Good Day / Bad Day - Hypermobility with Sharon Hennessey Part 1

What does it really mean to be hypermobile—and when does being "just bendy" become something more?

In Part 1 of this two-part conversation, we are joined by Sharon Hennessey, award-winning Australian physiotherapist, founder of The Hypermobility Project, and principal of Not Just Bendy Hypermobility Services. With nearly 30 years of clinical experience and lived experience as both an individual and parent navigating hypermobility, Sharon brings a unique and deeply practical perspective to this often misunderstood condition.

Together, we unpack the foundations of hypermobility, exploring what it is, why it occurs, and how it can affect children and teenagers during key stages of growth and development. Sharon shares her expertise in recognising the signs that may indicate a young person needs additional support, discusses the difference between generalised joint hypermobility and conditions such as Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), and explains why these presentations are frequently overlooked or misunderstood.

Whether you're a parent, healthcare professional, coach, teacher, or someone living with hypermobility, this episode provides an evidence-informed introduction to the challenges and strengths that can accompany hypermobility in childhood and adolescence.

Looking for hypermobility friendly clinicians? Check out the below directories:

https://www.ehlers-danlos.com/healthcare-professionals-directory/ https://potsfoundation.org.au/clinician-directory/

For amazing hypermobility resources, courses and tools please check out the below websites: 
https://www.notjustbendy.com/blog/
https://hypermobilityproject.com/clinician-tools

Looking for more Healthy Banter? Check out our website at https://www.healthybanter.com.au/ or follow us https://www.instagram.com/healthybanter.podcast/

Transcript

SPEAKER_00 0:07

Welcome to Healthy Banta, the podcast where women's health gets real relatable and just a little bit cheeky. We'd like to begin this podcast by acknowledging the traditional owners on the land on which we meet today. We would also like to pay respects for elders past and present.

SPEAKER_01 0:24

Hey Jules. Hey Meg, how are you? I'm so good. How are you? Oh, I'm really excited to speak with Sharon today. It's been great, yeah, so informative. It's been amazing. Sharon's the queen of hypermobility for all of you listeners out there. Yeah, she's a rock star.

SPEAKER_02 0:39

I've been telling everybody that she's coming on because I'm so excited that she's coming on, and her advice and knowledge is just so helpful for so many people.

SPEAKER_00 0:47

Oh, it was so good. Um, we've both known Sharon for a long time. So her information on this topic both today and in the past has been amazing. I'm going to read you a quick bio to give you her full picture because she is amazing at what she does. So Sharon Hennessy is an award-winning Australian physiotherapist and the founder of the Hypermobility Project, a clinician-focused education and training initiative dedicated to improving recognition, ethical diagnosis, and clinical management of hypermobility spectrum disorder, HSD, and hypermobile Ellis Danlos syndrome, HEDS. With nearly three decades of experience as a physiotherapist, Sharon brings a broad clinical background across musculoskeletal, neurological, rehabilitation, chronic pain, and pediatric practice. She is a principal at Not Just Bendy Hypermobility Services, where a team of physiotherapists focus on supporting clients with HSD and HEDS. Sharon presents nationally and internationally, equipping Allied Health professionals with practical assessment strategies and treatment adaptations that can be implemented immediately in clinical practice. Her work spans education, advocacy, and collaborative clinical research, and is informed by lived experience as both an individual and a parent, bringing additional insight into the complexity of this population.

SPEAKER_02 2:16

What a rock star! She's a rock star. And it is such a it's one of those uh areas that affects a lot of people. That can be not only is it quite interesting, but it can be highly complex and complicated. And Sharon easily breaks it down for us and helps us understand and gives us some great strategies to try for everybody out there that may be affected by hypermobility.

SPEAKER_00 2:40

Totally. She was amazing. We hope you enjoy it. Let's get into it. Don't trust these girls. Uh, today we are very excited and thrilled to welcome Sharon Hennessy to Healthy Banta. Welcome, Sharon. Hi, great to be here. Thank you so much for coming. Um, Sharon is an old friend and colleague, and she's also very much in the physio world, the hypermobility queen, I would say. Or rock star, whichever, whichever way you want to go. Yes, that is correct. So Sharon is um the CEO and principal physiotherapist for not just Bendy in Brisbane and also the founder of the Hypermobility Project. So, Sharon, can we maybe just start with what is hypermobility? Yeah, sure.

