Many of our patients with Hypermobile Spectrum Disorder (HSD) or Hypermobile Ehlers Danlos Syndrome (hEDS) have been told not to stretch, that stretching will injure joints that may already have excess mobility. However, stretching is not something to avoid. Whether the joints are hypermobile or not, stretching is beneficial as it improves blood flow to muscles, which helps deliver nutrients to tissue, and aids in recovery. Not only that, but having hypermobile joints does not always equate to overly flexible muscles. In fact, many people with HSD/hEDS experience muscle stiffness, particularly after age 40. Short and tight muscles, which are prone to injury, can negatively affect posture and joint alignment, which can in turn lead to joint pain and subluxations. Take the iliopsoas muscle for example. The psoas is a paired muscle (one on each side) that is responsible for hip flexion (bringing the knee to the chest), standing upright, and contributes to spine and pelvic stability. A short and tight psoas often can contribute to low back pain by pulling on a hypermobile lower spine, resulting in misalignments and pain. Another tight muscle that impacts posture in many of our patients is pectorals, in the upper chest. The pectorals are responsible for pushing motions and several shoulder movements. When the muscles here are tight or hold too much tension they often pull the shoulders forward and contribute to shoulder subluxations. I’m sure a lot of you can relate to this one! Muscle guarding can also be a concern with HSD/hEDS as it is often the way the hypermobile body protects itself.
Not only is stretching helpful for muscles and joints, but stretching helps the body relax, which means better nervous system regulation. When the body becomes accustomed to muscle guarding this can dysregulate the nervous system and result in sympathetic overload, or too much time in “fight or flight” mode. Stretching accompanied by mindful breathing can initiate the parasympathetic nervous system, allowing the system to spend more time in “rest and digest” mode. Don’t underestimate the power of sympathetic overload. It can cause poor sleep, contribute to poor digestion, anxiety, decreased immune function, and contribute to high blood pressure.
The way you stretch is important when you have a bendy body. Passive stretching is often where things go wrong. Flopping into pigeon pose might feel great, but it can put a lot of force on the pelvis and potentially sacroiliac joints (SIJs), which connect the spine to the pelvis. uMis-aligned SIJs can result in low back pain, hip pain, and instability. A similar stretch that is safer for the joints is the 90/90 stretch. (see link below). This pose is more active and helps avoid overstretching that can injure the hip or pelvis. Good rules of thumb when stretching are: only seek mild stretch, rather than a deep stretch, and keep the stretch active by engaging the opposing muscle (see example in link provided below). Seeking a deep stretch and going to end range can cause injury. The muscle might have stretched as far as it can, but the joint will continue to bend. Engaging the opposing muscles helps to keep the stretch in the muscle, rather than pulling on hypermobile joints. For example, when stretching the pecs, sometimes they are so tight that we bypass the muscle, but the shoulder can take on the extra movement. It might feel good at first, but it’s best to avoid putting extra strain on tendons and ligaments that are already too stretchy. Here’s a LINK to a video demonstrating the difference between active vs passive stretching.
For those of you with hEDS who struggle with tight muscles or overall tension, there may be a fascial component as well. Fascia is a sheath of connective tissue that wraps around muscles, nerves, organs, and bones. Fascia is elastic and should stretch with you. If it is tight, it can restrict movement and cause pain. Fascia is made predominantly of cells called fibroblasts which give fascia its elastic quality. In addition to providing support for the body’s structures, fascia aids in wound healing by contracting. When it takes on its wound healing role, it converts some cells to myofibroblasts. Myofibroblasts have the ability to contract the fascia, limiting stretch and lengthening. This is helpful for closing wounds as they heal but not helpful if the contraction is not needed. Normally, after healing, the inflammatory response ends and the cells then convert back to fibroblasts. However, in people with EDS and inflammation, the fascia develops an abundance of myofibroblasts that prevent the fascia from gliding as muscles contract and relax. The fascia can adhere to the muscle tissue, resulting in feelings of muscle tension and pain. The reason for this abundance of cell conversion is not yet clear, but is suspected to be related to mast cell activation syndrome/over active inflammatory signaling. This is an important new development in EDS research. If you would like to learn more about this research, you can watch Dr. Wang’s lecture at this link on YouTube. This research reinforces the importance of fascial stretching and release for people with EDS/HSD and inflammation.
The body is a complex system that is highly individualized. Universal directives often don’t serve everyone, and as you know, zebras aren’t the same as horses. What works for the horse doesn’t always work for the zebra, and what is helpful for one zebra isn’t always helpful for another in the herd. The good news is that Good Health is here to help you on your journey to find what works best for you.
Written by Jennifer Oechsner PTA
