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Episode 75: Hypermobile People Are People Too
1.3k Plays4 months ago
Welcome to Season 5 and Episode 75 of the Movement Logic podcast! In this episode, Laurel and Sarah are joined by Nikki Naab-Levy, strength coach and hypermobility specialist.
You will learn:
- What is hypermobility and how does it differ from flexibility
- What are the Ehlers-Danlos Syndromes and how do they differ from Hypermobility Spectrum Disorder
- Who can and can’t diagnose hypermobility
- Whether hypermobile people should never lock out their joints
- What are the most important considerations when working with hypermobile clients
- The negative consequences of catastrophizing positions as safe or unsafe
- Why social media focuses on the wrong issues for hypermobile people
- Strategies for hypermobile people to sense what level of activity they should undertake on any given day
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Transcript
Introduction to Movement Logic Podcast
00:00:02
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up to date and cutting edge tools, evidence, and ideas to help you as a mover and a teacher.
Running Experiences and Challenges
00:00:35
Speaker
Welcome to season five of the movement logic podcast. I'm sorry. I would like, I went right as you started talking and I was like, me no, I just almost said I'm Laurel beavers. or ha That's what it says on the sheet. ah Just kidding. That's why I got left. All right. It's funny. Welcome to season five of the movement logic podcast. I'm Dr. Sarah court and I'm here with my co-host Laurel beavers Dorff. Laurel, how are you doing?
00:01:06
Speaker
I'm doing great. I'm doing great. Is there anything good new with you in the movement world, things you're working on, things you're trying? I'm trying to run faster. Oh, cool. Nice. I'm trying to run faster. It's going well. I don't think I'm getting that much faster, but I am enjoying it as much, if not slightly more, as the months go on. I don't know what it is about running. but As they say, it's it's very addictive. Yeah, for some people, it's just like absolutely the greatest. And for other people like me, it's okay-ish. um but It wasn't great always. I mean, when I started running, I was like, why did I do this to myself? But I sort of signed up for a run club, and it was like, no, you're going to stick with this for however many weeks it was. It was like 12 weeks. And I have to say, like after the 12 weeks were up,
00:02:00
Speaker
you know yeah three months of running, you know however many miles I was putting in each week, ah something switched. Something kind of flipped for me. and um It's like you need that accountability in the beginning and then yeah you become you take over. right It's like the training wheels can fall off and you can just kind of go. Well, I wasn't in shape, ah cardiovascularly speaking, and to get into shape,
00:02:28
Speaker
where it starts to become enjoyable I think is especially difficult with something like running. I think it's easier when you haven't strength trained to start strength training and be like, Oh, this is kind of amazing at any point, but with the cardio, there's something about just wanting to stop, you know, wanting to stop and just not stopping and getting used to that feeling of wanting to stop. And then pretty soon something switched for me where I was like, I don't want to stop. I actually want to keep going. And I don't know when it happened exactly, but
00:03:02
Speaker
Yeah, and now um I look forward to running like every day I finish my run. I'm like, I can't wait to run tomorrow.
Introducing Nikki Navlevi and Exploring Hypermobility
00:03:08
Speaker
Amazing. That's so cool. It made me think when you were talking about it, because I also, I've been doing more cardio as well, because I was, real I realized that there's just very little in my life. And I also, I and i love weightlifting. I mean, some days I'm like, ugh, but for the most part, it feels good. it It's short-ish a lot of the time.
00:03:29
Speaker
And it's not that consistent effort. So like you get breaks, but cardio for me is like, I'm on the rowing machine and I'm like, okay, 20 minutes must have passed. And I looked down and it's been three minutes. you know yeah And it makes me think also about meditation because that's another thing that I, my experience has been like in the beginning, especially you're like, oh my God, when when is this going to be over? Like time slows down. It has that sort of same time slowing down component because you're uncomfortable.
00:03:56
Speaker
And then as you get more comfortable with it, you start to enjoy it. You start to look forward to it. So similar, similar qualities, I think. um agree yeah that's Agreed. Agreed. Yeah. So we are really excited about this episode today. Aren't we? Who's our guest? Nikki Navlevi. She is my business coach, actually. But She's also got a bunch of street cred as a former Pilates teacher, but ah now a strength coach. and I'm going to read her bio. right so This is Nikki's bio, so we'll let ah who Nikki is come through here in her own words, and then Sarah and I will gush about her. Nikki Nablevia is a strength and nutrition coach with over a decade of experience.
00:04:44
Speaker
helping hypermobile humans build strength, overcome injury, and navigate fitness mindset and body composition with chronic conditions. She holds dual BS degrees in exercise science and journalism from Ohio University. Her fitness wisdom has been featured in Girls Gone Strong, Self Magazine, and Women's Health. All right. So yeah, Nikki is someone that I meet with a couple of times a year to talk business, so she has lots of different skill sets and she's a delight. um Mostly what I love most about talking to Nikki is how she is very clear, articulate,
00:05:23
Speaker
funny and she doesn't mince words, right? She kind of just tells you how it is, which yes I just so, I find it so refreshing. ah Me too. Me too. Especially coming from a woman, I find it refreshing. I'm like, let's just, I don't need you to, I can handle it. Tell me what I need to do. you know I also use her so occasionally for for business things as well. And she's like, all right, here's what you're doing wrong. Here's what you need to do better. I'm like, awesome. Let me just write it down.
00:05:48
Speaker
Yes, exactly. I don't need you to spare my feelings. I'm not emotionally caught up in this. Just tell me what to do. Tell me what to do, yeah. Yeah. Yeah, she's really brilliant. And I always get so much out of talking to her, you know, whatever capacity. What are we talking to her about today?
00:06:03
Speaker
Today, we're going to talk to her about hypermobility, specifically the myths, somewhat persistent myths out there about what hypermobile people should and shouldn't be doing with their bodies. And we're going to focus, of course, on strength as well as mobility. um But yeah, that's our topic. Cool. All right. Well, let's get into our interview.
00:06:27
Speaker
Nikki, welcome onto the show. We're so excited to talk with you today about persistent myths around hypermobility and strength. Thanks for having me. I'm excited to dive in, get on the rant train.
00:06:41
Speaker
All right. So let's start with a real basic, you know, clarifying terms question before we get into it. Can we define what we are referring to when we use the term hypermobility?
00:06:56
Speaker
Absolutely. So hypermobility is really when joints are able to move beyond, and I'm using error quotes here, kind of what is considered a normal range of motion, knowing that everyone has different ranges and that variability is also normal. And that usually it's often going to be due to something like genetic factors that affect your connective tissue, ligaments and tendons. And I think it's important just to sort of outline that This is different than flexibility, which is really the ability of those muscles and joints to be able to move kind of through their full range of motion. I think some other kind of hallmark differences in hypermobility is that a lot of the time it's associated with joint instability. So on a neuromuscular level, like we have a hard time controlling the positioning of our joints.
00:07:41
Speaker
Also, you can be flexible without being hypermobile, and you can be hypermobile without being flexible, depending on if there's been any particular changes to the joints or the connective tissues. And also, you can be one hypermobile human who has some very, very hypermobile joints that have a lot of range of motion, next to some very, quote unquote, hypo-mobile joints that don't move very much.
00:08:04
Speaker
And then, yeah. That's me. All of us, right? it it's It's me too. And then, you know, I think the last thing is, is that hypermobility exists on a spectrum. So there are some people who are quote unquote hypermobile and have very few problems or no symptoms or no problems.
00:08:20
Speaker
And then there are symptomatic hypermobile people like me who want a very specific genetic lottery and have an assortment of weird issues that the medical system is not always, unfortunately, very well versed on nor is fitness land. So that's my short list. Hopefully that makes sense. So since we're talking about hypermobility, can we also When you're talking about those spectrum of symptoms that people can have, can we get into like what EDS is and how people can be hypermobile and not have EDS you know that it's that is that spectrum of symptoms? Yeah. i mean i I'm not a medical expert, right so I want to be really clear about that. I think what's tricky is that it, on average, I believe can take like up to 10 years or more to get an EDS diagnosis.