SPEAKER_04 3:31

So um hypermobility is basically um people who are more flexible than the average person in the population. Okay. And like flexible like like in their Yeah, in their in their in their joints. Yeah, in their joints. So if we think about, say, people who you've seen at the circus or circus performers or or people entrepezers, they're often very mobile, very, very stretchy. Ones that can kind of do the um weird and wonderful things with their bodies. Yeah, yeah. So that's one end of the spectrum.

SPEAKER_03 4:02

Yep.

SPEAKER_04 4:03

And then there's also um just normal people who are more stretchy than normal. Okay. So most of our Olympic athletes would have some degree of hypermobility, the swimmers, the tennis players, um, and and a lot of the other athletes as well. And then just in the normal population, we think about around 20% of Caucasians are hypermobile.

SPEAKER_02 4:25

Right. And Sharon, in terms of hypermobility, is it just like all the things we've described then, that we've been talking about that, the musculoskeletal system. Is it just targeting the musculoskeletal system or does it present in other ways throughout the rest of the body as well?

SPEAKER_04 4:40

Yeah, so I think we have to first distinguish between hypermobility that's that's um, you know, just generalized and not causing anyone problems. So we call that asymptomatic generalized hypermobility. And so that's when people have some extra range in their joints, um, more than average, and we can talk about how we work that out later. But then we have this other um condition that we call hypermobility spectrum disorder, and this is when we start to get signs and symptoms outside um of just joint flexibility. Some of the most common things would be pain, okay? And um, there are lots of other things that come along with that. So at this stage, when we're thinking about hypermobility as being um an issue with collagen, think that there's more stretchy collagen in the joints, allowing more mobility. Collagen is the building block of most of the systems in your body. So that means there can be collagen in your um legs, in your veins. So when you go to stand up, um you can get lightheaded because all the blood can rush down to your feet. Okay, it's in your gut, so that you can have a much lower rate of um digestion because rather than this peristalsis moving um things through your body through your digestion, it might just get stuck in a pocket and and just sit there. Okay. Other things could be the the little valve on top of your stomach might be a little bit more floppy, so you might be more likely to have reflux. Okay. So there's there's lots of things. Um, fatigue obviously is a big one. So for this, we think a hypermobile person just maybe walking around their house doing some like some light cleaning could be similar to a normal person walking up a hill in the amount of effort that it takes.

SPEAKER_00 6:26

And so that's a lot of systems coming into play and like it look like you know they they don't seem related. Yes. So how how do you how do you test for it or diagnose it?

SPEAKER_04 6:38

Yeah. So I think there's a few things to unpack there. Um, let's maybe talk about how we know if there's any hypermobility present. I think that that's a good start. Yep. So I think there um are two real ways to work that out. There's a thing called the Bitan and it's a nine-point test. Now, a lot of physiosan doctors are going to be aware of this test. So basically, you need to score more than five to technically be hypermobile as an adult. Okay. So the test is, if I could talk you through it, is can you touch your thumb and bend it down towards your forearm at the front? And if your thumb touches on each side, that's one point.

SPEAKER_01 7:19

Oh, zero for me. Zero for me.

SPEAKER_04 7:21

Okay, well, I get two.

unknown 7:23

Okay.

SPEAKER_04 7:25

Per side. Okay. Yes. Okay, so that's okay. So then the next two is little finger bending backwards, and it has to bend backwards to 90 degrees at the where the where the finger joins the hand. Oh shit. Oh no, she's not quite at 90. Isn't she? Oh, I know. And mine, I'm quite old now, so mine don't mine up. So that you don't count what Megan just did. Well, she just just turn it side on for me, Megan. Pro probably wouldn't call it 90, because if you look at the actual joint between those two, it's probably about 70. Yeah.

unknown 7:59

Okay.

SPEAKER_03 8:00

So you're still a zero.

SPEAKER_04 8:01

Still a zero. Okay, and then the next one is another arm one, which is you you stretch your elbow out and you try see how straight or if your belt elbow can also sort of bend backwards on itself. So if it can go more than 10 degrees past straight, then that's another point. Hyperextension of the elbow. Okay. And is that again one on each side? Yeah, so that's six. Then we have when you're when you're standing or lying, if the doctor's testing you, can you bend your knee backwards? Yeah. So knee hyperextension. In lying. Standing. Well, technically, in the official tests, it might be lying down, but we often just assess it in standing. So you've probably noticed sometimes when people are standing and you're like, wow, their legs sort of bends backwards a little bit. Yeah. Yeah, that's that's another.

SPEAKER_02 8:49

So it's anything beyond zero. Ten degrees.

