Recently I’ve met my friend Amanda for coffee. She said she has stopped doing yoga because her physio doesn’t think it’s good for her hypermobile joints. Actually not just Amanda, I hear this from my students all the time and I start to wonder- why do physiotherapists suggest that?
A string of questions pop into my mind:
· Are there conclusive studies done on yoga and hypermobility?
· Have these physiotherapists all done yoga before and unanimously come to this prognosis?
· Are all styles of yoga unsuitable for people with hypermobile joints?
· What’s considered joint hypermobility?
These questions have consumed my mind for days and I can’t help but start Googling up. So here we go.
Joint hypermobility as defined by NHS  is ‘some or all of a person's joints have an unusually large range of movement.’ It also suggests that many people with hypermobile joints are asymptomatic and some people such as- gymnasts, ballet dancers and musicians can even benefit from hypermobility. The Beighton Score test is a way to see if you have hypermobile joints. It is a simple 9 points system that quantifies joint laxity and mobility. In general, if you say yes to any of the following questions, you are likely to be hypermobile:
- Pull either of your thumbs down to your wrist?
- Hyperextend a knee or an elbow by 10 degrees? In other word, if you lock your elbows/knees, do they form a curve line?
- Bend a little finger back to 90 degrees?
- Put your palms flat on the floor without bending your knees?
If you’re curious, you can access the full Beighton Score Test here. 
Okay, so finally you find out you have hypermobile joints and it explains why over the years people call you gumbi, flexi and freaky in all of your yoga and dance classes. Now what? Should you give up your favorite Friday night reggae yoga class? Or you should quit Ashtanga yoga after years of dedicated practice?
The thing that baffles me the most is that not only there are no conclusive studies on yoga and hypermobility; there are actually no conclusive studies on hypermobility and exercise in general! Most sports therapists recommend low impact exercises while avoiding high collision sports such as rugby and hockey.  In fact it is recommended to do low impact exercises as it helps strengthen the stabilizing muscles around the joints. However, the overall relationship between exercise and hypermobility remains vague.
So why do physios call off yoga for people with hypermobile joints? I don’t know. It could be based on the presumption that yoga focuses on flexibility only and not strengthening. Moreover, ‘yoga’ as referred here is specifically yoga postures (asanas) and not all of the other things that truly define yoga such as meditation, pranayama, chanting, ethics and philosophy. In defense of the therapists, there are so many types of yoga nowadays and the applications of muscles engagement are vastly different from style to style (See my article on Yin vs Yang yoga), it is best to avoid yoga all together than to create further damages in their patients.
So what’s the verdict? Yoga or no yoga? Well, in the end, the choice is yours. But before deciding, there are 5 facts you need to know about yoga and hypermobility:
1. Hypermobility is a spectrum, not a disorder.
Like Frank’s hot sauce, hypermobility can range from mild to severe. Also you can be very flexible in one joint and not the other. Remember, most people are unaffected by hypermobility and continue to do all sorts of sports/activities. So chill, you don’t have a disorder/syndrome/malfunction. Honestly, we’re likely to suffer from hypochondriac than hypermobility.
2. How you practice yoga matters.
Most people are afraid that doing yoga with hypermobile joints will induce pain, dislocate joints and develop arthritis in the long run. But what really matter is how you’re practicing yoga will affect your hypermobile joints. For example, many hyper-flexible practitioners lock their elbows when in downward facing dog, the stabilizing muscles are relaxed and the entire bodyweight hangs in the ligaments around the joint. Since ligaments are not designed to sustain weight, over time this will cause potential problems such as inflammation, rupture or tear. To resolve this, you can micro-bend in the elbows and it instantly activates the stabilizing muscles thus properly supporting the joint!
Here are a few other things you can do to properly support your joints when practicing yoga:
- Pull back a little. For example in Warrior 2, instead of sinking into your hip flexors, come up a little higher and purposefully engage the quadriceps and the lower abdominals. If you’re familiar with bandhas- activate the mula bandha.