00:09:07
Speaker
And that is a certain, basically, there's certain it's a kind of ah considered a connective tissue disorder, and you can test for it. There are certain genes that they've identified. But then you can have people like me, I've had the testing done, who I technically meet the criteria for HEDS, which is Hypermobile OO Standless Syndrome. It's a diagnosis of exclusion. But I have not ended up in front of a doctor who knows what that is, so I can't actually get the diagnosis. So like for example, my chart says Hypermobility Spectrum Disorder, or HSD. And I think one of the misconceptions is that
00:09:41
Speaker
if you have quote unquote HSD or you're hypermobile without an EDS diagnosis, that you're going to be less symptomatic or not have problems. And that's just not true. I think the other thing is right. I'll just I guess I'll just list a short list of some of the comorbidities that come with it. But you can have something called POTS or orthostatic hypotension, which is basically very low blood pressure or dysautonomia.
00:10:02
Speaker
which is your nervous system isn't doing a great job of regulating your heart rate relative to your blood pressure. You can have a number of various GI issues. You can have a number of various pelvic issues um like endometriosis. I believe even PCOS is you're more likely to have anxiety is not the cause of our symptoms, but we may be more likely to have anxiety or more likely oftentimes to have chronic pain. joint pain. It's just it's all and I'm sure I've missed. all Oh, MCAS. So there's chronic fatigue syndrome. There's just so many different things that can go with it. And I think that that's often the part that's really overlooked and underappreciated is it's just like, oh, yeah, you just you're just really flexible. You just have some joints that move some extra
00:10:43
Speaker
just a little bit more, you're fine, your blood tests look normal. And I think that's what's really hard is that a lot of us are stumbling around with like these just assortment of really frustrating symptoms that are really interfering with quality of life. And we just there's not a lot of help or understanding around what's going on with us. Yeah.
00:11:02
Speaker
Can I ask a follow-up question? This pertains to like defining terms and also, you know, Nikki, you brought up scope of practice. I hear a lot, I see a lot online teachers referring to their students as hypermobile or giving advice sort of generally for hypermobile people. And, you know, I think sharing movement strategies as a movement teacher is, that's what we do, right? But what are your thoughts on movement professionals I'm going to use the word diagnosing, and I know that's kind of a loaded term because it really portrays or it reveals my bias. But I hear a lot of movement teachers online almost diagnosing their students as hypermobile. But, you know, just now you've told us that there's
00:11:45
Speaker
lots of different ways to be hypermobile and there's lots of different accompanying symptoms of different types of hypermobility like hypermobility spectrum disorder versus EDS. So what are your thoughts on movement professionals deeming their students hypermobile and who do you think is the group of people most qualified to give someone a hypermobility title? Oh, that's a big question. On the note of scope of practice, I think that how we present and phrase things is important. So I would never diagnose someone as hypermobile or go, oh, yeah, you got EDM. I don't know. why I don't know what this person has. and And at a distance, I can't or even just like I shouldn't be making any assumptions about their lived experience, even if I'm like, oh, wow, their elbow is hyperextend.
00:12:34
Speaker
That doesn't really tell me of anything other than they have a lot of elbow range of motion and I've worked with people whose elbows hyperextend who have no hypermobility related issues, right? Laurel's raising her hand now. So I think that assigning labels is not helpful. And it also is outside of scope of practice. So I think if I have someone, I start working with someone and they start presenting with a host of issues, I might be like,
00:13:00
Speaker
hey, have you ever been evaluated for? or Have you ever heard of this? This might be something that, because based on the symptoms you're having, that would be worth having a conversation with your medical provider about or your physical therapist about. I don't know. It's outside of my scope of practice to diagnose. so But if you know we can get a better understanding of what's going on with you, you have a better understanding than you know what you're working with. And then you know we can make more informed decisions for you. But I never assume anything. I just sort of ask a question at the most. And if I'm presenting information online, I do my best to say, this may work for you. These are some considerations that may be helpful, but also maybe not. Maybe your maybe your body responds completely differently because I cannot make a generic post and know that it's going to make sense for every single person. I have never seen that happen. um We are all
00:13:52
Speaker
individuals struggling with different things, we have different strengths, we have different belief systems. And so I think we just need to be thoughtful in how we couch that. Now, as far as getting evaluated, sometimes the first person to really sort of introduce this idea of, oh, you might be hypermobile, or you might meet like this HDS criteria, if you've already had the um you know, testing might be a physical therapist, they often sort of end up being kind of an entry point. As far as being able to diagnose, I think that one varies from state to state. Sometimes a rheumatologist can, sometimes a geneticist will do it it. It's kind of a mixed bag and I think that's what makes diagnosis so tricky is that when you go to the actual, like your PCP or something, a lot of the time they just kind of go, oh yeah, you're kind of bendy. And so a lot of it's, a little bit of dumb luck and also hoping that you get in with someone who is going to have a more robust understanding of what's going on and isn't going to instantly dismiss you dismiss you because you look too young and too healthy and they're like, why are you here? So it's just it it's tricky. from From my perspective, from a clinical perspective, when I started working as a PT, I had heard of EDS. And that was about all alls I sort of knew about it was like, oh, it's people who are like extra hypermobile, like more a little bit more. And
00:15:12
Speaker
you know Even the material, even the resources that were out there were nowhere near as detailed and defined as they are now. like Now, I think there's there's something like 11 or 14, I don't remember, separate EDS diagnoses that you can have.
00:15:28
Speaker
based on what exactly it's impacting in your body. you know I have a patient that I work with who has severe EDS to the point of, because you if you think about it, it's sort of attacking all the connective tissue, or it's not attacking, but it's the quality of all the connective tissue in your body. So she has problems with like detached retina.
00:15:47
Speaker
and her aorta, right? So there's actually really severe health consequences that can happen with EDS. It's not just about being a bendy person. And I think also, it's you know like you're saying, Nikki, it's sort of like what how has this information been disseminated through the medical field?
00:16:03
Speaker
it A lot of time does start with a physical therapist because we're the ones watching the person move and we also see things like, oh, you stood up and you got really dizzy. Hmm. You're really bendy. You stood up and you got really dizzy. You sat down and your heart started racing or something like that. like Those are all clues that like, okay, maybe there's something more going on here that that we need to send you to a doctor to to get you diagnosed. but Even without a diagnosis, I think for PTs and OTs, it's really on us to understand what we're seeing and, you know, diagnosed officially or not.
00:16:35
Speaker
you know, work with a person in, with all of those things in, in consideration. Okay. So we've all agreed that movement teachers should not be diagnosing their students as hypermobile. Can I get a, can I get a hell yeah. Amen.
Misconceptions and Myths about Hypermobility
00:16:49
Speaker
All right. Thank you. Non-practicing. Amen. i mean Yeah. I mean, the thing is, Sarah, is we can just go down a rabbit hole about this. So I'm going to stop us from that rabbit hole. Thank you. I appreciate it.
00:17:02
Speaker
riy So many thoughts went into my head, but I'm not going to derail us. Yeah. Okay. So let's talk more about this. This is more where where I'm heading now with you is more about how should a movement teacher behave or what should they do? There's this idea that it's not okay for people who have hypermobility to lock out their joints when they're exercising because when you lock it out, somehow the muscles aren't working and the joint is stressed or the joint is unsafe or it's going to just give out basically so that it's a really bad idea to do that if you're hypermobile. like The number of times
00:17:38
Speaker
in various settings that I've been told off about my hyper extending elbows is a lot. To the point where now I'm just like, shut up. But I myself also, you know, as a baby yoga teacher, I absolutely would see somebody who's locked out elbows and go, oh my God, like, you know, run over and be like, you need to micro bend your elbow to protect it. right Is it just that we don't understand what hypermobility looks like or what's happening? or this the like Why do we all believe that it's so dangerous? I think that's the sort of underlying idea is like, this is dangerous for your elbows or whatever joint. I think we just have a very poor understanding of loading mechanics. And then I think that that gets exacerbated by
00:18:23
Speaker
poor communication skills, right? Like i I think we can work with someone to address something that may or may not be favorable depending on the context without running over to them, like stop the presses with giant cartoon eyes waving our hands so everyone in the room turns and stares at us. And then all we want to do is go stick our head in an oven or at the very least never go to a class again, like the shame of the elbows. I have to have been shamed over my horrible elbows. My left one, it hyper extends more than the right. Apparently, that's also, and I mean, it's just the micromanaging is exhausting. And then when you're on the student end, right, you're either scared, or if you're more informed, you're just pissed off, but you don't want to be that person in the class telling someone, you know, to go and f off.