SPEAKER_04 8:52

Ten degrees beyond zero. And then it's can you touch your hands flat to the ground without bending your knees? That's one point. So that's nine. Okay. Okay. Okay.

SPEAKER_00 9:03

I can definitely say mine's zero for that too.

SPEAKER_02 9:07

Um, so if you've if you've scored five or more for that, yes, you can technically and theoretically say you are hypermobile. Yes. But it doesn't necessarily mean you have hypermobility syndrome. Yep, or spectrum.

SPEAKER_04 9:22

Spectrum. And remember, this is for people who are over 18 or it's skeletal maturity. There are different rules for kids. Okay. And they're looking at those at the moment. But at the moment, we're like, we can't really decide any hypermobility is present until at least five, because babies have such bendy, you know, development.

SPEAKER_05 9:42

Yeah.

SPEAKER_04 9:43

Um, so between five and skeletal maturity, they're saying um six out of nine at the moment. Okay, so same tests. Same tests. Yeah, but they need one extra point. Yeah, yeah. Yeah. But that could change again in the future. Um so that's are you hypermobile now? So I only get a three now. Yeah. Okay.

SPEAKER_03 10:02

Oh, wow.

SPEAKER_04 10:03

But there's another one, which was were you hypermobile in the past? So this is a five-point question.

SPEAKER_02 10:09

Uh, can I ask there for you? You're only a three now. Why what was your excuse? What did you say? Because you've got yourself, yes.

SPEAKER_04 10:21

So I'm only a three now because I'm in the in reaching the um the early years of my 50s. Okay. Okay. So so this this what what happened was this was a really helpful test, but what happened was there were lots of people who'd injured themselves or become older who still had all the symptoms of being hypermobile but didn't show up positive on this biton test. Okay, so then they there's another one we can do, which is really easy for anyone to do. It's five questions, and um, we just need to get a two or more out of five to indicate there could be some hypermobility there. Does this have a special name? This these questions. It's called the five-point hypermobility questionnaire. Perfect. Very creative title. Okay, okay. So the first one, and it might be out of order, some of the similar tests we just talked about. So the question is could you ever could you now or could you ever touch your thumb to your forearm? Could you now or could you ever touch the floor with your hands and flat? Do you consider yourself double jointed? Um and do have you ever dislocated your shoulder or your knee?

unknown 11:29

Okay.

SPEAKER_04 11:30

Okay. And then the last one is could you ever do the splits or did you used to ha do party tricks to amuse your friends? Yeah. So if you guys think back into your history, did you score anything on those tests? No.

SPEAKER_02 11:52

Were you a dancer or no? Definitely not. Actually, I was going to ask that question, Sharon. Because I'm thinking here of my daughter who did gymnastics. So she probably if you if she'd been left her own devices, didn't do gymnastics, she wouldn't have been able to do the splits. But then train to stretch it. Like, is that bad for people who might have a well tendency to this hypermobility, or they'll just be able to do it anyway?

SPEAKER_04 12:18

Yeah, I mean, you know, I think I think the people who are hypermobile tend to excel at some things. Yeah. And so they're they're more there's they have longer longevity in those sports.

SPEAKER_03 12:28

Yeah.

SPEAKER_04 12:28

Or less longevity in those sports, depending on whether they're a uh a really strong hypermobile person or whether they're a clumsy hypermobile child. You know, there's there's there's different groups, right? If we just go back to the five-point questionnaire quickly, just from the end. So I suppose for me, I probably never dislocated something, but I did used to have party tricks. My brother had this particular party trick even when he was 30, that he could fit through a wire coat hanger.

SPEAKER_02 12:55

Oh my god.

SPEAKER_04 12:56

He used to like to show a few. So did you say when he was 30? Yeah, a wire coat hanger. So we used to be able to sort of, you know, wiggle enough to be able to fit.

SPEAKER_02 13:05

Oh my goodness.

SPEAKER_04 13:07

Yes. So, and um, I definitely had thought I was double jointed and I and I was able to put my hands to the floor and do the thumb thing. So I okay so I got a full. Okay.

SPEAKER_00 13:18

So do you do you you don't need to combine those two tests to kind of get a diagnosis like to say you've got hypermobility.

SPEAKER_04 13:26

Yeah, but I think the the five-point questionnaire is an interesting screening tool. So, you know, we encourage, you know, physiotherapists who are doing questionnaires to pop it in their questionnaires and and just check on intake if there could be a a chance of some hypermobility. But what I end up with, because I am positive on that five questions, but not on the stretchiness right now, I'm a historical hypermobile. Okay.

