Surviving [solidcore] – hypermobility meets the megaformer

[solidcore] is a boutique fitness studio in Shaw area of Washington, DC; however, there are multiple [solidcore] studios in and around the DC area, and the [solidcore] brand keeps expanding.

The workout at [solidcore] is 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 to 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. [solidcore] defines its workout as:

“a 50-minute, full body workout, that uses slow and controlled movements to work your muscles to failure…yes, failure. With no more than 13 clients in a class at a time, [solidcore] is a class-based fitness studio that offers a workout unlike anything you have ever done before. We speak from first-hand experience when we tell you that the results are amazing. Not only do you burn an average of 600 calories per class, but for the next 20-24 hours after class, your metabolism is increased so your body can repair the muscles.”

I love everything about [solidcore]: the workout, the studios, Anne’s story (the owner), the instructors and the community. [solidcore] rocks. Period. I even like that they keep the studios warm, not to hot, but warm. If I could go daily, I would; however, I do have three kids, a budget and other things that I must pay for, unfortunately. In my first post, Striving for the [100 class club] – [solidcore] and the [hypermobile] participant, I mentioned the reasons why I feel that [solidcore] is an awesome workout for anyone who is in fairly decent shape and is up for a challenge –  [hypermobile] or not. I also briefly stated the benefits of this type of workout for those who have hypermobility syndrome/Ehlers-Danlos Syndrome – Hypermobility Type.

 
Here are my 6 suggestions for taking classes at [solidcore] with joint hypermobility/hypermobility syndrome:

1. Watch your knees – I do have to watch my knee alignment, but all

   

   instructors at [solidcore] 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. However, even if 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, but it just is what it is …… (see picture below)
   

   

 
Kneecap instability (patellar instability) is an incredibly common sign and symptom of hypermobility syndrome/Ehlers-Danlos Syndrome – Hypermobility type (EDS or HEDS for short). Interestingly, I’ve noticed that there are a number of us with EDS/HEDS, who have outward facing knee caps, even when not dislocated or subluxed. It’s most noticeable when in a lunge position. This slight structural abnormality appears to stem from the overall laxity of the knee-joint, and it’s more common in females than males.
Why would it be more common in females than males? 
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.

Kneecap instability can also lead to knee pain, specifically associated with movement of the knee cap. 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 EDS/HEDS, 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.

A few other key knee points about hypermobile knees and knee pain:

• Proximal 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 thigh (Ilio‐tibial tract), can cause foot drop (due to inflammation of the peroneal nerve), and may can mimic a DVT.
• Do not hyperextend your knees! (i.e. standding like this see below):

  

 
 
 
 
 
 
2. 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 correct positioning (i.e. not allowing my scapula to wing out), but that’s not a bad thing. Increasing shoulder strength and stability is one of the reasons why [SolidCore] is a such great workout. It helps make you become so [strong] and [stable] everywhere, even your shoulders.

3. Be prepared to work your gluts – Seriously, your gluts will be one fire and it’s a good thing. Go here to learn why. [solidcore] helps strengthen your gluts and core like non other. For many people with EDS/HEDS, muscle mass doesn’t always come naturally and it’s even harder to build. Because of pelvic instability and the way our bodies adjust to the instabilities in our entire body as we move throughout our day, glut 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, because glut muscles do not come naturally for us. However, strong gluts and hamstrings are critical for everyone, hypermobile or not, but can be specifically hard to train when you have EDS/HEDS.
Consequently, when you are hypermobile, your muscles have to work twice as hard as those of someone who does not have EDS/HEDS. The reason is because our muscles have to make up for the slack (i.e. laxity) in our tendons, ligaments and all other types of connective tissues found in our bodies. The amount of muscle work that is required to hold our bodies together and remain stable, is the same no matter how strong or weak our muscles are. However, the difference can be found in the amount of effort that is required. If our muscles are not [strong], going through daily life can become incredibly exhausting. When our muscles have to work twice as hard in order to keep the body together and as stable as possible, they tend to fatigue prematurely. Consequently, even more effort is required to do the same activities. 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.
What is the key point?
Watch for muscle spasms.  I tend to get horrid ones, and I wrote about them here. 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, D and B. If you want to know why proper hydration and nutrition matters so much when you have EDS/HEDS, go here to read more.
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 knee cap was not pulling off to the side, and his hamstrings and gluts were firing as they should.

