do so. I wasn't sure whether certain exercises were OK to do as a person with hypermobility, or whether they could be making the situation worse. It seems my fears were largely unfounded.
It was fantastic to attend the talks by a physiotherapist who specialises in hypermoblity, and hear a professional giving his expert views on how to exercise with hypermobility.
So here are my notes from two really interesting talk given by Jason Parry, a specialist physiotherapist in hypermobility, that was given as part of the London EDS UK events series. It is rather 'bullet-point' in its tone, but I wanted to make sure that I conveyed as much of the talk as possible so that it was a useful resource.
I hope you find it useful and informative. The notes below relate to aerobic / cardio exercise and strength.
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Exercise and Hypermobility
Jason Parry
Clinical Specialist Physiotherapist in Hypermobility
2 September 2018
Event held by Ehlers-Danlos Support UK.
GENERAL BACKGROUND
Exercise is a cornerstone of treatment for hypermobility patients.
Exercise can . . .
- Help with pain from stiffness and deconditioning
- Give you more energy to help with fatigue
- Help improve your overall stability
- Reduce the risk of injury
- Reduce the risk of dislocations
- Help reduce the symptoms of dysautonomia (such as POTS)
- Helps release endorphins aiding mood management
- Mindful movement can help take the fear out of moving and using our bodies
- Enhance general health and wellbeing
There are four types of exercise:
- Aerobic
- Strength
- Flexibility
- Proprioception / balance
It is important to incorporate all these forms of exercise into your routine, whether you have hypermobility or not.
AEROBIC EXERCISE
Includes swimming / walking in water, walking, going up and down stairs, using ‘pedals’, rowing machine and cycling, amongst other forms.
Pacing is important.
- Find a baseline of exercise that doesn’t cause you intense symptoms afterwards, then ‘grow’ your exercise from there. If you increase exercise (time or intensity) then get symptoms, decrease it again. But don’t stop altogether!
- It can be counter-productive to push through to finish an activity – don’t overdo it on a good day!
- You need discipline and self-control to know your limits and when to stop the exercise.
- Stop BEFORE symptoms arise, not BECAUSE they arise.
Benefits of aerobic exercise:
- Higher levels of fitness can reduce symptoms of fatigue and provide more efficient energy expenditure.
- The more you exercise the more you build fitness and reduce fatigue.
Cardio Exercise and Dysautonomia
POTS patients typically have a reduced circulating blood volume. Exercise training can increase blood volume.
Exercise may need to begin in a recumbent position (such as on a recumbent bike or swimming), then change to an upright position. (personally I found that using a pedal exerciser at home to be really helpful)
It can take two months or more before you are able to exercise in an upright position.
STRENGTH TRAINING
Benefits of strength / resistance training:
- Strength training reduces the risk of injuries and supports joints.
- Makes your body more robust for ‘real life’ activities.
- Provides additional support to painful and flexible joints.
- Reduces the risk of dislocation and subluxation.
- Increases resting metabolic rate.
Starting a strength training programme
- Work out the baseline of reps of an exercise that are suitable for you.
- Use a paced approach, as per the cardio approach.
- Movements should be done with control – slow and careful.
- Reflect on post-exercise ache – a degree of aching is normal but there shouldn’t be strong pain
** REMEMBER – it can take hypermobile patients twice (or even three or four times) longer to gain strength than non-hypermobile persons **
Hypermobility exercise is a long game – you need patience!
Exercises
- Strength training means using some form of load – gravity / bands / dumbbells / body weight / bottles filled with water or sand.
Pilates is also helpful – increases cores strength – super important for hypermobile patients.
Flexibility
Background
Hypermobile people can get stiff too! If certain bits of you are hypermobile then other bits can get stiff – the bits that we don’t use as much can get stiff.
Global muscles can overwork, causing them to ache and spasm.
Stretching is still important for people with hypermobility – just be very careful not to hyper-extend or go to extreme ranges – even if it feels comfortable or you can’t feel a stretch.
Can use a mirror to check that you aren’t hyperextending when you stretch.
Posture
We can get pain through poor posture.
Typically, slumping when sitting on the sofa etc.
So, change position regularly so muscles don’t get stiff from being held in the same place.
PROPRIOCEPTION / BALANCE
Proprioception is our body’s ability to sense position and movement within joints. It is how we know where our limbs are in space.
Proprioception is often not fully ‘sharp’ in hypermobile patients.
Relates to co-ordination so hypermobile patients may be clumsy.
But we can improve proprioception!
Good exercises to help improve our proprioception and balance include: tai chi, wii fit, single leg exercises, using mirrors when exercising or moving, taping joints (so when it feels tight then you know when to stop a movement as are hyperextending), balance boards, gym balls, pressure garments.
What are safe exercises? There aren’t any fully ‘off-limits’ exercises, but yoga should be approached with caution due to issues with hyperextending in certain positions.
Make exercise fun! Put on some music, use nice smells, exercise with a friend etc.
Summary
Exercise can . . .
- Help with the pain from stiffness and deconditioning
- Give you more energy to hep with fatigue
- Help improve your overall stability
- Reduce the risk of injury
- Reduce the frequency of dislocations
- Help reduce the symptoms of dysautonomia / POTS
- Help release endorphins and encephalins – aiding mood management
- Mindful movement can help take the fear out of moving and using our bodies
- Enhances overall health and wellbeing
Hope you found it interesting and useful!
Please follow the advice of your doctor as to all medical treatments, supplements, and dietary choices, as set out in my disclaimer. I am not a medical professional, and this is simply my story and the resources that are helpful to me.
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