Dr. Sarah Collins, PT, DPT is a physical therapist and yoga instructor with MovementX in Colorado Springs, CO.
What is Ehler-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD)?
EDS is a complex condition that has many subtypes though one of its most common presentations effects the composition of our joints and other connective tissue leading to overly stretchy ligaments and easily damaged or bruised skin and joints. Our genetics largely determine the make-up of our joints including the ratio of elastin to collagen.
Elastin is much stretchier than collagen and has been found to be present in much higher ratios compared to collagen for those with EDS. Those that don’t have a diagnosis of EDS, but experience excessive joint laxity that affects their function may fall into the category of HSD.
Is yoga safe to practice with hypermobility or EDS?
In short, yes! Yoga itself refers to an overall philosophy with a rich and interesting history. Our modern interpretation of ‘yoga’ most commonly refers to ‘asanas’ or poses and ‘pranayama’ or breath work. This means there is a wide umbrella of things yoga can offer and any given class may vary widely in what components of yoga it features.
That being said, those with a known hypermobility disorder should practice caution and work with a trained professional to best keep their body safe. Every person has individual susceptibilities in their body and a physical therapist familiar with yoga and hypermobility disorders can identify these areas to best reduce injury risk and optimize their yoga practice.
Are certain types of yoga better to practice than others?
The three most common types of yoga found in studios and gyms tend to be Vinyasa Flow, Hot Yoga, and Restorative or Yin Yoga. A Vinyasa class is typically faster paced and may involve lots of poses in a short amount of time which can prove challenging for beginners to ensure proper form. This may lead to injury and why a beginner practice or one-on-one attention is ideal before continuing to this type of practice. Hot yoga is usually not indicated for those with hypermobility as the higher temperatures creates even more tissue flexibility which could set someone with EDS or HSD up for injury. Restorative yoga, including Yin Yoga, can be practiced with caution. Yin yoga focuses on holding only a few poses for a long amount of time. If this is done in an end range or ‘stretched’ position it could lead to injury. Yin yoga classes are best used for their relaxation component and care should be made to stay in comfortable supported positions that don’t create stretch or joint strain.
What are the best tips for practicing yoga with EDS or HSD?
A customized approach is necessary to minimize injury risk, but here are 7 of our top recommendations made for those with EDS/HSD in regards to a yoga practice:
Focus on optimizing your alignment with each pose rather than how ‘deep’ you can take postures. The benefit of yoga for those with hypermobility is to gain stability and not to stretch as far as you can.
Familiarize yourself with poses in a beginner class or one-on-one format, ideally led by a physical therapist or after being advised by a PT prior to starting in a group format.
Find experienced teachers, but don’t rely on them to correct your form or make modifications to every pose. Even the best instructors simply cannot know what your body needs and cannot offer enough attention to do so during a group format.
Do YOUR practice and don’t compare yourself to others. Someone with excessive joint laxity can easily make yoga poses ‘look good’, but that doesn’t mean it’s the safest expression of each posture for YOUR body.
Know that many ‘cues’ you hear from a yoga instructor may not apply to you. If you hear an instructor encouraging you into a deeper stretch or to ride through some discomfort that may not be appropriate advice for your body. Advice to ‘just listen to your body’ may not be sufficient because you may experience pain hours after or even the next day.
Talk to your instructor before class. You don’t have to disclose any medical information that you aren’t comfortable with. In fact doing so may give you an artificial sense of safety when even well-informed instructors can’t guarantee your safety or customize things to you in a group setting. However, you may be more likely to stay safe and go at your own pace when you have already disclosed that you’re working with a PT and you may modify or opt out of things. Note that many studios have you fill out a medical form for liability purposes. Please don’t rely on instructors reading or understanding these forms to keep you safe.
Opt out of ‘adjustments’. Hands-on guidance, corrections, and massage are all commonly referred to as adjustments in a yoga class. Be clear that your studio or instructor provides an opportunity to ‘opt out’ of these and do so. If you’re not sure, this is another thing to make clear when talking to the instructor before class or ask a physical therapist about. While some yoga adjustments would be perfectly safe, it’s not worth the risk of injury.
Both yoga and hypermobility are very complex topics. Hopefully this article offered some brief insight as to why this suggests working with a physical therapist or other health professional to best protect yourself and optimize your yoga practice while living with Ehler-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD).
About the Author
Dr. Sarah Collins is a physical therapist and yoga instructor with MovementX in Colorado Springs, CO. With over 10 years of experience, she helps people of all ages and abilities move their best so they can live their best. Sarah Collins believes in the importance of prioritizing each patient’s individual values and goals for a custom experience. She has a strong passion for getting and keeping her clients active through every stage of life.
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