Hypermobility and Proprioception: What's with the clumsiness?
I’ve been asked to comment on the concept of hypermobility and proprioception in children (and adults). This is an interesting topic because once again, we have two ends of a spectrum in people with hypermobility. Those who have good proprioception and those who have terrible proprioception….(and then there are those of us who once had good and now have bad proprioception).
So, what is proprioception?
It’s the body’s ability to know where it is in space, in relation to other things. Generally, this is sensed through receptors in and around the joints and the inner ear (vestibular system).
Ever walked into a doorway and swear that it must have moved since last time you walked through it (5 seconds ago!)?
Or stubbed your toe on the same coffee table multiple times in a week or day?
This is proprioception, or poor proprioception to be more precise.
Poor proprioception is your body’s inability to judge where it is in relation to the things around it. With poor proprioception, we are more likely to run into things. Like door frames. It’s also the reason why a lot of people with hypermobility are covered in bruises and don’t know where they came from. They’re so used to bumping their way through life that they don’t even really register the contact with the “environment” unless it really hurts.
What does good proprioception look like?
You will usually see it in athletes - gymnasts, soccer players, tennis players… lots of sports people. They know where their body is most of the time in relation to the tennis ball, the soccer ball, the gymnastics beam. Their overall sense of where they are in space is excellent. They look coordinated and in control of their body. You will also see it in your non-bendy-bodied family and friends. Far less bumps and bruises - oh the bruises!
Their overall sense of where they are in space is excellent. They look coordinated and in control of their body. You will also see it in your non-bendy-bodied family and friends. Far less bumps and bruises - oh the bruises!
The process of proprioception is the same, but the quality of proprioception is different in the hypermobile population. It’s usually not so great in the ones who get labeled as “uncoordinated” or with a developmental coordination disorder (see my next post on this topic!). The body’s position sensors, the receptors which tell us where we are in space, are located inside our muscles, tendons, joint capsules, ligaments, skin (and inner ear). All of these by the way, are made up to some degree of collagen (connective tissue) which we know to be the defective “part” of the hypermobile genetic makeup (hence Ehlers Danlos Syndrome being referred to as a connective tissue disorder/dysplasia).
VERY VERY simply put:
If the receptor is in the ligament and the ligament is a bit lax or stretchy, then the message probably doesn’t get to the brain as accurately or at the same speed as it probably should. If a muscle is working overtime to compensate for a ligament, then maybe the message from the muscle receptor isn’t as accurate either?
And the joint capsule receptor? Well, if they have been stretched & torn from injuries, dislocations, sprains, strains, or just generally banged around by being hypermobile, then the information from them isn’t all that reliable either…. so it’s no wonder people with hypermobile joints can look like an uncoordinated bunch of body parts! The messages just aren’t as reliable as they are for our non-bendy friends.
There are actually whole studies done on proprioception and hypermobility, for example, one study was done by our friends over at The Children’s Hospital Westmead & The University of Sydney on proprioceptive acuity in children when they flex their knee and when they go into hyperextension (you can find the article here).
Yes, rest assured there are researchers trying to work all of this stuff out.
What’s interesting is that generally speaking we can actually train our bodies to have better body awareness. Even hypermobile ones. So, what does that mean? It means taking your child along to a paediatric physiotherapist who can give them exercises that will enhance their proprioceptive abilities. It is one of those things that needs to be practiced consistently. The more they do it, the better they get. The less they do it, the worse they get….unfortunately.
(Groan) Just another thing to add to your ever growing list of exercises?
Ask your physio or OT how you might combine the therapy activities so that you’re doing more than one task at a time where possible; or how to incorporate it into your child’s everyday routine. Kids already have a full-time job: school. Let's try to minimise the overtime they have to do.
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