There is a growing appreciation in medicine and manual therapy of the role that very flexible ligaments play in spinal and joint issues, and even in general health.
The body is held together by connective tissue, which is strands of protein, especially a protein called collagen. Fat is stored in connective tissue (e.g. tummy fat) but is an entirely different thing from connective tissue. Carbohydrates are used for fuel, or stored in the liver or muscles for energy reserves, but are also different from connective tissue.
Collagen itself comes in different types, and it organises itself into various forms of connective tissue. Joint ligaments, the skin and the kind of wrapping that folds around organs such as the heart are all examples of connective tissue.
This is simplifying a bit, but it is genes that determine how stretchy and strong ligaments are. I believe we over-estimate how much we lengthen ligaments through regular stretching and I suspect the benefits from stretching come from other mechanisms.
Bear in mind that ligaments connect bones to other bones, muscles connect to tendons (at either end of the muscle), and tendons attach to bones.
Osteopaths are very interested in how stretchy people are. We categorise patients as having;
- normal or stretchy ligaments (another word for stretchy is lax)
- normal or low amount of muscle
- normal or low muscle tone (tone means the resting tension of the muscle – floppy at rest, or firm)
For example, ballet dancers are likely to have loose ligaments (to allow them a fantastic range of joint motion) but also to be muscular, with firm muscle tone.
What would the best combination of all these factors be for long-term health and joint prospects? Probably normal or tight ligaments, and plenty of taut muscle.
The worst? I’m sure you’ve figured that out. Loose ligaments, little muscle mass and a floppy muscle tone.
Why? Because the first way to protect joints from excessive or abnormal motion is to have tight ligaments. The second? To have fast, powerful muscles that can quickly control joints and stop them from getting into trouble.
If you have the opposite of the above, then your joints will be more vulnerable. A joint might move further than it should, causing the joint to become irritated or even injured. Or the muscles that control the joint might spasm.
This is a simplification, and the modern understanding of all this is filling in the gaps, but this way of thinking about it does help.
So you can now see why the general medical term to describe this issue is hypermobility.
How common is it?
Research shows that up to 30% of females may have some form of this condition, and up to 10% of males. It is common.
So what might indicate that you or your children have loose ligaments?
- Perhaps the most obvious is the bendiness of your joints. Do your knees or elbows bend backwards ‘the other way’? There are some tests for this. The Beighton Score is widely used in research and clinical testing, although researchers see it as simplistic.
There are other clues.
- If everyday movements make you click and pop a lot, or if you have the need to click yourself to relieve tension and aches, then you might have hypermobility.
- If you find your body does not like exercise that place your joints at an end-of-range position (for example, yoga) that’s another indication.
- And perhaps your skin is prone to stretch marks?
- Or are your joints causing problems, which is then blamed on early osteoarthritic change by the doctor?
- Perhaps you keep getting plantar fasciitis or achilles tendon problems in both feet?
- Or when you were a teenager, did your knees give you problems?
If you do have hypermobility, then you have to work on low impact muscle strengthening to look after your joints.
For example, pilates, gym weights, swimming or running (but only on level ground).
Over the last decade, what was previously called joint hypermobility syndrome has been folded into the disorder known as Ehlers-Danlos Syndrome (EDS).
This classification is advantageous because having loose ligaments is unlikely to be something you have in isolation.
Other disorders (for example, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and even anxiety) are more likely to be present in EDS.
The mechanisms that link these apparently unrelated symptom clusters are beginning to be understood.
So if you or your child keep getting problems with your spine and joints, don’t only think about posture, exercise, sleep or health, but also consider this issue. It might answer many questions.