Hypermobility on the mat: some pointers for teaching yoga to people with Ehlers Danlos / Hypermobility Syndrome

hypermobilityThese suggestions for working with yoga students with Ehlers Danlos / Hypermobility Syndrome (ED / HMS) are written in response to the many requests for help and advice I receive from teachers of hypermobile students. They are neither exhaustive nor gospel. They are personal experience rather than expertise. I have been practising yoga with Ehlers Danlos (Hypermobility Type) since 1981 and have experienced many different attitudes and approaches from teachers. In the last decade-and-some, I have also been fortunate enough to teach many students with hypermobility.

While teachers with a normal mobility range are sometimes, understandably, anxious about how to work with hypermobile students in a beneficial way, most of the principles for teaching hypermobile people are also good practice for working with all students, so hypermobile people are easy to integrate into a general yoga class. Individual techniques for individual postures are outside the scope of this writing, but pretty much any principle for alignment and physical integrity you have learnt is potentially a great tool for hypermobile students. Feel free to use it. The following are some general possibilities to explore.

• Many beginning students share the popular view of yoga in our culture as the cultivation of flexibility. Frame physical practice as a movement towards balance and integrity. For some students this will mean working on strength and stamina; for others it will mean focusing on loosening restrictions in fascia and muscle. This approach will also serve your stiffer students, who may feel that they are ‘bad’ at yoga because they are not flexible.

• Guide hypermobile students to release (micro-bend) the insides of their elbows and the backs of their knees so that they are not supporting themselves by ‘hanging’ in their joints.

• If you are familiar with spirals, use them to guide alignment – as far as I can tell, it is impossible to spiral correctly and hyper-extend knees and elbows.

• Guide students to draw their limbs into the sockets rather than pulling them out. The general principle is to draw back into the centre rather than extending to the extremities. If you teach a vinyasa style, bandhas are key here – and generally very helpful for hypermobile people.

• In a hypermobile body, overworked and very flexible muscles often compensate for tight, contracted ones. Look out for this and suggest ways in which the student might rebalance, by stretching the tight places and strengthening the over-extended ones.

• Hypermobile people, by definition, have difficulties with proprioception, the ability to sense 1) the position of one’s own body in space, 2) the orientation of one body part to another, 3) the range of movement in a body part, 4) the degree of effort involved in carrying out a movement, and 5) which muscles need to be switched on and which switched off in order for a movement to be made in the most economical way. At the same time, many hypermobile people (particularly those who are also autistic) also have heightened interoception – awareness of stimuli arising within the body – and so may be receiving an overload of other sensory information. Be mindful of the potential for labelling sensation-sensitive students as hypochondriac or self-dramatising because they are registering somatic experience in a range that for the teacher is under the radar.

• A hypermobile student may find it helpful to have something to push into – this provides greater proprioceptive feedback and de-emphasises extending the joint as the main action. For example: ‘Press your elbows into my hands’ (to work with hyper-extending elbows in downdog), or ‘Press your shin up into your hand’ (to work with a hyper-extending knee in utthita trikonasana).

• Educate students about edge as a range of possibilities. Because of the limitations in their proprioceptive ability, hypermobile people may need guidance to be able to feel the softer edges on the spectrum. If a hypermobile student consistently chooses a hard edge, be aware that this may be because it’s the only edge they can feel, rather than concluding that they are an aggressive practitioner.

• Be prepared to adjust the hypermobile student’s alignment, in the same place, in the same way, again and again. Because of the proprioceptive deficit that is integral to hypermobility, most hypermobile students will need to feel the new alignment many more times than a non-hypermobile student in order to embody it.

• Offer only one verbal / physical adjustment at a time, even if there may be many things in an asana that you feel need attention. Proprioceptive challenges, together with interoceptive overload (which can act as a kind of interference), make it difficult for hypermobile students to integrate multiple or complex changes into their body and they will quickly get overwhelmed by too much information.

• Refer students to the internal – energetic, somatic, psychological – dimensions of yoga. Remind them that the intention of physical practice is to create a simulacrum for life, in which our habitual patterns (samskhara-s), so naturalised as to be transparent to us, can become opaque, and once visible may be worked with consciously. Physical practice is simply an opportunity in which yoga may occur; it is not itself yoga.

• In making physical adjustments, focus on helping the student to feel the dynamics of the posture rather than increasing the amount of stretch in it. Adjustment focused on stretch puts hypermobile students at high risk of injury.