00:19:08
Speaker
So I that's me So I right III don't like conflict and then my like, you know my like little lower teeth maybe capital T trauma brain kicks on and then I just completely disassociate but also story for another day, so I think I think what's important to know is that the answer is always going to be it depends. There are so many pain is multi-factorial, injury is multi-factorial, you cannot necessarily predict someone's experience by looking at the state of their elbow. You don't even know if that person's in full hype or extension. There are times people are telling me to microbend my elbows and I'm like, I got like 20 more degrees over here, calm down.
00:19:46
Speaker
so I think a better question to ask is like, how much load are we using, right? Because generally speaking, if things, joints are quote unquote more stacked under heavier loads within reason, that's going to be a more efficient movement pathway in terms of where forces land. So maybe that's not a terrible idea. But of course, if they're not perfectly stacked, that's also probably fine and is this person prepared to load in that position do they have good control in that range of motion or are they just like slamming into the end range because slamming into a joint without good control muscular control probably won't feel good over time. you know And and are they are they just prepared to load, period? So like I think that there's just a lot of questions to be asked. oh The one I forgot was, like do they have pain? Because on one hand, it's it's true that like we your muscles are not turning off at end range. I'm so tired of people saying that. That's such a weird statement to make.
00:20:45
Speaker
right your must They're not a light switch, but it is true that you have less force production at end range. and If your ligaments go further than the average person because you're hypermobile, then yeah um your muscles and tendons and all that are going to have to work a little harder to kind of hold things together. so End range will probably feel a little more precarious and you might need to be more thoughtful.
00:21:08
Speaker
But I don't think we need to catastrophize it. I think we need to look at it. And if we suspect that, hey, this position is probably not going to be favorable for the sake of muscle engagement, comfort, how they're going to feel afterwards, teaching them how to hold a new position with more muscular control, then we can have a conversation. And that's where we can maybe use alignment or biomechanics for the sake of like,
00:21:32
Speaker
movement education to sort of have an approximation of where to go, but we can couch that without telling them, telling a person that they are dysfunctional or they're going to hurt themselves because we don't know. Neither of those things are probably true. And also at some point that person is going to use their end range because that's how bodies work. So making someone afraid to go into it is a lot less helpful than teaching someone how to use the middle ranges and then start to use more muscular control at the end ranges. How'd I do?
00:22:02
Speaker
it Yeah, I mean, it sounds like it's the difference between teaching an alignment versus teaching a person. So if you think that hyperextension of any kind is inherently unhealthy, you're going to run around and teach that alignment or help people avoid that misalignment, regardless of each individual's experience with that alignment, whether or not they have pain and all the other things you listed, versus if you teach people, right, if you get to know the student and you know what their situation is on an individual level, it no longer becomes this black and white of, hyper extension is always bad and not hyper extending is always preferable. Instead, it becomes a more nuanced conversation where it's really based on each individual's needs, preferences, bodies, and I think then that's when we become much more
00:22:56
Speaker
helpful. The problem is that that just doesn't work as well on Instagram. It's too complex, right? And I think that's why we see, I'm making a point that that's why we might see a lot of black and white information, you know, hyper extension.
00:23:12
Speaker
propagandized as this like inherently unhealthy, unsafe, bad place to be, because that's really easy to speak to in a 30-second post or reel. It's very visual, and and I think that it takes a lot more nuance to sort of go, well, why don't you try both? How does it feel if You're a little less locked out. Do you feel your muscles more? Is something more comfortable? What's the difference when you're more locked out? Can you compare and contrast things? Now, of course, I'm saying we're doing this under very light loads or body weight, right? I'm thinking like four point kneeling stuff. I'm probably not going to have someone practice this compare contrast under a heavy barbell. Right. But, but by the time they're under a heavy barbell, like we've had the whole conversation. We've been doing this for a hot minute.
00:23:56
Speaker
But yeah, I think like it depends is just such an unsexy, unsatisfying answer because like then you have to like ask questions and pay attention and be willing to change your mind and possibly be wrong and have it be different every single time. And that's all very exhausting. Our brains love binaries. The problem is is that binaries don't serve humans. Yeah. And I think as well, you know, in a group setting, you think about how much time you have to have an individual interaction with each student in the room.
00:24:27
Speaker
you might have time to be like, hey, try a little less, try a little more, see how it feels. But you don't have you don't have time in that setting, in my opinion, to get into a lot of it nuance. And so maybe the sort of short answer is like, just leave them alone. And and I would say, yes, leave them alone and refrain from couching things in these really black and white, good and bad, safe and unsafe terms, because then what you're going to do is you're going to communicate to an entire group of varied individual bodies and people in situations and contexts that there's one right way and one wrong way, and you're going to miss a large portion of that class because they might have benefited from the wrong way. I have a question for you, Nikki.
00:25:17
Speaker
so I've seen online a certain influencer. She has a very large following, large presence on Instagram, and her presence is to you know help people with hypermobility move more safely. And she posted about a systematic review on back pain, and she wrote a 2020 systematic review of the research on back pain found no relationship between posture and the cause of back pain.
00:25:46
Speaker
which is you know another piece of evidence kind of pointing to this not so clear or existent at all relationship between posture and pain, which we talk about a lot on this podcast. But this influencer, her message was that this systematic review did not involve hypermobile studies.
00:26:06
Speaker
And therefore, she implied that that meant that the evidence from the systematic review did not apply to hypermobile people. Her message was that, no, actually, posture is really important for hypermobile people in the prevention of low back pain because specifically hypermobile people tend to, quote, hang out in their joints.
00:26:26
Speaker
and that this hanging out in joints can cause misalignment and then also tissue stress and irritation, which can lead to pain. So my question is, what are your thoughts on this train of logic?
00:26:38
Speaker
Do you feel that hypermobile people need posture correction more than non-hypermobile people for the prevention of pain? Is it the case that while there may not be a relationship between posture and low back pain for the greater population as a whole that this doesn't apply to hypermobile people? What are your thoughts? Sigh. um
00:27:02
Speaker
so no ah Face palm emoji. yeah This is one of those things where like I want to be clear that like if you're hypermobile, you do often have a lot of like weird physical problems that the average person is not dealing
Posture, Pain, and Strength in Hypermobility
00:27:21
Speaker
with. And we do seem to have a greater propensity for pain and all sorts of issues. So like this is not me saying that those things are not happening. But when someone makes a post like this, they make it sound like we're a different species. like We're not humans.
00:27:37
Speaker
like and And the thing I always I'm saying is like I'm like, yeah, our connective tissue might be different, a little different, but like we still have like muscles and bones and systems of the body like not everything is different. It's just more of I think we are more likely to have in my sort of observation a heightened response to things.
00:27:59
Speaker
And so I think that, again, we can look at this through a lens that's um maybe a little bit less, I'll just say, dogmatic. So when we, you know, I think one of the nuances, I'm sure you've covered this at length, right? Is that like, yeah, we know that like posture and pain don't correlate well.
00:28:19
Speaker
And we know that repetitive positioning without a lot of strength and control can be very uncomfortable or create an experience of pain for an individual. But that particular position or posturing that like we aren't tolerating well will vary from person to person.
00:28:36
Speaker
And this is still true for a hypermobile human. I think that in the case of hypermobile humans, we have more range to control. We often have perhaps more ligament laxity. And so we are going to have to be that much stronger and work that much harder to control our range and to control our posture and position. And so I do think that that sort of puts us in a situation where we might be more likely to adopt a repetitive position that can be uncomfortable. And then when you combine that with sort of this increased sensitivity ah to right to to exercise or to movement or to positions that might elicit an experience of pain, that's going to be something that we have to account for. right I think there's a lot of factors going into why we're having pain, but I don't think it's as simple as, well, you you have lumbar hyperextension, therefore you have back pain, but you only are going to have back pain with lumbar hyperextension if you're hypermobile. You're not going to have it if you're not hypermobile. That doesn't make sense.
00:29:32
Speaker
That's just not logical. It doesn't make sense from a biomechanics perspective. It doesn't make sense from a tissue loading perspective. It doesn't make sense from a pain and science perspective. like It's just not very logical. So like would it be interesting to see a study on hypermobile individuals in back pain? Sure. But I think that posture education, if they felt better afterwards,
00:29:53
Speaker
is probably for the same reason that most people do. It's because they're adopting new positions. They're stronger in more positions. They have more movement options. They have greater tolerance to holding different positions. And all of those things are going to, right, they have better control over the range of motion. And all of those things we know are going to decrease the experience of pain, but it's not because you quote unquote fixed your alignment.
