Last week when I laid out my 2017 goals and aspirations, I was firm in my decision to stick mostly to road running with a little bit of trail running sprinkled in here and there. Today I’m here to tell you why. On Monday I told you about my arthritis diagnosis. But the fun doesn’t stop there. I’m also hypermobile — which, as it turns out, is not ideal for runners.
Special Considerations for Athletes with Hypermobility
What is hypermobility?
Hypermobility occurs when joints stretch further or are more flexible than normal, resulting in excessive range of motion for that particular joint. Possible symptoms may be mild and include joint or muscle pain. But other symptoms can be more severe and include sprains, tendinitis, or bursitis. Hypermobility is also known as being “double jointed.”
Hypermobility is fairly common — affecting up to 25% of the population.
Why is it bad?
Many people with hypermobility never even know they have it as it never poses any problems. But for runners it could lead to chronic injury if not addressed properly through exercise and strength training.
Truth: when I was first diagnosed with hypermobility and psoriatic arthritis back in September, I didn’t take it seriously. But after the research I’ve done and taking a look at my injury history, it’s like dominoes falling into place. It’s literally all starting to make sense.
As I’m still working my way through this diagnosis, I’m realizing there is still so much I don’t know. The more research I do, the more I’m learning, but to be completely honest there isn’t much out there. What I do know is this:
Strength training is paramount
Hypermobile runners (and athletes in general) have an exaggerated range of motion which can lead to muscle imbalances and injury. Strength training properly (I’ll come back to this) is key to keeping injury at bay.
Hypermobile runners have reduced levels of proprioception
Proprioception is the body’s ability to sense joint movement and position in relation to the rest of the body. Hypermobile runners tend to have a reduced sense of proprioception and are therefore predisposed to injury due to miscalculation or lack of balance. Let’s get back to strength training.
Potential issues with strength training
Strength training is important for all runners and athletes. Most people can learn how to do a squat and a lunge with relative ease. But those affected with hypermobility and reduced levels of proprioception can end up misjudging range of motion during strength training. In other words, your squat may be flawless. My squat may appear flawless as I mirror yours, but since I can’t tell that I’m moving in a weird direction, I would never know if I was in a wrong position until it was too late. Make sense? The biofeedback available to runners with hypermobility can be severely lacking — and sometimes even flat-out wrong.
There have been many times over the last several years I would be in the middle of a squat or lunge and feel something not quite right in my knee, for example. Rather than continue with said exercise, I would end up stopping early. In retrospect that was the best thing I could have done. But the fact that my joints and ligaments are loose enough that I couldn’t tell I was doing something wrong until it hurt is not a good thing.
Therefore, not only do hypermobile runners need to be diligent with strength training, they need to make sure they’re doing the exercises correctly in the first place. That means taking the time to get into the proper positioning and not overdoing it.
Stretching and Yoga
I rarely experience tightness to the point that I feel I need to stretch after a run. And I’ve always been fairly flexible. Runners that are hypermobile are often encouraged not to stretch as it can lead to injury in an already injury-prone person.
Strength-based yoga, however, seems to work incredibly well — at least for me. In my experience, I’ve learned to hold poses and work on strength in a gentle and effective way with strength-based yoga. I’ve never experienced the random pains of stretching a limb too far like I have with regular strength training. Strength based yoga also helps immensely with balance and helps guide you into the correct poses in effect allowing you to use the correct muscles.
Road v. Trail
Trail running is not recommended for an extended period of time for runners with hypermobility. Trails are a great way to build muscles and train your body in new ways — you use similar (but different) muscles on trails than on roads. But there’s also a lot of jostling and uneven terrain to contend with over the course of a trail run. For those determined to run trail (like myself), it is advised to start slowly — just a mile or two here and there — and to also really work on your proprioception. That means slow and steady is the way to go: just because you can run a road marathon does not mean you can tackle a trail half. Sure, the distance may be half of what you’re used to but the terrain and jostling of ligaments and limbs is not.
Injury Due to Muscle Imbalance
One of the most frustrating things I’ve experienced over the course of the last two years has been injury after injury. First it was my IT bands, then it was shin pain, then it was ankle issues, and finally strange foot pangs. It’s been incredibly irritating to deal with if you want the truth. But knowing what I know now, I realize the hypermobility — and perhaps even the arthritis — is what has been plaguing me all this time. Even the slightest muscle imbalance coupled with the hypermobility could easily be responsible for the ripple effect of injuries I’ve experienced.
Back to my third point above: Strength training is key. In order to keep hypermobile ligaments in the correct position and prevent injury, making sure the surrounding muscles are strong and stable is the way to go.
If you think you suffer from hypermobility, it’s best to get it checked out by a healthcare professional. There are a few tests that may be administered (namely the Beighton score and Brighton criteria) to determine your hypermobility — but don’t worry, they don’t hurt! If you’re found to have hypermobility you may be prescribed physical therapy or your case may be mild enough to treat at home with proper exercises and balance poses.
Above all else, every runner is different. As a general rule of thumb: What works for you may not work for me and vice versa. It’s of utmost importance to listen to your body and respect rest days and strength training days. Don’t put yourself through the ringer and risk an avoidable injury. Get plenty of sleep, eat well, and maintain a healthy weight.
I’m certain I’ll circle back to this topic again in the future as I’m slowly working through this diagnosis. The more I learn, the more I want to share. I’m sure there are other runners out there like me that appreciate the information.
I may not be running as many trails as I hoped through 2017 but I’ll be damned if hypermobility and arthritis will rule my world. I just know I need to be careful and attentive going forward. Baby steps, people.
TALK TO ME!
Did you have a friend in childhood who was double-jointed (or could do the splits?)
Tell the truth… do you strength train diligently?
Do you have any questions about hypermobility? I’ll answer as best I can.
For another great post on this topic, check out Lisa’s post from Mile by Mile.