Issue #409 – Wednesday, September 13, 2023
Common Myths About Working with Hypermobility
Part II
by Gwen Miller
In Part 1, I looked at some common beliefs in the fitness industry about hypermobility. Now in Part 2, I will share some techniques that may be effective when working with people who have hypermobile bodies. Before we get into the specifics, we need to acknowledge that hypermobility is a spectrum, so different people will have different needs.
I have found that closed-chain isometrics and proprioceptive-rich environments provide an effective starting point for sessions to prepare a person with a hypermobile body for movement.
Proprioceptive-rich environments in our Pilates world mean using the mat, a wall, the back of the hi-back Chair, and small apparatus (props) to provide sensation so the client can feel where they are in space. This allows the client to release tension held both physically and neurologically and to increase their feeling of safety which improves learning and session outcomes. This approach provides an opportunity to do a quick assessment of where the client is that day.
Isometrics help the person recruit stabilizing muscles and aid in improving proprioception without the use of props. Using props engages our exteroceptive functions, which interpret external stimuli. It is also important to facilitate interoception, the ability of the person to interpret their internal state, along with proprioception. Using this sequencing, first, we are providing external support, then engaging internal muscles.
When using isometrics for building strength in stabilizing muscles, light pressure (defined as 5-10% of maximal force) is the most effective. These exercises are what I call “less is more” exercises. Less pressure and resistance ensures that the smaller, stabilizing muscles will be recruited. More resistance often means that larger ‘outer-unit’ muscles are recruited. It is essential that the client’s body is able to hold the isometric without strain.
Isometrics may be sequenced starting supine (using the mat) then side-lying (using the wall or a sitting box behind the back), then moving to seated (using the wall or the hi-back Chair or other prop behind the back), and finally moving to standing (using the wall behind the back).
Here are some examples of how I might sequence isometrics at the start of a session. This sequence may comprise most (or all) of a session with a person who is new to exercise, or is in discomfort; they might only be a short preparatory drill for a person who is athletic. These ideas may be helpful as a daily routine for your clients who have hypermobile bodies.
Emphasize a co-contraction of the abdominals and back, without resorting to bracing. Bracing stiffens the trunk, while conscious co-contraction will allow for natural movement with support of the entire cylinder of the torso.
Supine Isometrics / sagittal plane preparation:
Mat Press
The client is supine with knees bent and feet on the mat. Place props as needed to support the head, neck, and curve of the low back. Instruct your client to press their arms and feet lightly into the mat for 5 seconds, creating an isometric contraction. The abdominals may be cued if the client does not feel them co-contracting during the isometric.
Core Isometric
Instruct the client to place the palms of their hands on their thighs. If they cannot easily reach their thighs, place a sitting box or a moon box under their feet.
Instruct your client to create an isometric contraction by pressing their palms on their thighs and pressing their thighs into their palms at the same time. They can hold the isometric for 5 seconds, then repeat the Mat Press for 5 seconds. Repeat this cycle 2-10 times.
Bottom Lift
Instruct the client to press their arms and feet into the mat and lift their hips up just enough the feel the buttocks engage. Hold for 5 seconds. Repeat 2-10 times. This may be cycled with the Core Isometric instead of the Mat Press.
Supine Isometrics / transverse plane preparation:
AOS/POS Isometrics
Instruct your client to lift their right thigh over their torso and press the palm of their left hand onto the medial thigh just above their knee. This activates the anterior oblique sling from the left ribcage diagonally across the torso to the right low abdominal area and inner thigh. At the same time, their right arm and left foot press firmly into the mat, enough to feel the muscles of their right shoulder, mid back and left buttock working, activating the posterior oblique sling.
Hold for 5 seconds, and change sides. Repeat 2 – 10 times per side.
Supine Isometrics / frontal plane preparation:
Lateral Isometrics
Instruct your client to press their left palm to the side (lateral) of their left thigh. This isometric activates the left lateral line of the torso, hip and thigh. Instruct your client to press their right arm and right foot firmly into the mat at the same time. This activates the right extensor chain. Hold the isometric and count to 5 then do the other side. Repeat 2 – 10 times per side.
Side Lying Isometrics / frontal plane preparation:
Forearm to Hip Isometric (plank prep)
The client reclines supported on their forearm and hip with their legs stacked and bent at the hips and knees. Instruct your client to press their forearm into the mat and, while keeping their hip on the mat, and press their rib cage and waist away from the mat to form a straight line from head to tail. The hold time can start at 5-15 seconds and increase to 1 minute. This isometric may also be performed with their back against a wall for increased proprioception.
Standing Preparation:
Standing Wall Press
Instruct your client to place their back against a wall and walk their feet forward about 6-12 inches. The action is to actively press their buttocks, upper back, head, and arms against the wall, with palms facing forward. This isometric will create a co-contraction of the postural muscles with the abdominals. The intention is for it to feel similar to a plank. The hold time can start at 5-15 seconds, and increase to 1 minute per hold, up to 3 minutes of time under tension daily.
These and other isometric exercises prepare the client for strengthening in an upright position as soon as possible in the session. When people with hypermobility can stabilize their bodies, they are better prepared for effective movement and strength training.
I’m curious to know if you find these ideas useful for your clients. I’m happy to hear from you with any thoughts or questions, or to have a conversation.
You may find me at www.gwenmillerstudio.com, email gwenamy@sonic.net, or WhatsApp 1-707-486-5642.
Gwen is the author of Safe Movement for All Spines – A Guide to Spinal Anatomy and How to Work with 21 Spine and Hip Conditions, published by North Atlantic Books and distributed by Penguin, available from multiple booksellers.
As a Principal Educator for Balanced Body® Pilates Education, she enjoys mentoring teachers and developing community amongst movement professionals.
Gwen’s Pilates journey began after she was diagnosed with degenerative disc disease and degenerative joint disease. She had the amazingly good fortune to have contemporary Pilates legend Elizabeth Larkam as her primary teacher and mentor during her time at Balanced Body University.
She remembers, “during my training, it was me and two PTs in the Balanced Body modules at the San Francisco Bay Club. They were on a fast track, and I had not planned to be, but the moment I realized the opportunity I had, to learn how to teach Pilates from Elizabeth, I jumped on the train and never looked back. It was one of the best decisions I have ever made. Elizabeth was very much into post-rehabilitation, and her influence has stayed with me through the years. She was so gracious, when I had passed my Comprehensive exams and started teaching, she mentored me, talking me through how to teach a class, how to walk through and cue, and what to do to best be prepared and not to be nervous. I find great joy in providing the same excellent care and help to my students, honoring the mentoring she provided me by passing it along.”
As a Hendrickson Method® Manual Therapist Gwen combines orthopedic manual therapy with movement to help her clientele achieve and maintain their quality of life. She has coined the term “Integrated Therapy” to describe her blend of modalities.
Her advanced certifications qualify her to work with spinal pathologies, with an emphasis in working with scoliosis. She is a Corrective Holistic Exercise Kinesiologist (CHEK Practitioner 3), Master Scolio-Pilates® Teacher, and is Yoga for Scoliosis® Trainer certified.
Gwen’s current project, The Dynamic Spine: Safe Movement for All Spines (and Hips), is a continuing education curriculum and mentorship based on her book that synthesizes over two decades’ training and experience in working with special populations to educate and empower the next generation of teachers.