• Be aware that wide range of motion is only one aspect of hypermobility and that ED / HMS is one of a group of overlapping conditions. A hypermobile student may also be experiencing:

Dyspraxia.
Dyslexia.
Dyscalculia (difficulty with numbers and sequences).
Dysautonomia / POTS (disregulation of the autonomic nervous system: so they may feel faint coming up from head-down postures, and dizzy in head-back postures).
Fibromyalgia / chronic pain.
Chronic fatigue / general need for more rest than usual.
Irritable Bowel Syndrome.
Eating disorders / self-harm.
Higher than usual rates of anxiety / a sensitive nervous system that easily gets stuck in fight, flight, freeze / low-level PTSD.
Austism Spectrum Disorder / Asperger’s Syndrome.

• Be aware that while developing strength is desirable for hypermobile people, ED / HMS is a genetic condition of the collagen. While muscle strength can compensate to some degree for lack of tensility in the fascia, it can never create the kind of stability that is inherently present for non-hypermobile people (i.e. people with normally coded collagen). This compensatory form of stability is not automatic and must be consciously turned on and maintained. For this reason stabilising their body can be physically and mentally exhausting for hypermobile people.

• Know that yoga is very often not easy for hypermobile people. In fact, ED / HMS presents many additional challenges in asana work. These may include chronic pain, difficulty in stabilising the body due to lack of fascial support, limitations in proprioception (which, together with stability issues can make balance very difficult), dysautonomia (which may cause faintness, dizziness, a racing heart and unusual fluctuations in body temperature), frequent dislocations and injuries (which may require a longer healing time in a hypermobile body), and difficulty in building muscle mass.

• Avoid framing the holding of a posture as a feat of endurance. A hypermobile student may lack the fascial tensility to hold a standing posture for what would be a normal period of time for other students, even when they have good muscle strength. Holding beyond their comfort range may not increase the student’s stamina but may cause muscles to go into spasm, and tendons, ligaments and fascia to become inflamed and over-stretched.

• If you teach a yin style, be aware that for some hypermobile people an optimal yin stretch may be one to two minutes, and extending the hold time may result in damage to tissues. The appropriate duration will vary from person to person, and for the same person in different postures. Encourage students to track their own edge and emphasise that it is always OK to come out of a posture. The optimal hold time is not five minutes but when you feel ‘cooked’.

• Be extra-mindful of your own projections. Hypermobile students sometimes receive projections related to the teacher’s own desire to be flexible, and may be inappropriately praised or criticised as a result. Remember that hypermobility is not something that the student is doing; it is something that they are being. There is no choice or agency involved in being hypermobile; it is simply a genetic condition.

• If you are teaching a student who regularly dislocates (and may also be able easily to put themselves back in joint), keep teaching towards stability and avoid communicating any sense of fear or horror you experience in response. Be aware that this kind of dislocation is an everyday occurence for some hypermobile people and for them may not be a big deal.

• If your student is not aware that they have ED / HMS, it may be helpful to let them know that you cannot diagnose, but that you think they may be hypermobile. Many beginning hypermobile students struggle enormously with balance and stability, and may be having other unexplained health problems. It can be very useful for them to know that there is a reason for this. Explain simply and without drama, and offer as much information as they want to receive. For some students this will be a lot, for others little.

• Offer help to stabilise, strengthen and align the student’s extension rather than asking them to pull back out of it (or not to go so far). This way you are offering them something more rather than taking something away. Most students will be responsive to this approach.

• Be aware that for all sorts of reasons, hypermobile people do need to stretch. We all do. Unstressed tissues are degenerating tissues, and many hypermobile people have some muscles in a state of chronic contraction.

• If you teach an aerobic form of yoga, be aware that for people with the, less common, vascular type of ED / HMS and Marfan Syndrome (forms of hypermobility that also affect the heart and circulatory systems), aerobic exercise may be contraindicated because it can place too much stress on fragile tissues in the heart, veins and arteries and may lead to heart attack. Whereas many people with ED / HMS are unaware that they are hypermobile, those with vascular type and Marfan Syndrome are most often already diagnosed. This is because ED/ HMS runs genetically true to type, so it is likely that there have been instances in their family of early heart attack without the usual indicators of coronary disease (for example, a relative with low blood pressure, low cholesterol and a normal weight who had a heart attack in their forties). Talk to these students about the upper range of heart rate they have been advised by medical professionals to stay within and if necessary guide them to slow down and pause during any potentially aerobic sequences.