00:30:15
Speaker
does that make sense yeah total sense yes hypermobile people are people yeah i can't believe i have to say that i don't know who this influencer is i was like oh is this a game of guess the influencer i'm assuming they're not a clinician but what i would say is as far as like a No, sorry, I'm laughing because Laurel and Nikki are both. They're a polite teacher shaking their heads. No, like no, not a clinician. Not that you can't comment on research if you're not a clinician, but to give this person like the greatest benefit of the doubt, they may be making the point that
00:30:50
Speaker
it can be difficult to extrapolate research to other, you know, quote unquote groups if that group was not included in the initial research. But along that line of thinking, we could also say, well, this then also applies to Swedish lesbian nuns because there weren't any Swedish lesbian nuns in the study. Therefore, it doesn't apply to them either. Right. And so it's sort of using that parameter is using that sort of like idea from research, but using it in an incorrect way. I don't know if we know this, and I don't think we do, but was it the case that hypermobile people were excluded from all of the studies? Of course not. Of course not. So we are still seeing a variation of people. We just maybe don't have enough information to go, was this or was this not a totally valid point she was making? And I think Sarah has pointed to the fact that, yes, it's valid.
00:31:44
Speaker
research is you know incredibly difficult. to it's It's imperfect. Let's just put it that way. I think that we can we can assume there were hypermobile people then in this systematic review, unless you know maybe they were excluded, but I'm not sure how that would even work. so ye Nicki, one of the things that I noticed for people who have been diagnosed with hypermobility, whether it's an actual clinical diagnosis or whether it's just their movement teacher pointed it out in front of a whole room and now they are scared of it. They've been identified as like having a thing. right and Then sometimes because of that, it sort of goes to my previous question, they're then afraid of things like locking out a joint. like they they They've gotten so fear-mongered around it that
00:32:28
Speaker
they would never dream of allowing their elbows to lock out now because their understanding is that they always have to keep, you know, a micro bend. Is this fear justified? Or is it my fault for scaring my my students when I was a yoga teacher and telling them they had to keep a micro bend in their elbows at all at all times? This, I mean, I probably keep saying this, but like, this is so this is so individualized. And I think that we can educate without scaring the crap out of people and pathologizing things that sometimes are just normal or part of that person's anatomy. And I think one of the really important things about
00:33:06
Speaker
quote unquote, poster or alignment is that it's going to be relative to the individual. So a lot of the time, quote unquote, over correcting, right, I spent years over correcting my terrible rib flare, my terrible forward head posture and my terrible feet. And like, I mean, just everything is terrible, because I'm hypermobile, and I should lie on the ground and never stand up again. Apparently, that's the message I've been given.
00:33:28
Speaker
But truth be told, I had a lot more pain when I spent all of my energy trying to hold my positions in the quote unquote alignment versus just letting myself move and move in lots of ways and work on getting stronger. So I think it's one of those things where if you know that there is a certain position that's going to be problematic for you as an individual, then yeah, I mean, it might be helpful to pay attention to it. But you can't say that as like a sweeping commentary. Again, it it is it just goes back to like, what is that person's unique lived situation? And if they're having pain in a certain position, let's figure out why. Let's let's ask some questions about that versus assuming that something is wrong or something is going to deteriorate or something is going to be wrong forever. I think that that opens a door to inquiry. I don't think that that is some sort of like
00:34:21
Speaker
life sentence that like you right you're going to harm yourself forever. so yeah i'm not I'm not a big fan of microbend this and XYZ that. you know i'm I'm not going to get in an argument about cues because like maybe that works for someone, but but I think that we need to be really thoughtful again about sort of applying this one-size-fits-all idea where we give people a complex about how how awful their posture is. And again, I think we should go, well, how is that working for you? I've scotts i' worked with a lot of people who are like me. They've got really stiff thoracic spines. And maybe they have, oh no, a hint of a rib flare. But like it turns out that you can work on your thoracic mobility without ever saying the words rib flare. You can just you you can just look at someone. I know. You can just look at someone. And instead of going, oh my god, doesn't your back hurt? You can go, hmm.
00:35:11
Speaker
How does rotation feel? And then you can try a rotation exercise and then you can ask them how their back feels afterwards or how their body feels in general. And you never have to say the words rib flare. It's amazing. I don't know. I might have lost the thread there.
00:35:26
Speaker
No, I don't think you did. Yeah. I think um we can only blame ourselves slash any other buddy, any other buddy, anybody else who consciously or unconsciously have sort of labeled something on a, I mean, I think we just run into that problem globally. I see this in the clinic with patients who come in and they're like, my doctor said I have the neck of a 90 year old. And I'm like, well, what, what good was that? Because now you're just afraid. So this thing of like, we're putting the fear in people.
00:35:55
Speaker
about hyperextension or hypermobility that does not need to be there. like They may have no had never thought about it, and then suddenly now it's all they think about. Yeah. It's like giving someone almost like giving someone who may be more susceptible to pain, right which you mentioned is like one of the tricky things about hypermobility is there's some weird stuff that kind of crops up in the body. and hypermobile people might have to deal with a little bit more discomfort and pain and whatnot and and other symptoms that arise from their hypermobility. But it's almost like then in taking someone who we believe is hypermobile or they've received this diagnosis formally from a doctor, we almost give them a complex about it where we're like, okay, you're hypermobile. Therefore, we have to make you hypervigilant at all times of where your body is in space that you don't feel that pain. And in so doing, we actually potentially
00:36:49
Speaker
make it more likely that they're going to have pain because we know that one of the ways pain works is that when we expect to be in pain, we're more likely to experience pain, right? These are no SIBOs. And so even though these postures and positions that this hypermobile person can do with their body might be completely harmless to them, now suddenly we've communicated to them that they're not safe there.
00:37:11
Speaker
that they're not safe in their body that they must always be watching and always be protecting themselves and suddenly they're just walking around in a minefield of like potential disasters and what a place to be mentally and like I would hope that as teachers we wouldn't want that to be the thing we're teaching but I see online And just the way people talk about hypermobility, it's been so deeply problematized. And I'm not hypermobile. So I'm actually you know not one to talk about, from a personal standpoint, what what it's like to be hypermobile. But what I can imagine is that if I were hypermobile, this would just create another challenge for me. And additionally, what I would like to suggest is that, OK,
00:37:58
Speaker
Correct me if I'm wrong, okay because again, I'm not hypermobile, but it seems to me like there might be some like positives to being hypermobile, some upsides to being hypermobile. and like I'm not saying that we need to exploit those or be like, oh, you're hypermobile, so put your you know put your leg behind your neck because you can that's not what I'm saying. What I'm saying is that why is it couched as such an inherently negative thing all the time and why do we treat it like it has to be constantly micromanaged i mean i'm sure it's coming from ah a place of empathy with teachers wanting to keep their students feeling good but i think it has the opposite effect and i think that we can start to maybe rethink our attitude toward hypermobile students is being resilient is being capable of learning capable of getting stronger capable of healing
00:38:43
Speaker
capable of building capacity and kind of let go of this narrative of it always being about being unsafe or you know needing to protect and and be hypervigilant.
Strength Training Benefits for Hypermobile Individuals
00:38:54
Speaker
I think if we just shifted our attitude toward hypermobility in this way, we might actually be able to help people more. What what do you think? I mean, I'm not hypermobile, so i'd love I'd love for you to give me a little feedback on that.
00:39:05
Speaker
i I mean, I think it's one of those things where if you are a symptomatic hypermobile human, it does impact your life. It impacts your exercise life. It impacts your day-to-day life. like it even Even if you don't realize that you're a symptomatic hypermobile human, I started showing signs of dysautonomia. I don't have a POTS diagnosis, but it's probably POTS. When I was 13, I whacked my head on a locker and passed out. And they were like, oh, well, you're a teenage girl. Maybe you forgot to eat lunch. And no one did anything about it. And I went to my mom, who also probably has undiagnosed same issues as me. And she went and my mom's a doctor, by the way. Sorry, mom, if you ever listen to this. But she went, oh, yeah, in our family, we pass out. Sometimes that happens to me, too. And then I thought that was normal. I just thought that sometimes you pass out if you if you have my genetics and then you should just sit down.