4. Be mindful of your proprioception – Proprioception is the body’s ability to sense movement of the joints and their position. People with joint hypermobility due to EDS, usually do not have good innate proprioception.
What does that mean?
We can fall easily, bang our heads constantly, loose our balance often, and really have no ____ idea where our body is in space. You can be incredibly fit and strong, but still have terrible proprioception.
The good news – proprioception can get better and [solidcore] has been an excellent way to improve proprioception, for more personally. Of course, I didn’t start from a clean slate and had fairly decent balance when I walked into my first class almost 2 years ago; however, I still bang my head constantly. We all have room for improvement, and I still have a lot to do.
5. If you have concerns or questions, just ask. Every [solidcore] 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 if every instructor is aware of and knows what to watch for concerning joint hypermobility and/or EDS/HEDS, but they are all well-trained on proper alignment techniques and joint safety. As I mentioned above, I have never been advised incorrectly.
6. The biggest challenge when going to [solidcore], is your mind. Be prepared to work your butt off, and to be incredibly proud of yourself afterwards.

“[solidcore] is not just a workout. We are on a serious mission to help you create the strongest version of yourself inside and out.” –anne mahlum, owner and chief motivation

Special note: Ehlers-Danlos Syndromes are a set of heritable connective tissue disorders.  involving mutations to the genes that are responsible for the structure and function of the collagen protein – one of the main building blocks of our connective tissues. Connective tissue is the glue that holds are bodies together. A genetic that affects the body’s glue, such as with EDS/HEDS, can affect nearly every system in the body in some way. It’s impossible to know for sure what this type of defect will or will not effect, because so many other factors impact the expression of our genes – defected or not. Lifestyle, stress/trauma and other epigenetic factors are some of the main contributors to our gene expression. It’s important to note that not one patient with any of the identified and named types of Ehlers-Danlos Syndromes presents the same. Clinical presentation and severity of symptoms is wide and incredibly complex. While we have learned a lot in the last few years, we have even more that we have yet to fully understand. Vascular Ehlers-Danlos Syndrome involves genetic mutations to the Col31A gene, and is still considered the most severe type of EDS. Vascular EDS emergency information can be found here; however, in the event of an emergency or possible life-threatening event, it is advised that this information be utilized for patients with all types of Ehlers-Danlos Syndrome. 
Other pertinent links: 
What is Ehlers-Danlos Syndrome?
Signs and Symptoms of Ehlers-Danlos Syndrome
I have EDS, now what?
Questions and Answers about exercise and EDS (3 post series)
The importance of exercise on the expression of our DNA and the role of epigenetics
Proper neck alignment during activity when you are hypermobile
My butt is flat! Why sitting too much causes chronic pain, muscle atrophy and problems moving around.
Exercise and PT resources for EDS
Yoga and the hypermobile yogi
Climbing out of the EDS Spiral – My Zengo Cycle Story
Exercise and Dizziness 
Our Stories of Strength – Living with Ehlers-Danlos Syndrome
Disclaimer – while I feel that [solidcore] is a great workout for most people, hypermobile or not, if you have extreme mobility issues, are very deconditioned, or have trouble moving around during daily life, it’s recommended that you seek the advice of your physician or PT before starting any new program. [solidcore] is not suitable for everyone, but that does it’s not a goal that can be achieved with hard work. We are all different. You are responsible for making the best decision for your health. The opinions expressed here are my own and do not reflect the views of [solidcore], it’s owner, the instructors, EDS Wellness, SFHEDS or its affiliates. Content and information in this post, should not be seen as a directive or as a substitute for seeking advice of a medical professional. Please read full disclaimer here.
If you have any questions or would like to send me an email, please email: kendra@edswellness.co, or use the contact form below. 
[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]