• If your student is an experienced yogi, by all means offer suggestions for change, but be mindful not to sweep in and reconfigure their practice for them. Remember that the practice is the student’s. Because of the proprioceptive deficits involved in hypermobility, most hypermobile people receive limited information about where they are in space and where their body ends. As a result, control over their own body may be an issue for them and they may feel threatened by any suggestion that you are trying to take over. If your student appears resistant to your suggestions, consider this as a possibility and explore how you could work with them more collaboratively. A style that supports what they already know and adds value to how they already practise will generally be well received. Be aware, too, that hypermobility sometimes attracts a surfeit of technical imput. You may or may not be giving the experienced student something new. Enquire and offer rather than impose.

• Some people with ED / HMS are housebound wheelchair-users, others are elite dancers, gymnasts and circus performers. In a yoga class, some hypermobile people will easily be able to enter physically challenging postures and will travel swiftly through progressive yoga practices such as astanga vinyasa, becoming adept practitioners of advanced series. Others will be dogged by injury and chronic pain. One possible reason for this disparity is that ED / HMS is in fact not one but a group of many different genetic variations in the collagen. As genetic testing becomes cheaper and easier to carry out, more of these variations are being identified. Avoid evaluating hypermobile students on their physical performance. An ED / HMS student who is often injured may not be weaker or more pushy or more inconsistent in their practice than another who sails easily through increasingly more challenging sequences of asana. They may simply each have a different genetic variation in their collagen.

In general, hypermobile students try really, really hard, love working with their body and are a joy to teach. Trust your instincts, and honour and enjoy this opportunity to explore together.

I offer occasional workshop days on ED / HMS for (non-hypermobile) yoga teachers and for hypermobile yoga practitioners. For more information see http://www.movingprayer.co.uk or email jess@movingprayer.co.uk.

For general information about  ED / HMS see:

A Guide to Living with Hypermobility Syndrome, Isobel Knight, Singing Dragon, 2011.

‘Living with Hypermobility Syndrome’, Rebecca Allen: http://www.huffingtonpost.co.uk/rebecca-allen/living-with-hypermobility-syndrome_b_3379363.html.

A teaser for a documentary on ED / HMS by Lara Bloom – a really good five-minute introduction: http://www.youtube.com/watch?v=Y59bpnqeTUM&app=desktop

The Hypermobility Syndrome Association (UK): http://www.hypermobility.org

Ehlers Danlos Support UK: http://www.ehlersdanlos.org

The Ehlers Danlos Foundation (US): http://www.ednf.org

Ehlers Danlos Syndrome Network CARES Foundation (US): http://www.ehlersdanlosnetwork.org

The National Marfan Foundation (US): http://www.marfan.org

If you think you may be on the autistic spectrum …

… these are useful – and realistic (i.e. recognised by actual autistic people) – listings of characteristics. They are geared to women (who often go unrecognised), but also describe many autistic men:

Females with Asperger’s Syndrome (Non-official) Checklist’, Everyday Asperger’s, Samantha Craft.

Aspienwomen: Adult Women with Asperger Syndrome: Moving Towards a Female Profile of Asperger Syndrome’, Tania Marshall.

This entry was posted in (Dis)ability, Astanga vinyasa, Autism, Beginners, Body, Hypermobility / Ehlers Danlos, Teachers, Yoga and tagged , , , , , , , , , , , , . Bookmark the permalink.

33 Responses to Hypermobility on the mat: some pointers for teaching yoga to people with Ehlers Danlos / Hypermobility Syndrome

  1. Me parecen muy acertadas las recomendaciones y observaciones sobre la práctica de âsanas, en los practicantes con hiperlaxitud. Te comento dos cosas que según mi experiencia han ayudado a los alumnos: la primera es el uso de las cintas elásticas, y la otra los trabajos de fortalecimiento de los tendones con ejercicios de resistencia.

  2. Anna says:

    As a hypermobile person, (and teacher and ytherapist in training), I can attest to the fact that hypermobility can get you into trouble. I’ve had a “dead zone” from a chronic overuse injury years ago that kept me from feeling the right-most edge of my body (from pinky toe to pinky through the right ear). Proprioception difficulty indeed.

    Retraining my body has been one of the greatest gifts of inquiry I’ve ever had… Viniyoga was needed to cool out my Bikram-oriented type A max it out practice. I really really appreciate your post!