SPEAKER_02 13:52

Okay.

SPEAKER_04 13:52

So I'm my diagnosis would be historical hypermobility spectrum disorder.

SPEAKER_02 13:57

But now somebody listening to you today, Sharon, they could go if they're if they're in their heads going, oh, I think that's me, they could present to their health professional and say, Hey, I've heard of this Byton Byton score and I've heard of a five-point score. I I think I'm hypermobile. Can we just check through this? This is you know, people can bring it up with their practitioners, can't they?

SPEAKER_04 14:17

Yeah, they can. They can. And I think one of my main goals is trying to to train as many professionals as we can. But I think that the the knowledge isn't out there for everybody. So I think I would encourage your listeners if they went to someone to talk about this and their answer was, oh, that's not even a problem, that might not be the person to talk to about it. Good point. Yeah, yeah. Very good point.

SPEAKER_00 14:41

Find someone who's hypermobile friendly or aware to do it. Yeah. Is there somewhere where you can find that info of like people you can access? Yeah, that that are like um specialized in hypermobility, like kind of a Australian.

SPEAKER_04 14:54

There's a um there's an international website, the Ellis Danlos Society, the EDS Society. Yep. And they have a um a directory of um professionals who've put themselves forward as being interested in this. Yep. And then there's also the um Potts Foundation, the Australian Potts Foundation, also have a directory. Okay, perfect. We can look at that. And we'll get to and we'll get to why that would be a thing. I feel like we've got plenty of questions we have to until you're both about engagement.

SPEAKER_02 15:23

Here we go.

SPEAKER_04 15:23

If you want to go back to the kids thing with the stretching first, because I feel like we left that one in there. Go back to that and then maybe jump into like EDS.

SPEAKER_00 15:31

Yes.

SPEAKER_04 15:31

So there's certainly acquired hypermobility that usually happens in a particular joint. Um, that's uh coming that way from a um a sport or a repetitive activity or injury, maybe. Or from an injury, absolutely. But whether or not you stretch a lot to do the splits, I suppose we have to distinguish between are you stretching the muscle, are you stretching the joint, you know. So I think, yeah, it's a tricky one. I think you have to look. I don't think we, I don't think we ever the way we do it in our clinic, we don't just look at the bite and go, ha, you're hypermobile. You know, we we look at the whole, the whole thing. So there's so I think there's more we can discuss there about how would people tend to present in their life with this? Because that that picture of how people start off in life and where they end up in life by the time they see us is a very common situation.

SPEAKER_00 16:23

Yeah. While we're on kids, what else are we looking for? Like how else can it present other than just you know Bendy?

SPEAKER_04 16:33

Okay, so maybe we could look at a sort of a case example. Yeah. Yeah. Yeah, let's do that. All right, so um it could present along the lines of a I a clumsy child. Yeah. Okay. So often hypermobile children are clumsy, they might be running into walls a lot, they might be someone who moves really quickly or not at all. So they'll be running down the hallway or they'll be lying on the floor. Okay. So they they tend to be not great at controlling themselves, as from a physical point of view. So they're gonna run, run, smash, run, run, smash. Okay. So they might be getting recurring things like ankle sprains or complaining about growing pains a lot. Um, the other common thing is that they can present quite early with um tummy pain and constipation. Yeah. Okay. So whenever I hear of a constipated child, I start to think straight away, could there be some hypermobility, particularly if they've had testing and they can't find anything particular to put a label on. Probably some kids could be described by their parents as being whingers. So they're always whining about pain or being tired. Um, they could be coming home from school and lying on the couch, sleeping a lot. They can be school refusers, so refusing to get out of bed and go to school due to fatigue. Yeah. Okay. And they tend to be labeled with or have anxiety as well. Um, then there's the um whole other type of hypermobile child who is actually the fit, strong athlete, okay, who's into a thousand sports and is good at whatever they seem to try. And this child doesn't necessarily complain of um as many symptoms. They may, but it could be brushed off as just lots of little sports injuries. Okay. Because they're sporty, because they're sporty. And as long as they're staying strong and participating, then they usually do okay. It's when they injure themselves significantly and unable to continue to compete in sport, um, that's when sometimes the um the wheel falls off the wagon. Yeah. Okay. Because the the strength that they had developed with their sport and um their mental health that they had because of their sport sometimes falters when they're not exercising as much. And then some of those little injuries that had been um sort of ignored start to become more significant for them.