00:39:59
Speaker
so
00:40:08
Speaker
touch Like to say that like around like basically with the whole world swimming with the blood pressure of a corpse until I was like 36 years old because everyone just said That seems okay.
00:40:27
Speaker
And then I finally went on medication to raise my blood pressure. I was like, wait, people feel like this all the time. You don't always see spots. The the room isn't always spinning. You don't have to find a wall if you if things go a little gray. This is wild.
00:40:41
Speaker
so this isn't like this is who knew, right? Like it was like it was like a brave new world. So I don't want to like minimize that these problems are happening. But I think that the problem is is that we have very real problems that are being minimized. And then sort of benign issues may or may not be a problem. and And they're the thing that everyone just like puts like a big magnifying glass on and And none of that is accounting for the individual experience. And so I think, again, instead of making direct like, again, we can provide guidelines or considerations or things to try. If you're struggling with this, try that. Maybe this will work or that'll work. Right. But again, I think it's all in the presentation instead of just being like, well, obviously, that's the problem, because you should probably ask the person if they think it's a problem before you assume it's a problem. And you should probably ask it in a way that doesn't
00:41:35
Speaker
make it sound like you think it's a problem because you have no idea. Does that make sense? Oh my gosh. Super clear, super illuminating. I think that this mismatch between how hypermobile people are treated in the medical system versus how they're treated in a movement classroom is really touching on what I feel like before now I wasn't able to articulate, which is that I understand that it's a struggle, and I understand that they they need extra help. But are we helping them in the movement classroom by problematizing all these things about their body that, like you said, Nicky, we don't even know if that's a problem. It's not inherently necessarily a problem. So yes, very clear. Thank you.
00:42:18
Speaker
All right, next question. There's this idea out there that hypermobile people should keep loads light and movement very slow always when strength training. And that this will be just as effective for them and safer for building strength. So Nikki, do hypermobile people need to strength train differently in your opinion? And do you think advice to keep weights light and movement extra slow will help them to build strength?
00:42:44
Speaker
um I do think that we need additional considerations to strength training. So, again, I think what's tricky about this or worth considering is that, like again, we might have a whole assortment of issues. I believe there's some research out there suggesting that we have may have a harder time putting on muscle, though I i kind of wonder if maybe it's because of the way we're encouraged to train. I don't know.
00:43:07
Speaker
right i I truly don't know. but But I think the thing that is important to note here is that our bodies are still going to ah adapt and respond to load and and into loading principles. So like exercise science is still exercise science in a hypermobile body.
00:43:26
Speaker
the the wrench or the additional set of considerations is how are you introducing the load. And I think one of the things, one one of the biggest myths and one of my biggest frustrations out there is that we're told do high rep, lightweight. And when it comes to, again, some of the things that we've struggled with oftentimes as hypermobile people, maybe not all is going to be excess fatigue, excess soreness, heightened right just heighten sensitivity to exercise, even if you don't have a diagnosis of something like chronic fatigue syndrome. And one of the real ironies is that the things that often cause that soreness or that kind of, quote unquote, pain response to exercise is actually novel movement, so doing lots of different new things.
00:44:15
Speaker
and doing high repetition. And then on top of that, if you if the load is really light, like because we can't feel where we are in space, because we often struggle with body awareness or proprioception, we can't even fully control our joints. So when you give someone when you have someone do a high number of repetitions with a light load,
00:44:37
Speaker
they're more likely to be sore, they're more likely to have pain, they're less likely to exhibit good muscular engagement and control because they can't feel it, versus if we gave that person, again, I'm not saying a heavy weight, especially right off the bat, but if we gave them enough resistance that they could feel it, and we had them do a very low number of reps because there's a lot of fear and because exercise tolerance is often an issue, they would actually get a much better result short term because they would be less likely to be flared, they'd be less likely to have pain, they'd be less likely to overdo it, they'd have much better control. And then we slowly stair stepped it up. Then starting with this idea of basically doing everything in a high rep, low load, which is just kind of a recipe for constantly being in a revolving door for feeling bad. so
00:45:22
Speaker
it To me, it's just, it's ass backwards. It's just not how I would go about it with things. And so again, I think the thing, the one thing I want to add to this too is that a lot of the time as a hypermobile human, what you find is your your capacity or ability to lift something or do something is significantly greater than your body's ability to, your nervous system's ability to tolerate it and your body's ability to recover from it.
00:45:47
Speaker
So when you are introducing strength work or exercise in general, you want to start by meeting that window of tolerance, not the window of capacity. And that might mean that you're doing what feels like very, very little and you're just you just add a little bit at a time. And there's a fair amount of actual repetition. This is why strength training is helpful, where you might do the same thing. And then if you weren't hypermobile, you'd probably want to do this right for at least four, six, even eight weeks. And you just stair step up the weight with the same exercise. And that is going to start to close that sort of gap between what you can tolerate and what you can physically do. And over time, that gap can become much smaller. And that is my preferred way to look at it. That is my preferred way to work with people.
00:46:32
Speaker
And I don't mind someone starting with a three pound weight. If the three pound weight is the thing that's not scary and they're willing to use a three pound weight, I am all on board for a three pound weight, but we're doing three pound weight for three to six reps. And then when they feel comfortable, they can use a four pound weight and a five pound weight and a six pound weight. I'm not going to start them with like these really high rep situations because it's not effective and it's more likely to feel bad and there's nowhere to progress from there. Does that make sense?
00:46:58
Speaker
Yeah, yeah that's that's interesting. I find it very challenging sometimes as a strength coach to pull people back. And so I imagine that you run up ah you know against some personalities where that's where that's challenging. But you really can make ah quite a big change with much, much less than people expect. So yeah, that's that's some solid insight. High rep, low load.
00:47:21
Speaker
very counterintuitive causes more muscle fatigue. But it also, I mean, as you were talking about that, I started thinking about how, let's say just if we can all sort of imagine a generic position, let's say you're lying on your back, you're holding a weight straight up from your shoulder, right? So 90 degrees of shoulder flexion. And that's part of I don't know, some exercise that you're doing.
00:47:42
Speaker
If we think about one of the challenges that people who have hypermobility deal with, one of them is that poor proprioception, that difficulty feeling where you are in space. But we also know that the joints themselves are one of the areas of the body that contain a lot of proprioceptors. And if we want to feel them more, if we hoiked that dumbbell up to 10 pounds instead of three pounds, even without moving, that person's going to get a lot more feedback into the joint.
00:48:08
Speaker
of where they are in space. So from a sort of scientific clinical perspective, for some, I mean, I'm not saying that person should then like stand up and try to do, you know, full shoulder range of flexion ah with a weight that's too heavy for them. But I think there are times and positions where just for the for the mere sort of feedback effect,
00:48:28
Speaker
that going heavier with someone with hypermobility makes more sense than going lighter. But I think we're all sort of conditioned to believe that like, oh God, they can't tolerate anything. So, you know, three pounds forever. And your point about like, yeah, we start there, but we progress, I think is the important part that a lot of people miss.
00:48:44
Speaker
and And furthermore, a lot of it is giving the client or the individual the autonomy to decide what they want to do, right? Asking them, what do you think would be a good starting point?
00:48:58
Speaker
and just presenting them with options and then letting them evaluate what do they feel safe and comfortable doing because everyone has a different tolerance for like even what they're willing to try or test or what feels quote unquote safe. So like Laurel, you are like, that must be hard for some clients. Actually, most of my clients are great. They completely appreciate and understand why we're slowing down. I am the bad client.
00:49:22
Speaker
In case anyone is wondering, I am that person, right? I am that person. And, you know, we we could call me a bad client, but also that willingness or that missing that common sense fear factor is actually what's allowed me to move forward after moving backwards because I don't really have that fear. I'm like, oh, yeah, that might go horribly wrong. Oh, that went horribly wrong. What can I do different next time? Right. Six times later. Right. so Again, I think that so much of this just comes down to working with that person's comfort zone, but not limiting them, not sticking them in a box like, this is all you're going to be able to do forever. I'm like, cool, we have a starting point. You can lift three pounds. Nikki, I think you've said, don't banish people to the pillow fort.