  3. Great reading and well thought out article. I had a client last year that had this issue. I was besides myself when she just flopped into pigeon pose. Using words like integrity and hugging the bones she could not comprehend. Engaging the muscle she understood. On a personal level she was very tight with her time and I was more relaxed. I found this an interesting paradox. She was struggling with boundaries in her relationships and yet no boundaries in her body. Vinyasa flow was very difficult. Since she had no interest in yoga breathing, spirituality or mindfulness we parted. She moved on to weight training. I learned so much from this article. This can be a complex and serious dis.ease. Namaste’

    • jessglenny says:

      Thanks for commenting. In my view, HMS / ED is not a disease. It is just a different kind of collagen, which means that people with it have some different experiences from people who don’t have it. Personally I don’t consider myself ill.

      • Thank you for this clarity Jess.

      • Sandra says:

        I didn’t consider myself “ill” most of my life but I am 70 and the last couple of years have been difficult. I am trying to see EDS as a ‘condition’ and put myself in a place where I can accept the things I can’t change, and work with whatever I can. I still don’t perceive myself as ‘ill’ but I have to accept that to a certain degree I have become increasingly disabled. I have been doing yoga for the past 15 years — the last two years a restorative Iyengar class. It helps with strength and stability — but I am never going to be ‘cured’.

  4. Donna O'Neil says:

    I have hypermobility in parts of my body, but have aged to have arthritis in some of them. It’s only after 25 years of practice that I have learned to stabilize my lower back, which was always a source of trouble for so long. It no longer hurts. I had no idea that this syndrome could be linked with the other symptoms you mentioned, some of which are true for me. Amazing. I want to learn more.

  5. karina hosking says:

    I wish I could have given this to my severely hyper mobile daughters teachers, when she was as school! They thought we were being ridiculously over protective!

  6. Robbie Hollingsworth says:

    hi there,
    I just started yoga and am quite hypermobile. My biggest problem is in the knees, when the teacher says “lock your knees” for me that invovlves a 10 degree hyperextension, and i find it very hard to do a lot of the poses involving standing on one leg as it is very uncomfortable. there is no stability in my knees and they are wavering back and forth..

    • jessglenny says:

      Hi Robbie. I assume that you’re practising Bikram, as this is the only style of yoga I’m aware of in which students are taught to ‘lock the knees’. Most teachers advise that you keep the backs of your knees slightly soft, which if you are hypermobile will mean that they may be quite significantl bent to maintain alignment. If you lock your knees, you will not be activating the muscles designed to stbilise your knees, muscles which may already be under-active in somene with hypermobility. You will also be stacking your bones in such a way that your whole skeleton is out of kilter.

      • Robbie Hollingsworth says:

        yes it is bikram – and I don’t follow those orders as I know intuitively they simply don’t work for me! Thanks for the tips. I signed up for 1 month of bikram and find practising in the heat really helps but I’m sure there are other programs that definitely suit me better, which I will look into once the month is up!

        If you could tell me a few poses i could work on in my own time to help with knee instability that would be great!

        also forgot to mention that I really enjoyed your blog post and it’s great to here there are teachers out there that know how to work with hypermobility and can also practise themslves with it at a high level!

        thanks,
        robbie

  7. jessglenny says:

    I would need to work with you in person to suggest useful postures. It’s not so much what as how. It sounds like a good idea to explore different approaches. Good luck with your practice!

  8. Jac Nicole says:

    You don’t think ED is a disease? I just lost all hope in using this article as a helpful tool. I’m sure my friends who are getting brain surgery and having consistent strokes and seizures could convince you otherwise. I’ve practically lived in the hospital the past decade due to the complications of my EDS. It causes all of my friends with this syndrome MUCH dis-ease. It’s wonderful you aren’t ill. The group of inherited disorders causes most sufferers of EDS plenty of discomfort and are constantly ill. I don’t think it’s beneficial to denounce EDS as not being a disease for the awareness that is needed here.

    • jessglenny says:

      I find the words ‘disease’ and ‘ill’ disempowering. They belong to a medical model that hasn’t been helpful to me. When I understand my physical experience as just that, just more experience, however it manifests, I have the capacity to work with it, to be in it without becoming it. I have body experiences as a consequence of HMS / EDS that a doctor would probably classify as ‘medical’, but I’m not interested in that paradigm. I find that it defines me without serving me.

  9. Jac Nicole says:

    I can understand that in regards to your own experience and how you choose to see it, but it can be very misleading when you are attempting to teach and bring awareness to this cause and then say it isn’t a disease. I have been unable to walk for three weeks to the day due to my complications. I have friends who have life threatening vascular conditions. I know of a family who has lost four members within the past few years due to strokes from EDS. I do not think it’s helpful for us for you to misinform people about Ehlers Danlos Syndrome. Your experience and the validity of EDS being a disease should be two separate issues. I feel as though you are harming and misrepresenting this for the rest of us.

