Hypermobility is a connective tissue disorder with multiple systems of the body being impacted. This includes the joints and muscles. Often this can allow a young person with hypermobility to excel in sports and activities such as gymnastics, ballet, cheer, and acrobatics. Why? Because the joints ‘stop’ point is way beyond those without hypermobility. Hypermobile bodies are unstable in their posture and their instabilities are mistaken as flexibility. This blog is going to explore the impact of instability in the pelvis leading to pelvic floor dysfunction, discuss the differences in hypermobile vs non-hypermobile treatment of pelvic floor dysfunction, and the best route to take if you have hypermobility, EDS, HSD, or mast cell activation conditions.
What Is Hypermobility?
Hypermobility is a connective tissue disorder that is a result of mast cell activation. Mast cells are white blood cells originating from bone marrow found in the connective tissues throughout the body including the organs. Connective tissue is what binds structures together, to form the framework to support the organs and the whole body. Mast cells create an immune response by containing histamine, heparin, cytokines, and growth hormones. So some hypermobile bodies may show hives and allergic symptoms.
Mast cells can become overactive in ligaments and tendons and cause laxity of these structures leading to instability. This can show up as chronic neck, jaw, back, hip, knee, and ankle issues as well as pelvic floor dysfunction. As a side note, the hormone Relaxin, in women at the ovulation/menstruation/pregnancy, will over-flex the connective tissue and cause joints to move beyond their normal range of motion, resulting in joint instability and potential injuries. While hypermobility can occur in various joints throughout the body, our focus will be on its effects on the pelvis.
It is easy to categorize different symptoms of hypermobility to separate issues. And while more people are learning about hypermobility, a vast majority of the population and clinicians do not know enough about hypermobility to see the connection!
Where Is The Pelvic Floor & Why Is It Important?
Pelvic floor is the bottom portion of the pelvis where the vagina/penis, anus and the tissue in between, the perineum are. The pelvis is a complex structure composed of bones, muscles, and ligaments, looking like a bowl where pelvic floor is the floor of. Pelvis is the foundation of the spine and its stability is directly influenced by the lower extremities at the hip joints, the connection of the spine and the joints of the pelvis. The pelvic floor is a group of muscles and connective tissues that stretch like a hammock across the bottom of the pelvis, playing a crucial role in supporting the pelvic organs, maintaining continence, and contributing to core stability.
Hypermobility and Pelvic Floor Dysfunction
Individuals with hypermobility often display poor posture and abnormal movement patterns. The instability caused by hypermobility can affect the alignment and function of the pelvis. This can put increased strain on the pelvis which is the foundation of the trunk or torso.
In an attempt to instill stability, the muscles inside the pelvis, the floor and the wall of the pelvis, tend to contract from the inside to minimize the degree of instability. This can mean hypertension in some muscles and ‘letting go’ in others. The pelvic floor muscles may become weak, tight, or uncoordinated, leading to various pelvic floor dysfunctions. These are discussed in my blog: ‘Subtle signs of pelvic floor dysfunction‘.
How Does Pelvis Become Unstable?
The instability of the pelvis is a feedback loop involving the following:
Ligament Laxity
Hypermobility affects the integrity of ligaments, making them less effective at stabilizing the pelvis and supporting its movements.
Core Weakness
To clarify, your core is your torso and not just the abdomen! It is a barrel that has a front, sides, and back. Poor posture and unstable pelvic alignment can lead to weakened core muscles. Which play a significant role in supporting the pelvic region and the full body.
Muscle Imbalances
Hypermobile individuals often have imbalances between the muscles that flex and extend the hip joint. There is also a dysfunction of the spine connected to the pelvis and the movement of the pelvis which is the foundation of the trunk.
Sacroiliac Joint Dysfunction
The sacroiliac joint, which connects the spine to the pelvis, is particularly vulnerable to instability in individuals with hypermobility. In my blog: “Are pelvic floor exercises the same as Kegels”, the full anatomy of the pelvis is explained.
How To Treat Pelvic Floor Dysfunction in a Hypermobile Person?
Managing pelvic floor dysfunction in individuals with hypermobility requires a multi-faceted approach that addresses both hypermobility and pelvic floor issues.
In hypermobile bodies, proprioception (knowledge of where each body part is in space at any given time) is weak. In my clinic the focus therefore is:
- Exercises to strengthen proprioception
- More frequent assessments and exercises related to postural neurology
- Activation of the extensor muscles before each treatment session
- Dynamic Neuromuscular Stabilization which are Developmental Kinesiology exercises. These exercises are what we all have done as babies to go from helpless infants to running toddlers. Low-impact exercises with special attention to the form vs reps and sets.
- Sports taping with the intention to bring sensory awareness to ‘when’ to stop the joints. This is important with positions such as standing!
- Lifestyle modification
- Sleeping positions with special awareness of the ankles since many hypermobile individuals have unstable ankles
And of course, addressing more than the pelvis given that all joints are impacted by hypermobility.
Hypermobility can have far-reaching effects on the body, and one of its lesser-known consequences is its impact on pelvic floor function. Understanding the connection between hypermobility and pelvic floor dysfunction is crucial for early identification and proper management.
If you are hypermobile and suspect or know that you have pelvic floor dysfunction, it is important to seek care from a clinician who is familiar with the hypermobile body. Contact us if you need help at any time.
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