00:50:06
Speaker
yeah well Like, and again, then people think I'm anti-props and I'm like, no, if someone, I use props all the time. If someone feels better with a prop, we're using damn prop. But I don't assume that they're, they have to use a prop. I don't assume that they're always going to need to use a lightweight. I don't assume that they're not capable of something. I just go, I guess what I do is I look for people's strengths.
00:50:29
Speaker
i look for where we can kind of hyper mobile people were constantly told what's wrong with us and i'm like well what's right you're willing to try what's right okay you can't lift thirty pounds can you live five great you're doing it you're showing up you're trying something right I think that so much of it is just we need to shift our perspective from like what's wrong with you to how can we make things possible and how can we include the right considerations to make things possible so you can be successful and so you don't have to be so afraid or in pain all the time or in pain to the same level that you are right now. Hell yeah.
00:51:04
Speaker
Yeah. If we're continuing on this topic of strength training, what are some ways, and we we all hopefully know at this point that strength training and weight lifting weights, heavy lifting in particular, very useful for women. I mean, useful for everybody, but useful for women, especially pre, during, and postmenopausal, et cetera, et cetera. But what are some of the benefits that you see that are specific to people with hypermobility as far as gaining, like really gaining strength?
00:51:31
Speaker
Yeah, I mean, I would love to see more studies on this because so much of what I have to say is anecdotal from my own experience and from just working with so many clients over the years. When I started strength training, I wasn't expecting my pain to get better. I was kind of in this state of like, I was just tired of being put in a pillow fort and told I was dysfunctional and everything was wrong with me and being obsessed with posture was like, you know,
00:51:52
Speaker
It just wasn't doing anything for me anymore. So I was like, screw this. I'm going to go do something. I'm going to go do the thing that everyone told me not to, because that's kind of my personality type. um and And I just I didn't really know what I was doing. I bought a program that based off of all the recommendations I just gave was completely inappropriate for hypermobility. And I think what's interesting is it's dis they had like a million reps of things. It still worked after like three to six months. I was like, huh,
00:52:20
Speaker
I no longer wake up unable to turn my head to the left every two weeks. like i know I no longer have this weird hip pain if I accidentally step off a curb with a locked knee. and like i just All of this niggling stuff that I've had for years and years and years just stopped being so niggling and I was like, that's really interesting.
00:52:40
Speaker
And so i think I think a lot of what it does for us is I think on a neurological level, it's constantly giving your brain feedback on where your joints are, which I think that creates a sense of safety in the nervous system. ah We also know that it increases your tolerance. So you're just you're going to be more tolerant of different positions.
00:52:59
Speaker
in day to day life and what you're doing. So I think that just even without the strength piece, just that neurological input is very, it it's very secure, it helps us feel where we are, and it increases our ability to sort of withstand various
Managing Hypermobility: Strategies and Insights
00:53:12
Speaker
loads. I think that, you know, we know that like your ability to increase your strength output is going to be your it's means that you can then kind of hang with stuff in your daily life. You're less likely to feel like it's not that you're never going to have a problem again. I still have all sorts of dumb joint issues from doing nothing, but you're a lot less likely to like have this weird elbow shoulder neck thing because you decided that you were going to take every piece of laundry you hadn't done in three weeks, put it all in the same basket and drag it down two flights of stairs. You're just less likely to suffer after that.
00:53:42
Speaker
So I think that like that proprioception, that joint control, I think that just on a psychological level, there's something incredibly power empowering about being able to do all these things that everyone told you was wrong with your body. I think that if you're like me, and you didn't grow up being necessarily a terribly athletic kid, I'm not super coordinated, which I learned is also probably part of the fact that I have very long limbs and very floppy joints, right? I'm like, huh, I can actually build this skill. I'm not I'm not going to win any power lifting or any coordination, you know,
00:54:14
Speaker
competitions anytime soon. When I move quickly, I still kind of look like a bunch of popsicle sticks that are just flying through space. But like, at least I can do these things now. And I can do them without being so afraid of hurting myself. You know, I mean, I i look I look wild doing power work, right? It is not it is not pretty. So to your point about going fast, I think that you should only go as fast as you can control. But I will say that I still look pretty goofy doing fast movements. It's a it's a wild ride.
00:54:42
Speaker
Well, what's interesting about, as you were talking, I just kept thinking about like hypermobile people are people too. That all of the things you are discussing is also what happens to everybody else who starts yeah strength training, right? They're weird aches and pains go away. They are getting the confidence to be able to do things that they've been told that they couldn't do.
00:55:02
Speaker
maybe they still look crazy when they run, but it doesn't hurt, you know, or whatever, right? It's like, these are not exclusive gains that only people with hypermobility get from lifting. This is true across the board. Yeah, so it's just less apparent to most people that it's also true for hypermobile people.
00:55:20
Speaker
Right. Right. Which unfortunately prevents people who have hypermobility and potentially stand even more to gain from strength training from strength training. So it's a real shitty thing that that's the message. Right. I mean, I think the other thing I will add is that.
00:55:38
Speaker
You will continue to be hypermobile even as you get stronger and you may continue to need certain considerations so like you will possibly again everyone is different you will possibly still respond more favorably to lower volume or doing shorter workouts, but high quality work. So like appropriately challenging load, but maybe not as many exercises so your body can recover. That sort of thing. um You might still need to do things if you have dysautonomia or POTS or the static hypotension. You probably are going to have to kind of have like a flare plan or like adjust your program for bad body dates. like These things are still going to continue to be very real.
00:56:20
Speaker
But at the same time, you're still going to get all, to your point, all of the benefits of exercise as anyone else. And generally speaking, the stronger you are, the less you have to stress about some of the joint stuff. So a lot of that other crap is still going to happen. But I find that once you hit a certain threshold of strength, a lot of that joint stuff stops feeling like such a liability. Cool. Yeah.
00:56:46
Speaker
As I said, I'm not personally hypermobile, but I have come to understand, and this is pretty counterintuitive, that people with hypermobility tend to have a good bit of tightness. and This is often surprising to us non-hypermobiles, because we assume if someone is really bendy, they couldn't possibly feel or experience tightness. And isn't that amazing? Right. ah So anyway, my question is, is this true? Are they tight? Are they more tight than non-hypermobile people even? And what do you feel, Nikki, are the best solutions for alleviating this tightness? Should they just stretch more?
00:57:20
Speaker
I mean, the first question is what is tight? Tight, I think is a, it's it's a descriptor. It's an experience. So I think that we may have more joint stiffness at times next to the areas that have maybe the most joint laxity or hypermobility. So it's not uncommon. And again, you see this presentation and just non-hypermobile people too.
00:57:44
Speaker
But like you know I've got a neck where like I can turn my head like the exorcist and I've got a thoracic spine that's like a steel vise. That is most likely my brain trying to create a sense of stability where there isn't any. right so Can you have genuinely stiff areas of your body? Absolutely.
00:58:04
Speaker
And can you feel extraordinarily tight in areas that have very large, that are capable of very large ranges of motion or hypermobile? Also true. And that's what's tricky about it. So, you know, I mean, I think we've all had that experience as a teacher where we have someone come up to us and go, my hip flexors are so tight. And then they go into like the biggest, like back bendy, over split quad stretch thing. you've got I'm not a yoga teacher, but like, right. they they They like put themselves in a position where you're like, huh.
00:58:33
Speaker
Okay, that feels tight they're like all the time and they're like rubbing their hip flexors, right? So like, I think that experience is real. i think it does so I think it can feel very tight and it kind of makes sense because I think we have a lot of sensitivity or sensitization where we sort of often sometimes hang out in N range.
00:58:50
Speaker
And I think that the reason why we love stretching is like it it it has kind of right it it's a sensation. It feels good. And so I'm not necessarily anti-stretching, but I think hanging out at N-range without muscular control generally isn't going to feel good for most humans long-term. And I think that if you are looking for a better long-term solution, so like short-term ah We know that like massage, like if done you know not where they're hammering on you but in a thoughtful way or ball rolling or foam rolling or maybe even some sort of dynamic mobility work, can have an analgesic effect. It can kind of maybe feel good or calm things down. and and I'm not against those things right if those tools help you feel better and they make things feel a little bit less sensitized.