SPEAKER_02 18:55

And is that because the the muscles play an important role in protecting joint, Sharon? Absolutely.

SPEAKER_04 19:00

So I'd like one of my common phrases is that we get about 30% of our stability in our joints from our ligaments, and the other 70% comes from our muscle function. Okay. So if you've got a good muscular system to help compensate for any increased flexibility in the joint, um, then you're going to be in a much better place. And that's what we all know as physios, right? That the better control someone has of their joint, the less likely they're going to be having issues with it.

SPEAKER_02 19:28

Yeah, absolutely. And if you go back to your two-case scenario, so you've got child number one who's the clumsy, painful winger. Not they're not painful, as if they're in pain and they're a winger. Yes. How obviously from what you were just how you were describing that, it would be helpful to encourage that kid into sport, but how do you do that when they they are feeling pain and they're clumsy and it you know, I guess it it would be trying to find things that are successful at all?

SPEAKER_04 19:59

Yeah, I mean, I think it depends on on where you're sitting with it, right? So modification can be important. Okay. So I think we're very rigid with kids' sports in a way that we're not with real athletes, you know. So I think it's um I often f find non-contact sport to be ideal and um being able for the child to be able to be trusted to modify if they're not feeling well that day. So I think it's the old problem with go run the cross country, how come you're not running? And forcing the kids to run, and then they go, Oh, I have to come, I have to run, and then running on a sprained ankle or something, because I think everyone's used to obvious injuries, they're used to a broken arm or someone physically rolling their ankle and falling to the ground. But a hypermobile kid like my kids, if you just wal run along and you land heavily, that could be enough to to set pain off. So I think it's all about you know, us trusting kids and and and why would kids pretend to be in pain? I I just don't understand that idea that we label children like that. So I suppose from my personal story, you know, that's part of why I I'm here where I am. You know, I think you're passionate about it. Yeah, because I I was hypermobile and was identified at uni as being hypermobile. And I remember them pulling me aside and going, I don't know if you're gonna ever be a physio with those thumbs. Particularly if you want to be a musculoskeletal physio. And I said, Well, what can I do about it? And they're like, Well, there's nothing you can do. So I I was aware I was hypermobile from very early in my career in my 20s. Um, I was a tired child, okay, so I was always mum was always making me energy shakes and giving me iron because I was fainting and things like that. But I didn't have a lot of pain because essentially, if I was doing a sport that I love doing sport and I hurt myself, then you know, back in the day, the way to stop having that pain was just to not do the sport and so I didn't really develop those I didn't have pressure to compete right so I became more of a studious person wasn't till I was um in first year out as a physio when I had gotten quite good at doing karate and I was um trying out for the state team that I got a kick to the neck and then everything just started to to unravel from there okay so I couldn't do my karate anymore I was in my first year of um of being a physio at the Royal very big hospital lots of lots of stress and pressure and then you know I've learned a lot about myself since then let's put it that way. Yeah well that would have been challenging too and so then every time I go on a physio course throughout my life I've always been put up the front as the um as the um the demo stage actually I remember being at some in services with both of you where I may have been put up the front and laughed at oh isn't that funny why is she doing that and everyone going this is a textbook example of how not to stand and um you know and I was like okay and I learned so I became my like I call it an N of one you know when we're doing research we say the N is how many people in it so I've been my own experiment my whole life. Yeah and that was fine until I had babies.

SPEAKER_02 23:24

I was going to ask a question can I take you back one step? Can I go back to as a pubescent teenager raging hormones for your body does that affect people with hypermobility and what was that like for you or for other people?

