Stretching the truth

Hypermobility is a condition refering to systemic or localised extreme joint mobility, often diagnosed as such because of its tendency to cause pain and chronic instability, which in turn leads to injury and then more pain. My personal understanding of Yoga practice is that through concentration on one method we aim to summarily mitigate extremes in the total human.

Anatomically speaking, hypermobile joints are a real problem for our tensional integrity and can cause the entire structure to collapse. Is it safe for a person diagnosed with an associated Joint Hypermobility Syndrome to practice Yoga? My answer is predictably: absolutely, with appropriate control measures. In order to fully understand hypermobility, it is necessary to have a basic understanding of cellular biology and its expression in biotensegrity.

My colleague recently posed a problem submitted to him by a Yogi/surfer who has chosen to cease her Yoga practice in response to her problems with hypermobility. She asked for some “stretches” she could do to address her issues, which we decided was itself of course a problematic notion. Ash points out that we humans like to do what we’re good at.

We naturally want to bend in the direction of predisposition, so if we’re strong we want more pushups and if we’re flexible we want to keep stretching. It is normally an innocuous confirmation basis, doing more of the stuff you like because you’re good at it, but when our tendencies verge on the extreme then we need to impose some constraints and realign habits so that what we’re good at is also what is good for us in the long run.

Someone who has to stop doing something they love, such as Yoga, has been forced into this decision because they have naturally been led into their dangerous end-ranges of movement because that’s what felt good at the time, and unfortunately did not have resources sufficient to stop themselves from overstretching. By resources I am talking about an experienced teacher, or prior personal experience/training.

Long-time practitioners of Yoga will disagree on many points, but most of us can agree that if your method of Yoga is hurting you, then you need to reasses whether or not it is Yoga that you’ve actually been doing. The last thing a hypermobile person should be doing is stretching; however, I hope to make a convincing argument that a hypermobile body will benefit from practicing Yoga within a structured set of parameters tailored for their particular biological factors.

Let’s take a look at one of the most common of what I will call “disintegrities” that appear in almost every Yoga class I have ever taught. Hyperextending elbows, particularly in females, are so common that I read the level of the class by how many wonky elbows are visible in the first downward dog. Reading experience in the bones, I consider the presentation of hyperextending elbow(s) to be:

1) the mark of a beginner, and

2) injury waiting to happen.

Hypermobility is even more dangerous because it affects proprioreception, or our ability to distinguish the relative position of our joints in space.

This reduced awareness is a driving force behind why beginners to Yoga, particularly young flexible women, will find it so hard to make those micro-adjustments to take them out of that 10-15% extreme end range… they simply aren’t aware that it is a problem in the first place! It feels “good” to be in that end range, and it evokes that sexy bendy image we associate with being “good at Yoga,” so the young women attending these Yoga classes often err on the side of blowing out their joints because they’re not being instructed sternly enough by a caring teacher. Since my own elbows are prone to this particularly insidious form of hypermobility, I like going back to this as an example of how it pays off to own up to your truth and go back to basics.

Understanding the Anatomy

The elbow at first glance might seem like a straightforward hinge joint, but rarely does a hinge exist without some rotation required to power the joint further along in the kinetic chain. So it goes with the elbow, a joint composed of three articulations of three bones; the humerus, the radius, and the ulna. The first two, as I will now illustrate, provide the hinging aspect we associate with the elbow. These two, the humeroulnar and the humeroradial joints, produce flexion and extension of the elbow. The proximal radioulnar joint provides the rotation needed by the forearm to supinate and thus articulate the movements of the hand. Three primary ligaments support these articulations: the annular ligament, and the medial and lateral collateral ligaments. With the ligament laxity associated with hypermobility, the elbow extends beyond 180 degrees and is said to be in ‘hyperextension.’

As we are so often reminded, nothing in the body exists in isolation and the mechanics of any joint often display patterns inherent in the phenotype of the entire individual, on every level. In terms of a hyperextending elbow, there is a strong genetic factor involved and women are more likely to present with hypermobility, so someone predisposed to the condition will often see the same overbendiness in their mother’s elbows. Furthermore, the mechanics of the joints, crus of struts in a tensegrity structure, are largely dictated by the aggregate torsional forces distributed on a cellular level through the extracellular matrix (ECM).

Recent research points to molecular biology as the underlying flexibility factor, in that the number of fibroblasts present naturally within a particular human will dictate that body’s level of flexibility at large (Myers). Fibroblasts excrete collagen fibres into the ECM and thereby make the matrix more dense. Collagen is the most abundant protein found in the body and creates the density and strength in the more viscous connective tissues. The more collagen present in a given body system, the more structural integrity it has. Although a gross oversimplification, it would still be useful to understand that the the more flexible the body, the fewer fibroblasts it must have.

Ligament laxity, loose joints, overstretched ligaments, all these terms are often used in conjunction with hypermobility. Ligament weakness and cartilage deterioration leads to chronic pain in the following cycle:

  1. A ligament is damaged through overuse or trauma, such as a sports injury or an accident.
  2. Because of the ligament’s poor blood supply, it does not heal (unlike muscles, which have a good blood supply and heal quite easily).
  3. Over time, the injured ligament weakens, like a stretched rubberband that has lost its elasticity.
  4. Since ligaments function as joint stabilizers, the injured ligament is no longer capable of doing its job.
  5. As a result, the muscles must compensate. They begin to ache and spasm and, eventually, the joint or vertebra in the area begins to compensate as well.
  6. Overgrowth of bone occurs to help stabilize the injured ligament, which leads to arthritis, and a whole new level of pain and disability.