00:59:35
Speaker
but long-term It's just not to hammer, keep hammering this, but like strength training really is a much better solution. And it's because when we are able to control our ranges of motion, they're just generally speaking less likely to feel quote unquote, tight. And there's probably a number of reasons why that is. But I would say that stretching is probably possibly a poor short term solution may have a mild analgesic effect, probably a poor long term solution that isn't going to get you very far.
01:00:08
Speaker
Yeah, yeah i ah for me, I experienced less tightness once I was stronger and I thought of it like my brain giving me now the green light on movements that prior to being stronger felt warranted more of a red light because it You know, I'm anthropomorphizing my own brain, but it was like, my brain was like, no, no, no, no, you're not ready for that. So red light, tightness, tightness, tightness. And I experienced, you know, strength creating for me, not even more range of motion in a lot of respects, but more pain free range of motion as well. All right. There's this idea out there that we can stretch or strengthen the wrong muscles with mobility or strength training and that
01:00:53
Speaker
especially for hypermobile folks, in order to reduce this tightness, whether it be through you know stretching, massage, strength training, it's really about getting it right. So that means strengthening the right muscles and not the wrong ones.
01:01:08
Speaker
What do you think about this idea that we need to strengthen the right muscles in order to reduce tightness effectively for hypermobile folks especially? I said this before, sigh. um No, so it's one of those things where I think that sometimes these models, um right? It's a model, this idea of you're going to use bigger muscles, local, and you know, what what what it what is it? Global mobilizers versus local stabilizers. I can go back in my old Pilates teacher brain, dust off those cobwebs. i think I think it's a model. And I don't think that models are inherently but bad, but I think when we start talking about things in a way that is inaccurate and scares people out of moving and gives them a complex, that is not good. So I think a better way to approach approach this is to go, well, first off, acknowledge that sensation is a crapshoot. You can use something without feeling it. You just, you can. So especially if you're someone who has, you know, some issues with proprioception and body awareness, trying to chase a sensation is a really frustrating way to go about doing things. So my preferred way to look at it is like, what position are we trying to help you be stronger in?
01:02:21
Speaker
And what movement constraints do we need to create to help you be in that position so you can feel more of the muscles that you are trying to feel? And that's not about good and bad muscles. That's just about going like, huh, you really feel X in this position, and we'd like you to feel more Y, perhaps, or you just don't seem to get in that position as easily. So let's figure out how to get you there.
01:02:44
Speaker
Right, so i think ah I think a good example is let let's go with like the upper trap. The upper trap is apparently you're never supposed to feel the upper trap. I hope everyone can tell what sarcasm is here. oh Right? but But it is true. People can have genuine discomfort and even pain in their upper traps. And i ah I notice a lot of the time there's then also a lot of fear around feeling it. So we've got kind of a fixation on what we're feeling and fear around feeling it, which means we're more likely to feel it and more likely to feel bad afterwards, which is not a good combination.
01:03:18
Speaker
And so if I have someone, for example, doing a row and I'm watching them, I'll often see one of two things. They are either shrugging their shoulder in the row, so they've got more upper trap recruitment. And then we can have a conversation about trying to find a different position where maybe there's a little bit more joint centration. So yes, they theoretically may have more rotator cuff, but I don't need to say that. And they might feel more of their back and they might feel less of their upper trap, right? So they're just getting stronger in a different position, so they're not repetitively using the other one as much.
01:03:48
Speaker
Or conversely, I might have someone who has been told to pull their shoulder back and down and into their back pocket for the last 10 years. And that person is actually has their shoulder so locked down that all they feel is their upper trap because their upper trap is in constant stretch. And so in that case, I go, what happens if you don't do that? And then their shoulder shrugs a little higher relative to where it was. And they're like, oh, my I don't feel my upper trap nearly as much.
01:04:13
Speaker
And so, again, I think that sensation may or may not be information, depending on the context. But I don't think it's about good and bad muscles. And I don't think it's about having, I love this idea that certain muscles are overly strong, right?
01:04:30
Speaker
i find think that's a pallati thing i so I find that seldom do we have overly strong muscles. Usually what we're missing is some sort of global strength or we're constantly doing exercises that are causing us to feel that quote unquote overly strong muscle, right? Like if you lie on your back with your legs and tabletop,
01:04:50
Speaker
And you don't do, so particularly if you don't do strength training, you are going to feel your hip flexors and not just your core because you are in hip flexion. And so telling someone that they shouldn't feel their hip flexors is a pretty wild ride to me because yeah what else is going to hold their legs in that position? Of course you feel your hip flexors, your hip flexion, and you're there for 40 minutes depending on who's teaching the class.
01:05:12
Speaker
You should definitely just go lie down and atrophy those guys because they're too strong. Or just stretch them. You just need to stretch them. right Or that. or that stretch yeah That will that will like basically drain the strength out of them. That's right. So Nikki, you mentioned before the idea of you know hypermobile people, even if we do all of these things that are going to be helpful, like strength training, that you you're still going to have your symptoms sometimes. You're still going to have flare-ups or what you've called bad body days.
01:05:42
Speaker
What are, can we, I would love for for anyone who's hypermobile and listening and just like nodding their head and like, yes, but what do I do? Are there strategies that you give to your clients that you can share here, sort of global strategies?
01:05:57
Speaker
Absolutely. And I would say I'm going to give more of a framework of how to create your own strategies than prescribe strategies, because what I do will not work for everyone. And like it that there's just a lot of ways to go about it. So I think a better way to think about this is Again, our problems are real. And when we are in the middle of hanging onto a wall and we have horrible brain fog and all these things are happening or we have a pain flare, it's hard to decide what to do. You don't have the mental resources. And so I think it's helpful to think ahead about what you want to do. So for example, you can kind of think about it like red, orange, green. So you can think about what what would my movement routine, what would my exercise routine look like?
01:06:43
Speaker
on a green light day. Everything feels good. Everything is going well. I also might have a tendency to overdo it. So I'm going to plan not to overdo it. I'm going to think about what my Mac should be too. But what what would that day look like? And then you can go, OK, what are some scenarios where I wake up and I'm a little off and I can expect X, Y, and Z symptom? What should I expect from myself? How might I adjust my strength workout or my general workout?
01:07:08
Speaker
Maybe I will walk instead of run. Maybe I will do only half of the exercises. Maybe I will do the workout, but I will do it with lighter weight than normal. right Whatever it is, you have to decide like what is your capacity. And then you go, all right, what is what am I going to do on kind of that red on kind of that red day where it's like it's just I'm flared? and And your decision ahead of time might be to be like, it is in my best interest to do nothing.
01:07:33
Speaker
or it might be like I actually feel best if I just do a little bit of like rolling or breathing or you know, stretching or whatever, right? Like maybe I have some sort of like little routine to feel good. And so I think it's, I think it's helpful to think about it like that and then to give yourself permission to acknowledge that your problems are real and there might be times where not doing something is the right answer. But I think if you can think about the situations that most commonly occur and then you can decide ahead of time how you want to handle that, that is the way to go about it. And you can do that with anything, right? I also do that with like,
01:08:08
Speaker
meal planning. like if i If I have a week where I'm like, oh, I'm underwater, ah you you better believe that rotisserie chickens and Trader Joe's, this is like my go-to. I'm not cooking things from scratch. Are you kidding me? so i think that again I think it's fine. I think that when you're hypermobile, you wake up every day in a different body, and I think it's good to have a plan to navigate the world with whatever you body body you wake up with. And then if the plan you make doesn't work,
01:08:33
Speaker
then note it and then adjust it and until you have something in place that actually kind of makes sense for you. I think that's fantastic. I have patients who are hypermobile and have you know the the sort of more extreme host of symptoms, EDS you know diagnosed or not, where The fear of flaring is so kind of like preeminent in their mind that it makes them fearful of almost all movement, which we know ultimately is not going to be helpful. So if I have someone who you know has had a week of
01:09:09
Speaker
red light days and all they've been doing is lying down. I do my best to kind of convince or coach or help them you know move on to like, okay, well, let's try just walking around your house or or to get them to get them out of that fear place.
01:09:25
Speaker
Do you have strategies that you use that are effective? First, it's helpful to acknowledge the fear, right? So i think that I think that when we have that level of fear, the thought becomes very, very in intertwined with us and kind of our identity in a way. And so I think one of the first things that can be helpful to do for yourself is to sort of go, OK, is this ah necessarily like a cold, hard fact?