SPEAKER_04 23:39

Yeah so absolutely so I really do think it's a really important time to keep an eye on our hypermobile girls through puberty um because hormones can start to change things very quickly in hypermobiles. Yeah in what way well I think there's it's a combination there's a lot of stress happening at that time in your life with school but also um lots of hypermobiles have really heavy periods okay and a lot of pain. For a start that starts to affect people's ability to to function at school but we know what we we don't know everything about it but what we do know is when you hit puberty your your hormones are all over the shop right and even a normal woman who cycles when you're coming to those days before your period your estrogen level drops and your progesterone level goes up. And traditionally hypermobile people when you hit that drop in estrogen you become a little bit more bendy. Okay. Okay because estrogen is protective protective because it because it it helps muscles it helps muscles and I think it reinforces forces the the ligament properties or you know I don't I don't it's not my area you know you guys might understand that better than me. But what I do know is that my hypomobile clients if they've got they'll often have migraines okay at that time of the month or during their period or if they're extremely um affected and they'll tend to dislocate more during the times of their period. So often they'll try to skip as many periods as possible because they know once they have it they might end up a couple a couple of particular patients will end up dislocating joints during that time. So I suppose when you're doing that and you're starting out on these things then then hormones can can play a little bit of havoc with that. And then if you're getting injuries and then you add this this sort of like let's not get into the medical system and how we we um don't really deal with women's problems. We don't really deal with teenage women's problems at all. Okay so add the gaslighting of the kid plus these hormonal features um things can it's a tricky situation it can it can actually get it you know you can be down one end and be quite quite well and and and have a few pains and then the other end is quite significant and I think hiding in every high school is one or two of these girls or boys significantly affected by hypermobility who may be unable to eat unable to attend school dislocating joints I've got girls requiring requiring you know enteral feeding like it can actually get to a point that it's debilitating quite debilitating. And I'm not trying to say everyone ends up there but but one of my my dreams would be how to go to every school in Brisbane and say who's the one you've got who's always sleeping here and complaining that they can't eat and vomiting and everyone thinks it's the biggest winger that in the world they're probably the one we need to find.

SPEAKER_02 26:36

And they might not necessarily be they might not necessarily be dislocating or anything. Hey no like they could just as you said have those couple of joints but the periods are really terrible and they've got all these other symptoms happening so it they might be like a silent yes as you're saying a silent summer.

SPEAKER_04 26:53

Yeah I think you don't want to think that every like I've never dislocated a joint. Yeah none of my kids have ever dislocated anything so I think I think that's where where some people and some of the medical community who I love thank you everyone may be thinking of those extreme cases. Yeah and I think picking up those extreme cases still in the literature it's somewhere between 10 and 22 years before they get picked up. Wow um but I want to pick up the people before they get there.

SPEAKER_00 27:21

Yeah yeah just because even having some of those like really easy management strategies like whether it's skipping their period or like that's just so helpful for them like to be able to live yes and to even just understand it.

SPEAKER_04 27:34

So we need to sort of you know like I'm not in sports in any way but we need to allow some changes like okay you're the shooter for the team but you've got your period maybe you need a backup person to help you know we can't just be no matter what forcing everyone to to work at their peak. It's a really simple strategy you can just implement it yeah and I think in the athletic community they're finally starting to catch on to that that there's going to be different periods of training within a women's cycle.

SPEAKER_00 28:02

Is it um more common in females and males?

SPEAKER_04 28:04

Yes so in kids it's one to one yeah one boy to one girl um past skeletal maturity or 18 it's six women to one man. Oh wow yeah so we think again that could be hormonal based so we're thinking is it something to do with the testosterone and is it that because the testosterone helps build muscle mass and help builds bone density okay yeah and we're also seeing it in the trans population when um women are are uh transitioning to be male yeah that some of them are having decreased symptoms.

SPEAKER_02 28:39

That's so interesting.

SPEAKER_04 28:41

Because they're increasing their testosterone yes so that they're finding in their less joint dislocations um and improved ability to build muscle mass. Yeah. Okay. I've also seen it in some people that it hasn't gone as well as they'd hoped. Um but again it's anytime you're having a a you know a physical transition or a hormonal transition I think it's a great time to reach out to your physio or your trusted professional and just see if there's anything you can be doing to um to help.

SPEAKER_02 29:13

Like one strategy that yourself and Megan were having a quick chat about before we came in to record today was the concept of good day bad day. Do you want to tell our listeners what that is because that's so helpful. Yeah.

