I’ve made it no secret that I’m still working on regaining my strength & stamina from my most recent EDS spiral. Strength training is key when you are hypermobile – our muscles do what our connective tissues cannot. Finding ways to build muscle without adding stress to already unstable joints often becomes the difference between functioning or having to stay in bed with debilitating pain. Hence, why I love working out at Sculpt Studio. Everything about Sculpt: the Megaformer, the classes, the studio, Mary (the owner), the instructors and the community – rocks. I can often find parking easily. And, if I’m 5 minutes late, I’m still welcomed with open arms into class. That pretty much defines winning for me on so many levels.

The Sculpt Workout is intense and effective with results that matter.

The classes at Sculpt are based on The Lagree Method, which uses a Pilates-like machine called the Megaformer. The Lagree method was developed by Sebastien Lagree and is based on the idea that “physical fitness is made up of five basic elements: Cardio, Strength, Endurance, Body Composition, and Flexibility.” Interestingly, Lagreefitness.com states that most fitness programs attempt to incorporate these five principles in a single workout, but The Lagree Method “meets all the elements of physical fitness; not just in 1 session but in each and every move.” Studios that focus on the Lagree method are all a bit different. Each studio develops its own brand and hones its personal workout style using the principles of The Lagree Method and the Megaformer. Sculpt Studio defines its workout as:

“Our workouts give you the highest RPM* available (*results per minute!) in an intense 50 minutes that effectively combine Strength, Endurance, Cardio, Balance, Core and Flexibility and can torch up to 500 calories with minimal impact to your joints. Our goal is to leave you sweating, sore and wanting more!”

Sculpt offers a traditional Megaformer class (Sculpt Classic), Sculpt Pilates (a more traditional Pilates workout), High-Intensity Interval Training (HIIT) Circuit Training, and more. Strength training on the Megaformer, including traditional Pilates exercises, are the main reasons I have made significant progress in correcting the kyphosis and scoliosis in my back – and the winging of my scapulae. During one class, the instructor commented on how I need to keep my scapulae down. I laughed and told her that “it’s my life’s goal to be able to keep my scapulae from winging.” It’s definitely something that’s easier said than done when you are hypermobile. Most importantly, classes at Sculpt have also helped me stabilize my SI joint, pelvis, hips and entire lower body.

Below, I’ve listed 8 tips for workouts on the Megaformer with joint hypermobility or a type of hypermobility-related disorder:

1. Keep a microbend – With joint hypermobility (AKA – “double-jointed“ or “loose joints”), it’s important to be mindful of your range of motion in all joints, especially your joints that are most “bendy.” While I’m not über hypermobile in my elbows, they still hyperextend. In fact, every joint in my body is hypermobile – both big and small joints. When lifting weights or doing arm exercises, I do not extend to my “full range of motion,” even if the activity calls for it. To protect my joints, I focus on keeping a micro-bend in my arms when working out and in my knees at all times. I’ve also learned to sleep with my knees slightly bent and often do the same when laying face down (i.e. on a massage table). My knees easily dislocate if bumped, or if I relax too much – something I’m fairly obsessed with preventing.

2. Watch your knees – I do have to watch my knee alignment, but all instructors at Sculpt watch each participant’s knee form. When each class has an average size of twelve people, you get plenty of help and correction, if necessary. Kneecap instability (patellar instability) is an incredibly common sign and symptom of a hypermobility-related disorder such as Hypermobile Ehlers-Danlos syndrome (hEDS) or a type of Hypermobility Spectrum Disorder (HSD). This slight structural abnormality appears to stem from the overall laxity of the knee-joint, and it’s more common in females than males. Interestingly, even when I have correct form, some instructors seem a bit perplexed by my knee cap and how it points outward and not forward. It looks like I need to correct my alignment when I actually have proper form. I’ve come to realize that there are a number of us with hypermobility, who have outward facing kneecaps, even when not dislocated or subluxed. It’s most noticeable when in a lunge position.

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Pic from ergon24.com – proper kneecap alignment with physio treatment. Click on image to be directed to blog/website.

When looking pictures of correct kneecap placement in a lunge position, I found a blog post by a competitive cyclist (ergon24.com – no idea if he’s hypermobile or not), who also wrote on the same two things – proper knee cap position and glut muscles not firing as they should. In his blog post, the writer shows pictures of his progress after doing a specific type of therapy with one of his healthcare practitioners. The result? His kneecap was not pulling off to the side, and his hamstrings and glutes were firing as they should.

 3. Be mindful of your shoulder positioning and aware of winging scapulae Shoulders are typically one of the weakest joints in the body. I have to watch mine and make sure that I’m focusing on proper form (i.e. not allowing my scapula to wing out). Increasing shoulder strength and stability is one of the reasons why Sculpt is such great workout.

4. Be prepared to work your glutes – Seriously, your gluts will be one fire and that’s a good thing. Go here to learn why. Classes at Sculpt help strengthen your glutes and core like no other. For many people with hypermobility, specifically those with a type of EDS, muscle mass doesn’t always come naturally — and it’s even harder to build and maintain. Because of pelvic instability and the way our bodies biomechanically adjust to other instabilities as we move throughout the day, our glutes and hamstring muscles tend to be weaker and harder to engage. Many of us work our butts off (literally) for the little muscle we do have.