01:09:53
Speaker
that if i do if I do anything that it's going to be worse, or is this more of like, my brain is telling me that if I get up and walk around my house, I'm 100% going to feel worse. And then you can sort of go, well, is that thought true? And is it helpful? And I think at that point, I think we can all agree that thought's probably not helpful.
01:10:17
Speaker
And we don't know if it's true a lot of the time, right? Our brains like to try to predict the future and our brains are just terrible fortune tellers. And so I think that sometimes just separating that out a little bit can be really helpful and then sitting with that and then, you know,
01:10:34
Speaker
deciding sort of playing out scenarios and then deciding what you think would be self-serving. Like, okay, maybe I'm just going to walk in a circle, sit down and check in with how I feel in 20 minutes. Like you can pick some really, really small action. Again, I think that everyone's comfort zone is going to be different. I don't think we should go Rambo on our nervous system and I don't think we should discount the feelings that we're having, but I think sometimes it's helpful to sort of just try to create a little separation between ourselves and our thoughts because I don't know about y'all, I can tailspin into some really unhelpful thoughts sometimes that don't make a lot of sense if I were to look at them 24 to 48 hours later because I'm in that kind of stress state. Does that make sense? Oh, yeah.
01:11:19
Speaker
This next question that I wanted to ask you kind of you know dovetails off we were talking about, it seems like for a lot of people with hypermobility and possibly because it's been so fear mongered by a lot of people in the fitness world. It seems like at least for a lot of people who have had struggles with things like exercising or lifting weights, that ah if you have this hypermobile identity, it conflicts with the idea that you could be fit or strong. like Like, I'm broken. I can't do this. You know, I'm weak. I'm always going to need considerations. Can you speak to that a little bit? Yeah. I mean, I think, right, it can be, it can come at you from all sorts of angles. It can come at you from like, yep, I was a really unathletic kid and oh, now I know I have hypermobility. And so obviously none of this is in the cards for me, right? And that, that can create a lot of limitations because we just were like, well, if it's not for me, I probably shouldn't try, right? That can kind of create a situation. There can of also be um a
01:12:18
Speaker
mourning of a loss of identity if you were an athlete and you were really active and now you've had several years of problems and you're like, right, I've lost this athletic identity, these two things feel in conflict, or you can it can it can be I think for me, where it's been an interesting challenge is that like, I'm like, I am someone who does things, I'm going to do them. And I'm probably going to do them hard because I did it's a bit of a personality type. And then that conflicts with my hyper mobility identity, because my my brain might be like, we are
01:12:50
Speaker
we are go, go, go and my hypermobile body is like, uh, sit down, bitch. We got things to contend with, right? Like they're just not on the same page. They're not my brain and my body do not agree a lot of the time. And so I think that we have to consider things from like multiple perspectives. So like,
01:13:08
Speaker
You can be someone who is hypermobile and you have considerations and you are going to honor those considerations of your hypermobile identity and needs. And you can be someone who can aspire to do hard things and you can work up to doing harder things while also respecting that you have some real issues that you need to contend with and consider. And so I think that it's possible to sort of look at it from both lenses and go, these two get to exist together. How can I make choices that both make me feel like that, quote unquote, athletic identity, if we're going to look at it from that perspective or that capable?
01:13:44
Speaker
identity. And and what what am I going to honor from my hypermobile side? Because I know that it ignoring it is not going to be helpful and is actually not going to help me reinforce some of these other things I want to be doing. Right. I love that. Both and. Yes. How or what do you hope changes about education, particularly around fitness and strength for hypermobile folks that you feel needs improvement out there?
01:14:13
Speaker
in social media land. If you could wave your wand, what would change? I think that, like, how do can I say this constructively? I think it's one of those things where I would like us to take a less dogmatic binary approach to this, where we can acknowledge that these challenges, these symptoms, these experiences are all very real and legitimate, and we shouldn't ignore them or dismiss them or pretend that they're not happening.
01:14:41
Speaker
and There is the potential to be able to do things. There is the potential to be able to do more, to get stronger, that we will benefit from strength and load, that we are capable of challenging our bodies if we build up to it thoughtfully, that everyone is going to have a different capacity but that we all have the potential for some level of capacity and doing the things we want to do in some way, shape or form.
Conclusion and Listener Engagement
01:15:04
Speaker
And I think that is what's missing. I think everything is just very prescriptive and and and just filled with weird rules that are not helpful, right? Do this, not that. And it's like.
01:15:14
Speaker
For who? Why? How long? Right. So I just wish that we took more of sort of an education approach and an empowerment approach of sort of like if you're struggling with this, here's some ways to try to look at it or do things instead of just being like, yep, you're broken. Everything's terrible. You should probably lie down. Definitely be afraid. Like I just I just don't think that's a helpful way to teach. I just don't, you know. Yeah. Amazing. Last question, which is where can people find you?
01:15:43
Speaker
if they would like to continue learning with you. And I'm probably most active on Instagram, um if it's a social media channel. So, Natalie V Fitness, go visit the show notes, you'll never figure out how to spell it. ah And then my website is NatalieV.com, which you'll also never figure out how to spell, so go visit the show notes. And I have a couple programs, a beginner one, an app-based one, I do nutrition coaching and other stuff. It's all on the website, but you know just shoot me an Instagram, to DM on Instagram, I guess, if you have a question. So, yeah.
01:16:12
Speaker
Amazing. Oh, and I have a podcast. That might be helpful. Sorry, not to cut you off. um It's called Results Not Typical, and Laurel and Sarah are going to be on it soon, so yeah just wanted to give a shout out for yeah the two podcasts. Amazing. Well, Nikki, this has been a phenomenal discussion. I've learned a lot, and we just love everything you're about. Love talking to you. I crack up at least six, 12 times every time I talk to you because
01:16:43
Speaker
Your rants are amazing. And your ability to articulate complexity in clear terms and be funny and you know have so many different examples to you know convey these these ideas is is just off the charts. like You're an amazing educator. We are very lucky to have had you on. So thank you. Thank you so much. Well, thank you. It has been great talking with you. The feeling's mutual.
01:17:11
Speaker
Okay. Well, that was our interview with Nicki Navalevi. And so for references that we mentioned in this episode, be sure to check out the show notes and friendly reminder that if you're not on our wait list for bone density course lift for longevity, we are launching soon and you want to make sure you're on that wait list because it's the only place to get the sizable discount that we're offering.
01:17:36
Speaker
Finally, if you like this episode and you want to help us out, it does actually really help us out. If you could please leave us a rating, write us a review, subscribe, and or share this show with a friend, share it with the your entire you know contact list, because the more people that know about us, ah we get you know more people listening, more people sharing, the better we feel.
01:18:08
Speaker
The happier Laurel will be. The happier I will be. I just always want to plug the fact that Laurel loves our reviews so much, and I always find out about the review because Laurel texts me about it. So I also really enjoy hearing about the reviews that we're getting secondhand because I don't check it as often. So make people make Laurel happy. Please do. It's so easy. You just write a review. You give it a little five stars. And you say, you know especially just compliments about Laurel. She really likes compliments. No, I'm just kidding. I'm kidding. I'm kidding.
01:18:38
Speaker
But, you know, what we're doing, it's not ah devoid of effort and work and time and energy, you know, and we put it out there for you guys for free. Basically? No, completely for free. We're not paid anything. What do I mean, basically? So we want you to enjoy it, but we wanna get it out there and you can help us do that. So if you've got a moment or a couple of moments or even five minutes, help us, help, help us. Oh shoot, I should have like worked out a, I was gonna be like, like, take Jerry McGuire, help me, help you, help us, help them. Help yourself, help us.
01:19:15
Speaker
Yeah, sure. Help yourself. Okay. So anyway, what's our new sign off? See you in a fortnight? Oh yes, see you in a fortnight. Okay, ready? Okay. Oh boy. See you in a fortnight.
01:19:30
Speaker
I feel like we were kind of on different rhythms there, but it ended well. Just say it say it like you were just going to say it to me. Okay. Okay. I get because it's something I say to everyone all the time. See you in a fortnight. See you in a fortnight. Okay, ready? Okay, ready? Yes, three, two, one. See you in a fortnight. See you in a fortnight.