SPEAKER_04 29:27

Yeah yeah so it's sort of um hypermobiles another way you might notice or think hmm this sounds a bit like me is this tendency to boom and bust. Okay. So you tend to have a really bad day and you feel really tired. So you so you allow yourself to rest. You might watch a show or lie down or or take off some things off your plate. And then the day you feel good you do everything. In fact you might even rage clean the house which I have done many times. It involves cleaning everything cleaning out the cupboard frantically and screaming at everyone as to why no one has helped you clean out the cupboard. And then usually giving up when everything's all over the floor. Okay. Could also be ADHD I would admit but that's it's the same sort of uh theory with exercise so we we we talk about pacing and that's trying to say that on a good day you don't want to do um double the amount that you would do on a bad day okay but you do want to do a bit more and then hopefully you'll have less bad days because you're not overdoing it on your good days. But as a way to to then say well when I'm busting and I can't do anything let's try and still do some things. So I'd often say to a client we might have a series of exercises and I might say these are the ones I want you to do. You can do these in bed these are the ones to help your muscles relax these are the ones to help you focus on your breathing your parasympathetic nerve activation so we can we can rest and recover. Okay we might throw a little bit of stability work in there if we know that there's some instability in a joint that's causing problems you want to keep keep those muscles working and then on a good day then we might go well the good day is the day that you're gonna stand up and you're gonna do your squats and you're gonna do your little light weights and you're gonna build a little bit more muscle okay so it might be you you might have three good days a week and it might be you're gonna walk 15 minutes on those days. Okay. It's it's or it could be a gym class it's gonna be different for every person. And I think the hardest thing for hypermobiles that I've come across is um and I when I say hypermobiles I mean symptomatic hypermobiles those people who having problems is accepting that you're different to your peers and that your endurance and what you can do might not be as much. So you might go well I'm gonna go to the Michael Jackston musical maybe I shouldn't pull everything out of my cupboard that day load on the not saying anyone did that I'm just saying that you need to spread out your load a little bit.

SPEAKER_00 32:01

Yeah because it's also the case I think um we touched on this before briefly to just about um length of injury time to like for a for example a sprained ankle um and as physios we go yeah six weeks you'll be you'll be fine um but it's different in the hypermobility space as well right yeah yeah so what we think is in general it takes around twice as long to recover for those who've got supermect symptomatic hypermobility.

SPEAKER_04 32:31

I'm not sure if that's that how that works for non-hyp like non-symptomatics but I think by the time we get into those symptomatic feelings and I suppose when you're talking what what does it mean you're a symptomatic hypermobile we never really talked about that. The criteria is pretty clear it's that you've got significant pain okay in um more than one area for more than three months. Yeah okay or lots of repeated injuries. Yeah okay so it it's sort of that presentation so um yeah so often people will be slowly getting better but their therapist might go oh it's six weeks you're not better you better go get a scan there must be something serious going on and then there becomes a big wait for treatment for scanning for orthopedic surgeons only to say no you're fine you know you'll be fine in six months so I think it's just that sometimes things take a little bit longer to get better.

SPEAKER_00 33:27

Can that also be a bit detrimental to the stresses that are added into that oh absolutely like with like you know they get stressed so then the body is in the state of stress.

SPEAKER_04 33:38

Absolutely and it's the fear right and so there's this other thing that they call kinesophobia okay fancy big word but it means fear of movement. Yeah and I think that there's definitely um a high prevalence of kinesiophobia in symptomatic hypermobility and for good reason it's a fear that you're going to injure yourself by just doing something little okay but then the less people move we know that motion is lotion and the less you move and the less you feel confident in motion the more likely you are to hurt yourself. So it's a bit of a self-fulfilling prophecy so we're always trying to encourage people to move and to also let go of the fear. Like even me talking about this everyone's probably going oh I better pull my core on if I'm hypermobile and I just like to say no it's not about that. Yeah because most of a lot of the symptoms that we see in hypermobility aren't even from dislocations or instability they're from the muscles the superficial muscles gripping on really whole tightly to try to hold you together or to feel the joint. And so I have a lot of patients who are referred who go, I've been told to come here because they think I'm hypermobile but I'm the stiffest person I know and they are really stiff in the muscles because they're they're co-contracting around the joint to try to hold them together. Once we start to look at it they go oh my god I had no idea underneath all that stiffness I was actually flexible. So it's quite complex in that way. So that people might do this bite and then go, yeah, but I'm I'm actually really stiff. It's not that every single joint in every part of your body is mobile. It's some are moving too much and a lot are not moving enough. And so that the one that moves too much gets all the pressure and the one that doesn't move at all just stays really stiff and so it's about rebalancing these things.

SPEAKER_02 35:37

Yeah.