- Hold the posture longer. One way to build strength is to hold the posture longer and consciously engage the muscles around the joints.
- Move slowly. When getting in or out of a posture, slow down your movement and draw your attention on muscles activation. This will prevent you from ‘flopping’ around. For example, if you’re going from standing to a backbend (drop-backs), first engage the legs and abdominals then move slowly into the backbend. Just flopping into a backbend puts tremendous stress on the lower back.
- Practice he postures only if necessary. If you have hyper-flexible hips, it doesn’t make sense to do deep hip opening postures (ie: leg behind head, pigeon, frog poses). Depending on how hypermobile you are, you can skip them entirely or only practice them a couple of times a week.
3. Find the right style of yoga
Not all styles of yoga are the same. So it’s crucial to pick the right style of yoga if you’re hypermobile! Here are some common types of yoga:
Hot Yoga: It’s best to avoid it. The heat loosens the joints even further and you’re prone to go beyond your already wide range of motion.
Hatha Yoga: A very safe choice. Hatha Yoga usually moves very slowly from pose to pose and holds for a longer period of time.
Vinyasa Flow: This is a toss up. The teacher sets the tempo of the class ad also many teachers insert chaturangua (low push-up) into the sequence, which can potentially over extend the elbows- if necessary skip the chaturangua or use modifications (place the knees down).
Kundalini Yoga: This type of yoga uses many kriya (cleansing) exercises to awaken the dormant kundalini energy at the base of your spine. Kriyas are usually fast, repetitive motions done over an extended amount of time. Careful not to snap into your joints and take breaks if needed. Best is to consult with an experienced Kundalini teacher and ask for his/her advice.
Ashtanga Vinyasa Yoga: Ashtanga has set sequences and many ‘vinyasas’. Here the vinyasa refers to jump back and jump through (moving through chaturangua) from postures to posture. It can be very hard on the hypermobile joints. However, you can always modify it or skip them if necessary. A great thing about Ashtanga Yoga is that it focuses a lot on alignment and muscles engagement.
Iyengar Yoga: This is an alignment focused yoga method developed by the late B.KS Iyengar. I think it’s a great style of yoga for hypermobility. Just be careful not to go too deep into the postures.
Yin Yoga: A common view is to avoid Yin Yoga. However, essentially the physical aspect of Yin Yoga is to expand the fascia. Fascia builds up in everyone- including people with hypermobile joints. In addition, the classic yin postures are not nearly as deep as the postures in Ashtanga or Iyengar yoga. By working on the safe edge, you can gain tremendous benefits practicing Yin Yoga. Here is a great article written by Bernie Clark. He explains in great length how Yin Yoga is safe for people with hypermobile joints: Hypermobility and Yoga.
4. Shift your focus
On the physical level, it’s important to shift your focus from flexibility to strength building. That doesn’t mean you stop stretching altogether. Flexible people still need to stretch! However, going deeper and deeper into a posture doesn’t make you a yogis, it just makes you a contortionist. So create a balance between strength and flexibility. On the mental level, we can draw wisdom from the Daoist Philosophy. “Dao” means the middle way, it depicts the perfect equilibrium of yin and yang.  If you always lean on the hard edge, maybe soften a little. The goal is to find neutrality in our approach to practicing yoga. Pushing not too hard but not too soft. This will also help eliminate the fluctuations of the mind’s activities thus creating calmness from within. (More on mind fluctuations here.)
5. Listen to your own intuition
Our intuition when combined with knowledge is more trusting than any professional’s advices. Understand how your body functions and see what works the best for you. If your passion is to do yoga, then do it- just do it safely. And if doing yoga postures is not for you, you can still gain a lot of benefits from doing other aspects of yoga such as meditation and pranayama (breathing exercise).
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1. Hypermobility as explained by NHS: http://www.nhs.uk/conditions/joint-hypermobility/Pages/Introduction.aspx
2. Access the full Beighton Score Test here: https://www.shoulderdoc.co.uk/article/645
4. More on Daoism: https://en.wikipedia.org/wiki/Taoism