    • jessglenny says:

      This blog is about my experience of movement practice. Personally, I don’t find the medical model of hypermobility helpful. If you do, that’s great. I’m happy that it’s helping you. Please feel free to trust your own experience rather than mine and to ignore anything I say if it doesn’t work for you. I’m not here to speak for anyone else. I’m not an expert or a representative; I’m a hypermobile person speaking out of my own experience of practising and teaching. This is the truth as I have felt it. The intention is not to minimise the seriousness of the repercussions of HMS / EDS for anyone who has it, but rather to view HMS / EDS within a different paradigm. If I see myself as the victim of a disease, I feel trapped, damaged and powerless. I personally find that a paralysing situation. I prefer to choose forms of understanding that allow me movement and capacity for change within an acceptance of what is. Thanks for commenting.

  10. Jac Nicole says:

    You can have a disease and not be a victim of it. I am not trapped, powerless or damaged because I admit that I have a disease. I disagree and think it’s very damaging for the rest of us when you claim that EDS is not a disease. Nothing forces you to feel powerless, but your own mind. I am not a victim of my illnesses and I don’t let them define me or depict how I view myself. I don’t think educating people of EDS and saying it isn’t a disease isn’t helpful for anyone including yourself. THANK YOU for misrepresenting this issue for the hyper mobile and Ehlers Danlos Syndrome community. I’m glad it makes YOU feel better to create more difficulty for the rest of us. How helpful of you!

  11. KT says:

    Jac Nicole – It seems as though you are misinterpreting this article for a medical journal rather than tips for yoga teachers to consider when they may come across hyper-mobile students. The author is merely expressing her subjectivity towards the damaging personal and social connotations and stigma that a word such as ‘disease’ holds. She quite obviously states that it is in her ”her view” that it is not a ‘disease’. It is great to hear such a freeing attitude in life much needed in our society (see Ted talks below). A great post and very enlightening, Thank you Jess.

  12. Dace says:

    A very big thank you for this post! As I delve deeper in to yoga, I am continually learning. Yet I find little discussed about HMS. Many of my joints are hypermobile. As a student, I am learning that some teachers provide verbal cues which are able to bring me in to the asana without going down the familiar hypermobile route. I love it! A whole new perspective and experience!
    I am definitely bookmarking this post!

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  14. YogaMeli says:

    As a yoga teacher, with HMS, I thank you for this article. I even posted a link to it on my own website. I wish I had met teachers with HMS experience, when I first began a yoga practice almost 20 years ago. Luckily, I did, when I met my first teacher trainer, and she changed my practice and taught me to help others with similar joint openness.
    I recently underwent bilateral arthroscopic knee surgery, to repair damaged cartilage to both my knees, due to a lifetime of going too far and too deep into my hypermobility.
    Thank you so much for helping to bring awareness to this.
    ~Melina Donalson

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  18. Nona Rutter says:

    Thank you for sharing this critical information. I’m in my 60’s, hypermobile and a long-time yoga practitioner. Have returned to doing a home practice solely and not going to yoga classes. I’ve always believed in the value of one’s own practice but have also learned a great deal from several excellent teachers. What I’ve realized, however, is how difficult it is for an instructor to modify class to suit so many body types. And, it took me many years to learn to not listen to instructions that would be useful for people who were “stiff” but totally wrong for my overly flexible joints. I also recognize that classes activate my tendency to push too hard into poses that may not be appropriate at that moment. Since yoga is truly about awareness and joining spirit with body/mind, doing one’s own practice is an excellent way to truly listen to that still small voice within and to let it guide the practice.

  19. Cath Kilner says:

    Wow! I just clicked on your article from Matthew remski’s blog and had a real penny drop moment. I have been told by a physio before that I have hyper mobility in my spine. I’m not sure if this makes me hyper mobile or not but I felt as though your article was written just for me. Especially what you wrote about not having awareness of your body. I sometimes feel myself at a low point as I do try practicing yoga to help alleviate pain in my back. I have recently just become really confused about whether yoga has been contributing to the pain all this time? I have cut back on the yoga and tried to walk every day …again it is like I do not understand what is going on. My other issue is that I live in a remote community where i am the only yoga teacher so do not have a teacher that can help me regularly. Perhaps I need to try clinical Pilates or something more subtle! Thank you for giving me another perspective on this. Perhaps I will try looking into the other links too!
    Cath

    • jessglenny says:

      I’m glad it was helpful Cath. I’ve found the great gift of a complex body is that it offers much greater potential for learning on all sorts of levels. Good luck with the journey!

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