Hypermobility Syndrome, AKA Joint Hypermobility Syndrome (JHS), Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT), Hypermobility Spectrum Disorders (HSD)

July 30, 2015

Yoga - a double edged sword in H-EDS/JHS

Yoga is one of the most effective system of fitness approaches to not just physical but also mental well-being. If you have H-EDS/JHS and suffer from chronic musculoskeletal pain, there is a likelihood of you gravitating to yoga at some point in your life to explore its curative claims. And if you are young as well, you will find yourself rather good at doing the difficult poses - fostering your belief that you are doing something good for your body and yoga will help your condition.

But a person with H-EDS/JHS is likely to do more damage than good to his body by yoga - not because yoga is bad for them but because they are more likely to be doing it wrong.

If you are already diagnosed with H-EDS/JHS, you will most likely know from researching what precautions to take while doing yoga. However, the trouble arises when you are not aware that you have H-EDS/JHS or isolated hypermobility of any joint (without H-EDS/JHS).

People with H-EDS/JHS have lax and easily injured ligaments, tight muscles, chronic pain, impaired body balance (due to poor stability* and poor proprioception**), dysautonomia#, frequent dislocations and injuries (which may require a longer healing time in this condition), and difficulty in building muscle mass.  [http://www.movingprayer.co.uk]

So when as a person with H-EDS/JHS, when you do yoga, these are the things that may act against your body:

1. You may be stretching your ligaments instead of your muscles to achieve a stretch or a pose
2. Your poor proprioception may lead you to overextend your lax joints without being unaware of it. 
You may be further damaging your lax ligaments by doing the postures in incorrect ways unless you have a yoga teacher who has expertise in yoga for people with hypermobility of joints and H-EDS.  
3. In a general yoga class, you may be under pressure to be able to do what others are doing. You might focus excessively on "flexibility" which to the untrained eye may mean the same thing as being able to do a pose and hold it for a long time. 

What you should do to get the best out of yoga if you have JHM/H-EDS/JHS:

1. Focus on core stability and core strengthening- the central axis of muscles that give us strength and balance. You may find slow and deliberate movements more beneficial than fast flowing movements, especially if you have poor proprioception or are at present in a deconditioned state (poor fitness). 
2. Do not stretch trying to reach as far as you can in a range of motion- top short of stretching to the max. Try not to pull our limbs out of the joints with posed that make you stretch and reach out - focus more on poses that need you to pull back in. 
3. Stop short of extending your knees and elbows completely. Do not do the poses that require contortion even if you can do them easily, especially so if you have tendency for subluxation or dislocation. 
4. Focus on poses that enhance balance and stamina. 
5. Do not do anything that does not feel right or causes pain. Do not try to hold the poses for a long time - it is not a sign of strength for you. Instead, focus on more repetitions. 
6. Good posture, good gait and good distribution of balance does not come "intuitively" for you - find a teacher who will focus on your posture and balance more than the complete poses. It may take you weeks to understand the body mechanism and balance to actually do the pose correctly, and thereby, reap its benefits. 
7. Do a little but do it daily. Consistency is more important than duration and quantity, especially during bad days/weeks/premenstrual exacerbation. If fatigue is a problem, it is better to do 20-30 minutes of yoga, three times a day, each time focusing on different types of exercises. 
8. In case of doubt, it is better to check with your doctor regarding the safety of an exercise. 
9.  Take into account what particular musculoskeletal/articular and extra-articular (not related to joints, other than musculoskeletal) symptoms or conditions you have and customize your regime of experiments accordingly. 
10. Focus also on other aspects of yoga - apart from postural exercises - meditation is immensely helpful if you have anxiety disorder as well. 

Recommended Reading:

I would highly recommend two resources if you have H-EDS/JHS and intend to begin yoga. 
1. Read this document - it is the single most valuable document for yoga with hypermobility syndrome. 
2. Essential Yoga: An Illustrated Guide to over 100 Yoga Poses and Meditation by Olivia H. Miller is a books that I find very easy to refer to when picking up different set of exercises - like those for balance or those for spine. 

~ ~ ~ ~
* In H-EDS, there is weakness of fascia - thin sheets or bands of connective tissue that look like membranes, that are present inside our bodies. Fascia attach, stabilize, enclose and separate muscles and internal organs. The fascia are made of collagen which is primarily defective in H-EDS/JHS- and therefore the fascia is weak in such cases leading to an inherent deficit of strength and stability. 

**Proprioception is a sense of position we obtain from sensory receptors in our joints - which is different to the position sense we get from our inner ear mechanism and visual cues. Proprioception lets us understand the position of our body in space and the orientation of one body part to another. It also allows us to perceive the range of movement in a body part and the degree of effort involved in carrying out a movement. Finally, proprioception lets our brain understand which muscles need to be switched on and which switched off in order for a movement to be made in the most economical way. 

#Dysautonomia may lead to low blood pressure causing you to feel giddy or faintness or a pounding heart especially on exercising; there may be inability to maintain body temperature or withstand heat.