SPEAKER_04 35:37

And I think incorrectly they've been told to stretch stretch stretch stretch stretch which is not necessarily good right yeah so I mean I think I think stretching is isn't we call contraindicated it's not like never stretch but I think it's about thinking about what are you stretching? Stretch and why right so I I often when I used to go to the gym I'd often you know it's hard when you're a physio when you go to the gym it's a bit like a hairdresser walking through the mall that there's certain things that you can't not see and you just want to run over and give them your card but you don't and you see like um sometimes well meaning personal trainers stretching someone's hip into extension as much as possible. And when I'm looking at it they're not stretching the hip flexor muscle they're stretching the back because the whole back is arching. So I think it's about if you're stretching you've got to make sure that you're feeling it in the muscle not in the joint. Yeah okay and it's a muscle that's already tight so I do get people to stretch but more than that I get them to try to move in and out of positions. So we sort of call them postural reversals. So you know rather than slouching or sitting up ramrod straight which is where most hypermobiles go particularly of the older age group because as a kid that was drilled into them to sit straight. I'm encouraging them to come out of those positions and back into those positions so that they're not statically gripping things. So we want to have a nice posture but we want to feel fluid to move in and out of it. We don't want to walk with muscles you know gripped on to try to hold us in certain positions. And we do a lot of breath work and we do things called contract relax whereas you you contract the muscle and then when you let it go it lets go more than it had at the start. So I think there's lots of ways to find relaxation. I think yoga's controversial sometimes for hypermobiles and you know I went through my share of doing yoga myself because I felt so good I was always the best in the class you're not asking about yoga. And it depends on the type of yoga certainly um I've had patients who've been really into yoga and eventually we've had to pull back on the amount of yoga and introduce some Pilates based work as well. And so then we sort of say all right well you get so much mental help from your yoga and you're stretching and you feel you need that for your muscles good but we also need to then work on that muscle strength and control. And so we can't just be yoga yoga yoga okay we need to have a variety of things in there particularly if it's that yoga where you do long deep end range holds okay because and in a hot environment you could be overstretching a little bit yeah and that's sort of two days later when you go oh I'm getting tight I better go back to yoga maybe that's your body actually saying hmm that was a bit much for my body so it's sort of the other thing I'd say with hypermobility is we have this this understanding in the world that you go to the gym you get DOMS okay 24 to 48 hours.

SPEAKER_02 38:51

That's delayed onset muscle soreness so when you feel a bit sore after you've been to the gym that's what your DOM is.

SPEAKER_04 38:58

Yes exactly but um in hypermobiles sometimes those DOMs seem to stretch on for days so you know there's if you're if you're feeling DOMs if you're going to the gym and you're feeling DOMs but the DOMs also feel like you've got the flu. Okay so you actually feel like after you've exercised that you've become a little bit sick like you're coming down with something then that can be a sign that you're doing a little bit too much. Yeah. Okay. And sometimes that's associated with some of these other things that come along with hypermobility.

SPEAKER_00 39:37

Well that's a wrap for the first part of the discussion with Sharon today. We hope you enjoyed it and took lots and lots out of it because we sure did.

SPEAKER_02 39:45

Oh yeah I know there'll be a lot of women out there who they themselves might have seen or heard something that reminded them that hey maybe this is something that is affecting me or they'll be looking at their children and think oh yeah actually this information will be really quite helpful.

SPEAKER_00 40:02

Totally or practicing some of those Byton scale um movements just to check in. A lot of this can be found on the not just Bendy website which we will link to and we'll more specifically link you to into the blogs on that site which are really really useful. These are more for the general population so for you as a patient or if you're concerned about a loved one. We will also link into the hypermobility project which Sharon is the founder of and this is more for clinicians out there listening who want to get some some really great resources including screening for red flags as well as uh courses links to courses that Sharon has been developing and running.

SPEAKER_02 40:43

I think Sharon was also saying that on that page there's a newsletter that anyone can access so you don't have to be a clinician. So if you're looking for some more information about hypermobility link into the newsletter and and I think the red flag survey is something that anyone can look at and print out and take along to their practitioner or clinician that they're seeing as well. So that's a really helpful resource. Yeah really really helpful. Yeah she's been very generous in sharing that information with us. Yeah. Hope you enjoyed it today guys we'll catch you next time and that's a wrap for today's episode of Healthy Banter we hope you're leaving with something useful and maybe something worth sharing with a friend because that's what we're all about women supporting women one honest chat at a time. If you loved hanging out with us make sure to share follow or subscribe on Instagram YouTube Spotify or just head to healthybanner.com.au so you never miss an episode. Take the advice that helps ditch the guilt and keep cheering for yourself. We'll see you next week for more stories, more science and even more banner. Healthy Bander is hosted, produced and edited by Megan Jewels our main music theme is composed by Ada Aqual. Healthy Bander is not a licensed health service it is not a substitute for professional health advice treatment or assessment. The advice given in this episode is general in nature but if you are in need of individual advice or consultation please see a healthcare professional if you are struggling call lifeline on one three triple one four