Hypermobility and Scoliosis
How many of us have envied those who are flexible, or have marveled at the amazing feats of gymnasts, ice skaters, yogis, and Cirque du Soleil performers? As a culture, we are entranced by flexibility; the beauty, the gracefulness, the perceived greatness of being flexible.
Extreme Flexibility
A commonly held belief in our culture is: “If I were more flexible, I would feel better, or be better, or look better” – you can fill in the blank here with your own perceptions of what being more flexible would do for your life. Although there is some truth in this belief, meaning that some individuals will feel better if they are more flexible, there is a dark side to flexibility that needs to be part of the conversation.
If you were to ask an individual who has a Hypermobility Syndrome, such as Ehlers-Danlos Syndrome, how great their lives are because they are so flexible, you will likely get a death stare, or at best, a pitying fake smile, followed by a schooling in hypermobility.
Being too flexible can be a burden, to put it lightly.
Flexibility is a spectrum. On one end of the spectrum, low flexibility, and on the other end of the spectrum, extreme flexibility. Guess what? There is such a thing as “too much of a good thing.” When an individual is extremely flexible in their connective tissues, we call it hypermobility. Historically we called these folks “double-jointed”. It’s important to note here that flexibility is everywhere in the body, in every system, and can wreak havoc on those systems: musculoskeletal, digestive, vascular, etc. For insight into the day in the life of a hypermobile individual, read this manifesto by a physician who has a Hypermobility Syndrome who has dedicated her career to helping those with the same diagnosis. Back to hypermobility and scoliosis. What’s the connection? Many, if not most, of our patients with adolescent idiopathic scoliosis are hypermobile. It is well documented in the literature. Although we still do not fully understand the exact reason scoliosis originates and progresses, we know there are multiple factors involved in the etiology: genetics, increased hormones during puberty, and connective tissue abnormalities (i.e. hypermobility)1.
Let’s break down the genesis of scoliosis: bony changes begin to occur in the spine called RASO (we’ll cover this in a future post). The ligaments and muscles, being hypermobile and having less “stiffness”, are unable to stop the progression of RASO into a scoliotic curve. It comes down to structural integrity. If the beams used to construct a high-rise building weren’t made out of the right material, and therefore weren’t stiff enough, the structure of the building would be compromised. The building would begin to sag or list. This is what we hypothesize is happening in the spine during scoliosis.
So we know hyperflexibility, or hypermobility exists, and we know there is a high incidence of it in those with scoliosis. Now what do we do about it?
STABILIZATION. We use the muscles around the spine (or whichever joint we are working on) to stabilize the bones. Muscles, unlike ligaments, have the ability to get stronger and to get bigger. This is our best weapon against hypermobility syndrome.
The Schroth Method, boiled down, puts the spine into its best possible alignment, and once there, activates muscles in the spine, in the ribcage, and the core for long periods of time. Practiced regularly, these muscles get stronger and begin to stabilize the loosey-goosey spine joints. Hypermobile patients begin to feel better because their muscles are doing for them what their ligaments have failed to do.
Ever wondered where you are on the spectrum of flexibility? The Ehlers-Danlos Society has come up with a quick test of flexibility called the Beighton Scale. You get a point for each of these joints that is hyperflexible: the knees, the elbows, the thumbs, and pinky fingers, and the spine. The higher your score, the higher your flexibility (Remember, you DON’T want to Ace this test!). We do this test on every new patient that we see in the clinic. Try it!
The next time you are green with envy of another’s flexibility, remember that it is not always a gift. The ultimate goal is to be equal parts flexible and stable. So let’s start stabilizing!
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