Note from TG:  Given the special, niche population we work with at Cressey Performance – baseball players – it’s no coincidence that we deal with many athletes who walk in on day one with a preponderance towards being “lax.”

Too, it’s not uncommon to see this in the general population as well, as we’ve also had our fair share of yoga instructors, dancers, and overall “stretchy” (for lack of a better term) people walk through our doors.

It’s a unique circumstance to put it lightly.  Is laxity bad? Yes and no.  For some, being lax allows them to do what they do – and be successful at it.  While for others it can be the bane of their existence. All told if it’s not approached with delicate hands and some careful thought to programming, as a coach or trainer you could be causing more harm than good.

In this guest post by former Cressey Performance intern (and resident breakdanceologist), Miguel Aragoncillo, he dives into this often overlooked (and under-diagnosed) phenomenon.  It’s a two parter, but it’s chock full of awesome information.

I hope you enjoy it!

My own story of hypermobility begins with breakdancing throughout high school and college, and later dealing with it while taking up the sport of powerlifting, and still managing it to this day. I have quite a bit of congenital laxity – in some ways it helps, other times it hurts.

When I worked as a personal trainer for a few years after college, I was convinced that the general population displays tightness due to a combination of work demands, poor posture, and a lack of exercise. This would be illustrated through tightness in their hamstrings, back, and pectorals, and that they would usually need to static stretch in order to decrease that tightness.

From my own time spent breakdancing, I was aware that I was fairly flexible, but it wasn’t until I began reading Eric’s and Tony’s blog that perhaps there was some genetic predisposition that allowed me to slip into certain positions without stretching for hours on end. This point was driven home further after completing an internship at CP in the fall/winter of 2012 last year.

While my time in Massachusetts was filled with pitchers with laxity, talks about glenohumeral instability, and deadlifting to techno (<—- Note from TG:  YES!!!!!!), I discovered that there was more to this self-flexibility observation than I had imagined.

Hypermobility or being congenitally lax involves a series of tests that present themselves in various joints and ligaments due to a lack of specific protein called collagen. In fact, I determined that I was indeed hypermobile through a self-adminstered Beighton Laxity Test.

Personal anecdotes aside, hypermobility affects enough of a population to be documented, namely in those who have African, Asian, and Arab origin, along with youth due to growth and structures not fully developing quite yet. (Chaitow & DeLany).

Concepts Behind Congenital Laxity

Namely, as a strength coach and personal trainer, it comes down to managing the effects of laxity, whether it is taking a pro-active approach through exercise selection or referring to further treatments through a physician’s care.

To break it down, joint stability is a combination of passive stability (think ligaments and tendons), and active stability (agonistic and antagonist co-activation). Further…

“Functional joint stability is determined by the interaction of several factors… joint geometry, the friction between the cartilage surfaces, and the load on the joint caused by compression forces resulting from gravity and the muscles acting on the joint. Of all the factors contributing to the functional joint stability, the load imposed on the joint is one of the most important.” (Lephart and Fu, p15)

Theoretical Approach to Joint Instability

If there is a lack of stability within any movement, there could be several reasons for said instability: weakness of a stabilizer, lack of bony congruency, lack of synaptic signaling from the brain to the affected joint, along with a proprioceptive deficit in said joint.

While each case of hypermobility is unique to the individual, there are a few overarching themes that should be reinforced when talking about stability, namely, co-activation of “agonistic and antagonistic muscles to create stability and coordination for functional joint stability” (Lephart and Fu, pg 15)

Putting this into action would involve proper positioning during exercises that you may be familiar with already: planks, push-ups, rows, squats, lunges, and Tony’s fave – deadlifts.

With hypermobile athletes, there are two points to be made: 1. Stopping a joint from reaching full hyperextension and 2  Encouraging a partial range of motion as variations for beginner athletes. By encouraging a safer range of motion, there will be an increase in proprioceptive feedback on top of increased muscular activation in the major stabilizers of the shoulders and hips. With these tools you can create a safer environment for your athletes, along with adding a more varied exercise selection to choose from at the same time.

To use a common ankle sprain as an example, there is a prevalence for inversion of the ankle to occur. Signals from the brain must be sent to the ankle to provide an equal or greater eversion force to prevent an injury from occurring. “The response (of an ankle injury) is still the body’s dynamic response to a potentially dangerous situation, however, and it seems reasonable to assume that the faster the reaction is, the greater the degree of protection achieved.” (Lephart and Fu, p243)

However, there are a few instances which may present themselves, namely the muscles that must be activated through a conscious awareness of a possible injury from occurring due to an over-inversion of the ankle will be insufficient to react in time.

When discussing injury prevention, the discussion for bracing and taping vs zero bracing is brought to mind. The argument for bracing and taping includes providing proprioceptive feedback from the skin’s mechanoreceptors. These receptors can provide proprioceptive information or may facilitate joint proprioception by increasing sensitivity or motoneuron excitability. (Lephart and Fu, pg.306)

So in regards to the extremely lax athlete, there may be some theoretical benefit to wearing a brace, but at the same time there should be a push towards encouraging an increase in joint position sense during both static exercises and dynamic exercises.

So whether you believe in joint centration and encouraging those activation of joint stabilizers after centration, or utilizing bracing to increase proprioceptive feedback, the end goal should be the same – increase proprioception and re-establish proper stabilization of major joints.

I personally would like to have my cake and eat it too, or food analogies aside, I’d love to see training encouraged in a proprioceptive rich environment, sans the bracing, and after training and outside in the regular world, perhaps wear the brace or taping to help in “everyday activities”. After a period of time, retest various movements and joints by using a variety of stabilization tests or assessments and reassess the plan of action.

With athletes who display  Cirque du Soleil-like flexibility, here are a few drills and exercises that may be more beneficial and specific to helping establish this proprioception that I keep on harping on about, particularly reactive, perturbation-like drills, and finding reference centers for the body.

Managing Hypermobility with Exercise Selection

For lower body reactive drills, progressions involve hurdle hops, single leg hurdle hops, all the way to lateral bounds (or heidens) – all involve “sticking” or landing the movement.

Emphasis should be on maintaining tension through the hip external rotators and avoiding a “knees-in” movement during landing. These exercises can serve as a progression for youth athletes and advanced general population clients, as the cause for knee internal rotation during flexion is increased due to structural variances of passive structures in the knee in a hypermobile population. (Lephart and Fu, p60).

Upper body drills involve perturbations during various drills – whether it is during a static movement such as a quadruped med ball perturbation, or a more dynamic movement such as perturbating a side lying windmill, these are all great variations to use to reinforce proper stability of the humerus within the glenoid socket.

Further, after being exposed to the philosophy along with attending a few seminars held by the Postural Restoration Institute, there seems to be a manageable series of movements that will help encourage viable movement within the hypermobile population.

Speaking with several coaches, physical therapists, and fitness professionals, there seems to be a concerted effort to finding “reference centers” within the body for those who may be “floating in space”, a common feeling for those who are affected by hypermobility.

These reference centers are facilitated through various positional breathing techniques, and a few of these breathing exercises have been referenced by Greg Robins and Eric Cressey throughout their blog. Specifically, these “reference centers include the left abdominals, left ischial seat (sit bone), left heel and right arch.” (-3)

A hierarchy for exercise progressions would be first to develop force in a static or isometric fashion, and from there develop the force through dynamic movements to help increase proprioception in specific stabilizers. This in turn will help to create a protective mechanism within the faulty joint for healthy movement – whether in everyday life or on the field.

And that wraps up Part 1.  Tomorrow I’ll delve into some more challenges facing the “lax” athlete, assessment, as well as provide a unique case study.