Good at Yoga

The disparity in flexibility levels across a given population has everything to do with molecular biology, ie, how collagenous each of the individual bodies in the room is comparatively. Flexibility is by no means a guage of a person’s aptitude for Yoga. In Yoga, on the most basic level, we are training our attention to respond to these variables with ever-finer levels of discriminative action. There is an unfortunate misconception that it is possible to be “good at Yoga” in the same way someone is good at skiing or crossfit.

The myth that being flexible equals “good at Yoga” has probably taken root in response to the omnipresent bombshell contortionists in lycra featured in the media as the manifestation of Yoga. A person’s level of flexibility is genetically predetermined and reinforced by lifelong habits. You can tell how “good” a person is at Yoga by how they have learned to control their hypermobility, or in the case of a more collagenous and therefore less mobile person, they become better at Yoga as they learn to breathe more fully into their dense cellular matrix.

If your ECM is more flexible, the struts in the structure (your bones) will be allowed movement greater than what is optimal for keeping your precious cartliges safe from the oblique forces that these struts present when allowed to move forcefully into extreme end ranges. In our example of Downward Dog, we are examining a very basic posture as a means of understanding why hyperextended elbows is a setup for injury; imagine the potential danger for a hypermobile person receiving an assertive adjustment in Supta Kurmasana!

Yoga teachers, beware: in our effort to take students deeper than they could go on their own, we owe it to them and ourselves to observe first and touch carefully, always guiding the student to root back into their bandha. Even the most experienced teachers will eventually realise that in the case of molecularly flexible people our efforts should be judiciously reserved to strong verbal cues and strength-building rather than taking legs further behind the head.

With regard to the elbow, a good Yogi is one who has learned to ‘microbend.’ None of these monumental displays of Yoga virtuosity involve getting the legs behind the head or binding in Marichyasana D. Some of the most impressive acts of Yoga are so subtle that we can’t see it happening from the outside.

For an eloquent discussion of how to teach Yoga to a hypermobile student, look to Jess’s practice blog post Hypermobility on the Mat. My intention here is to point out that flexibility is an anatomical factor in an equation that can be balanced through Yoga practice, in most cases, by tweaking the associated factors of strength, proprioreception, attitude, and vayus.

Vayus?

Yes, these “vayus” or “airs” of movement in the pranic body as described in Yogic principles can be thought of as directional forces governing actual bodily processes. The hypermobile phenotype has fewer fibroblasts, producing less collagen, which results in an ECM of a more watery constitution. As such, the physicality of the hypermobile body could be considered as energetically diffusive, thus an intelligent Yoga program for such a person would naturally consist not of “stretches,” but of integration-focused work to stimulate prana vayu and bring the practitioner back into the core and out of that 10 – 15% extreme end range of their joints.

Stronger and less flexible individuals will learn to increase the range of their pranic body through deeper breathing and more expansive movement that becomes more flexible as the body heats up. In contrast to the integrative efforts needed to balance the hypermobile body, the effort of continuously moving the body against its own natural resistance will create copious amounts of heat to aid the stiffer practitioner in safely breaking down the tightness inherent in their particularly collagenous ECM.

The vayu diagram gives the interested practitioner of Yoga a way of working with effort that stretches and integrates the ECM in a ratio that harmonises with its existing genetic qualities, history of injury, and frequency of practice. The tighter the body, the greater its need to raise prana and diffuse the heat from the inside out through the entire body. The comparatively loose practitioner will benefit from increasing samana vayu, practicing uddiyana bandha, and generally drawing energetically inward to create density.

the PRANA Physical Location Function Blockage results
Vyana (diffusive) peripheral nervous system, pervades entire body circulation, movement poor peripheral circulation, numbness
Udana (ascending) throat, upper chest, head thought, speech, exhalation, growth, nervous system cognition, communication
Prana (inward moving) heart, chest, lungs respiration, sensory perception heart and lung conditions, lethargy
Samana (equalising) navel digestion and metabolism; homeostasis digestive problems
Apana (descending) below the navel elimination, reproduction & childbirth, immunity
menstrual problems, sexual dysfunction, constipation, hemorrhoids

The Good Yogi

Yes, people at both ends of the mobility spectrum can and should use Yoga principles to address their mobility factors, and the first step is reconsidering the approach to basic postures such as Downward Dog. The Good Yogi is humble and seeks out a teacher who will keep them right on these tiny yet crucial points of alignment that can develop into nascent injuries. Without a teacher, practitioners might have to learn from their injuries instead. I am an example of someone who was for many years too stubborn to accept basic corrections to my Ashtanga practice, and paid the price in the form of knee surgery.

Wizened by experience and now grateful for my teachers, my advice to anyone asking if its safe to practice Yoga is yes, but make sure to choose your teacher wisely and then PAY ATTENTION. The language of Yoga is best appreciated in all its glory as a system of cultural metaphors handed down as experience from one body to the next, a lineage of personal wisdom that give us a means of examining scientific concepts through another lens. These connections ultimately broaden our understanding of what treatment is required for total healing regardless of flexibility.

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