5. Watch for muscle spasms.  I tend to get horrid ones, and I wrote about them here. Because our muscles have to do twice the work than the muscles of someone who is not hypermobile, the result is often painful muscle spasms and sometimes more permanent muscle contractures. This is also one of the main reasons generalized chronic fatigue and Chronic Fatigue Syndrome (CFS) are common comorbid conditions with hypermobility-related disorders. The amount of muscle work that is required to hold our bodies together is the same no matter how strong or weak our muscles are. Going through daily life can be incredibly exhausting. When our muscles are weak and have to exert a ton of effort just to hold our joints stable, they tend to fatigue prematurely. Consequently, the result is a lot of tight, sore muscles (i.e. spasms), just from living. Add extra weight on top of that, and it’s the perfect recipe for becoming a hot mess.

The stronger your muscles are, the less effort required for normal daily activities. You will move more, move better and with less pain. You will also feel a lot less fatigued. If you do find that you are more than sore and have pain from muscle spasms, soaking in warm water with Epsom salts can work wonders. Additionally, make sure that you are properly hydrated with electrolytes and getting adequate amounts of magnesium, vitamin D, C and B. If you want to know why proper hydration and nutrition matters so much when you are hypermobile, go here to read more.

6. Be mindful of your proprioception – Proprioception is unconscious perception of movement and spatial orientation arising from stimuli within the body itself.” People with joint hypermobility often lack proprioception — we sometimes fall easily, bang our heads constantly, lose our balance often, and really have no ____ idea where our body is in space. You can be incredibly fit and strong yet still have terrible proprioception. The good news – proprioception can get better and Sculpt has been an excellent for me personally.

7. If you have concerns or questions, just ask. Every Sculpt instructor is well-trained, and they are there to motivate and encourage you. No one will make you feel bad. It’s never once happened to me, or in anyone in a class I’ve been in. I cannot say that every instructor is aware of and knows what to watch for concerning joint hypermobility, but they are all well-trained on proper alignment techniques and joint safety. As I mentioned above, I have never been advised incorrectly. And if I am, I’ve learned enough and trust myself, to know what is best for my body.

8. The biggest challenge when going to Sculpt is your mind. Be prepared to work your butt off, and to be incredibly proud of yourself afterward.

A few other key knee points about hypermobile knees:

  • Patellar Instability is more common and more noticeable in females than males partially due to female biomechanics, and partially due to hypermobility. Females usually have a pelvic width that is wider than the width of their knees when standing, which is referred to as an increased Q angle. Q angle is a term used for the 3 anatomic characteristics that lead to having a an increased Q angle. Structurally, this can cause additional strain on the knee-joint and uneven use of the four quadriceps muscles that attach both the pelvis and the knee. If a woman has unstable ankles and a pelvis due to EDS/HEDS, this can become especially problematic.

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Q angle differences in females vs. males

  • Kneecap instability can also lead to knee pain, specifically associated with movement of the kneecap. Knee pain due to patellar instability is normally associated with Patello-Femoral Syndrome (PFS). Patello-Femoral Syndrome can be caused by a number of different issues; patellar instability caused by an underlying connective tissue disorder, such as EDS or HSD, is one of them. When I did a quick google search, I found many websites with a ton of decent information on PFS, but many lack crucial information on the association between PFS and different hypermobility syndrome(s). However, Dr. Pradeep Chopra discussed PFS, as well as other common joint ailments associated with EDS/HEDS, when he presented on hypermobility and chronic pain management at the Ehlers-Danlos National Foundation’s 2015 Learning conference.  His presentation can be found here.

 

  • proximal_tibiofibular_joint1363775707756Proximal Tibiofibular Joint (PTJ) – a smaller joint that is another common cause of knee pain, but is often overlooked. If subluxed (misaligned), the PTJ joint can press on a peroneal nerve and cause pain. Subluxation of the PTJ is a common finding in athletes. PTJ pain is usually on the lateral aspect of the leg below the knee. Knee pain due to the PTJ is especially felt when squatting. PTJ pain can also be felt in the thigh (Ilio‐tibial tract), can cause foot drop (due to inflammation of the peroneal nerve), and may mimic a DVT.
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      How to not hyperextend when standing – fr. Left to Right. Left – way hyperextended. Middle – hyperextended, but braced a bit. Right – not hyperextended and has a microbend to protect knees.

      Do not hyperextend your knees! (see picture to the right)

Special note: 

It’s important to remember, that each person with hypermobility is different, as is the degree of mobility in each joint. People with “loose joints” due to conditions such as Hypermobility Spectrum Disorders or a type of Ehlers-Danlos syndromes (EDS) are often not hypermobile in both big and small joints. However, there are some people who are hypermobile in every joint (like me!). Additionally, A person can appear not so flexible, or “too stiff,” and still have hypermobile joints. Flexibility and hypermobility are not one in the same. You can be flexible, but not hypermobile and vice versa.

A FEW EXAMPLES OF THE VARIOUS JOINTS IN OUR BODIES:

Small joints = feet, toes, fingers, and hands.

Large joints = pelvis, knees, hips, and shoulders.

Other typical hypermobile joints = the TMJ, ankles, wrists, neck, and the spine.

Helpful Links: 

About hypermobility-related disorders

The Beighton Score Assessment for joint hypermobility 

What are Ehlers-Danlos syndromes?

Understanding the 2017 Ehlers-Danlos syndromes (EDS) & Hypermobility Spectrum Disorders (HSD) Diagnostic Criteria 

Vascular EDS emergency information

***This post is an updated version of SURVIVING [SOLIDCORE] – HYPERMOBILITY MEETS THE MEGAFORMER’***