Running with Hypermobility

Running with Hypermobility

In this article, I'm going to share what I've learned over the years when coaching runners with hypermobility syndrome. There are in fact a number of key considerations to take into account when coaching athletes with different degrees of hypermobility syndrome.

Running with hypermobility presents unique challenges, specifically when it comes to preventing running injuries. Hypermobile runners need an increased focus on exercises that improve joint stability and strength to remain free from injury.

In this article, I'll explain how I have worked successfully with hypermobile runners in the past. I'll also be suggesting some exercises for you to try for yourself...

running with hypermobility

Hypermobility - Too Much of a Good Thing?

It's fair to say that a certain degree of flexibility is important for any runner.

In fact, many of us runners struggle with issues that stem from a distinct lack of mobility and flexibility around key areas, such as the hips.

In both runners and triathletes, I find that lack of flexibility particularly becomes a problem around the hips and the ankles. I for one know this is something I need to work continuously on!

This lack of available motion can cause the body to compensate through other less desirable movements in order to find motion from elsewhere in the kinetic chain, in order to get through the running gait cycle.

The human body is fantastic at cheating and "finding a way" when it comes to movement. Often to its own detriment!

However, there is a significant population of athletes where the problem isn't too little motion being available, but too much motion.

Hypermobile runners certainly face their own set of challenges!

Runners who display a degree of hypermobility, have a greater range of motion available around many of their joints, which they have to control effectively as they run.

Test your hip stability with this quick exercise -> Glute March Exercise for Runners

The simple rule is that the more mobility a joint has, the more stability it requires.

These hypermobile runners present their own set of coaching considerations when it comes to training load and injury prevention.

The following is based on my coaching observations having worked with a number of hypermobile runners...

Physiotherapists (and anyone else for that matter) - feel free to add your thoughts in the comments section :)

Normal Flexibility versus Hypermobility

Some runners are more flexible than others, for sure. Just because you are more flexible than your training partners, this doesn't necessarily suggest that you are clinically hypermobile.

Somewhere in the region of 4-15% of the population are thought to suffer from the genetically inherited Hypermobility Syndrome (HMS).

The video below demonstrates the tests used to determine an athlete's Beighton Score.

Sports physio, Adam Meakins describes Hypermobility Syndrome nicely in a blog post (source) by stating:

It’s a syndrome that affects the connective tissue in our bodies, this is the stuff, the glue that holds our tissues and body’s together, it forms our ligaments, tendons, muscle, skin and most other things, there are different sub types and with hypermobility you have too much of a certain type and its disorganised in its structure, this is caused by a gene mutation and it is nothing that you can or could have prevented.

Due to this gene the connective tissue is very pliable or stretchy and so allows excessive movements of the body’s joints, this excessive movement and lack of control around a joint can then produce ‘arthralgia’ or joint pain believed to be from the shearing (side to side) forces that the joint experiences in day-to-day movements.

Challenges Faced By Hypermobile Athletes

I'm not going to get into the question of:

'What form of exercise is best for those with Hypermobility Syndrome?'... 

Needless to say, exercise is definitely the way forward compared to no exercise!

You will, of course, find that some forms of exercise are more or less stressful on the hypermobile body than others.

As this is a running blog, I'd like to focus more on what we as coaches and therapists can do to help hypermobile athletes become more resilient to the rigours of running.

Nine times out of ten, in my experience runners will run - hypermobile or otherwise.

'Don't run' is rarely an acceptable long-term solution!

Having coached a number of athletes diagnosed with various degrees of hypermobility syndrome, there are a number of common issues I've noticed.

The good news is that if their training is adapted to take into account their HMS, their ability to train and compete successfully is noticeably improved.

1. Impaired Joint Proprioception & Control

When any athlete suddenly finds an increase in the available range of motion at a joint, for example as an acute effect of PNF stretching around the hip, sometimes they find that they lack the neuromuscular ability to maintain dynamic control throughout this newly increased range of motion.

In the short-term, until their body learns to control the new range, they struggle with proprioception and control at the joint while working through 'new' ranges of motion.

Now imagine this going across many joints throughout the body. All the time. That's how I (without HMS) try to describe the proprioceptive and neuromuscular control challenges faced by athletes diagnosed with HMS, based on their feedback.

Where many non-HMS runners will need to spend time on range of motion exercises (various forms of stretching) - HMS athletes will instead need to spend time learning to control the often huge amounts of motion they already have.

Proprioception exercises for hip, knee and ankle

Proprioception exercises for the shoulder... for swimmers and triathletes

2. Flawed Movement & Muscular Activation Pattens

I've noticed that hypermobile athletes have an outstanding capacity to 'cheat'.

Not in a Lance Armstrong kind of way, of course - but the 'using all the wrong muscles for a given exercise' kinda way!

I'll often find that in comparison to most athletes, those with HMS will find it difficult to feel the correct movement and muscular recruitment pattern. Their intrinsic feedback is often pretty poor. However, it seems to be a simple case of finding the right combination of cues and appropriate exercises to establish good firing patterns. The key is that the athlete needs to feel what it is to move with the correct pattern, and the correct muscles firing.

Athletes can often find a way to trick you into thinking that they're doing the exercise right, by 'going through the movements'. An important lesson learned by all new coaches or therapists at some point.

The point is that HMS athletes seem particularly good at this... and require constant attention initially to get the feedback going!

An example of coaching a simple Glute Bridge focusing on maintaining lumbar and pelvic position - rather than compensating through allowing excessive lumbar extension:

The Glute Bridge is a pretty obvious choice as an example - and a very basic exercise - but one I see performed badly on a far-too-frequent basis.

If our athletes can't get the patterning right here, who can we expect them to squat, lunge, swim, bike and run well?!

3. Muscle Activation Before Running

While this advice clearly isn't restricted to hypermobile athletes, I've found that in many of those I've coached with HMS have benefitted greatly from getting into the routine of activating key running muscle groups before each running workout.

Routines like this pre-run glute activation sequence are great for priming key muscles before you run.

4. Should Hypermobile Athletes Stretch?

It would be all-too-easy for me to come out with the generic advice of telling hypermobile athletes not to bother stretching - as they have more than adequate range of motion.

On the whole, I'd stand by that advice, as strength and control must be the priority in HMS athletes.

Of course, there will however always be the occasion where stretching a certain isolated area may be beneficial for a given acute or chronic complaint - take advice from your physiotherapist on this one...

Take Home Messages

Athletes with hypermobility syndrome need to spend significant time training their body to control the extra motion they have available to them. With mobility must come strength through-range, neuromuscular control and stability.

Often hypermobile athletes require increased input and feedback to establish good movement patterns and feel the correct firing patterns.

From Twitter!

As I was putting this post together, these tweets came in...

Ellis and Jeff together sum it up nicely :)