I'm just about to start training a client who is double jointed, and I would like to find information on this subject. Any thoughts would be appreciated.
"Double-jointed" is a misnomer that refers to hypermobility of joints. But even "hypermobility" might be seen as another misnomer as long as the client is within her physiological range of motion.
Hypermobility, however, isn't always just a quirk that can be ignored.
A study published in the Journal of Rheumatology (Vol. 27, No. 7) indicates that joint hypermobility can be a sign of impending fibromyalgia or a "fibromyalgia-like syndrome."
More specifically, people who had been diagnosed with fibromyalgia but who didn't meet the stringent American College of Rheumatology diagnostic criteria were five times more likely to have joint hypermobility than people who don't have fibromyalgia.
The conclusion of the study was that "repeated minor trauma [from moving the joints past their intended range] may result in musculoskeletal pain that may eventually amplify into a more diffuse pain syndrome recognizable as fibromyalgia," according to Mary Ann Fitzcharles, MD, associate professor of medicine at McGill University in Montreal.
She continued, "Hypermobility is not the only or the major factors in the development of widespread pain or fibromyalgia, but rather a contributing mechanism in some [people]."
There's also a group of Hypermobility Syndromes that can (but rarely) indicate genetically-based conditions ranging from the aptly named Benign Joint Hypermobility Syndrome to the potentially deadly Marfans Syndrome.
Although it's imperative that you make sure your client has been recently cleared by a doctor, here's a quick screen you can do called the Beighton test of joint mobility:
- Can your client passively extend her little finger beyond 90 degrees? Score one point for each side, left and right.
- Can she flex her wrist and touch her thumb to the flexor aspect (underside) of her forearm? One point for each side.
- Can she hyperextend her elbow beyond 10 degrees? One point for each side.
- Do her knees hyperextend? One point for each side.
- Can she touch her palms on the floor while keeping her knees fully extended? One point for each side. (Keep in mind, however, that physicians vary on what score constitutes "hypermobile.")
As far as program design, generally speaking, people with hypermobile joints need to work on joint stability and should emphasize so-called "closed chain" (another misnomer) exercises.
Be aware that some people with joint hypermobility experience joint pain after vigorous activity. Rheumatologist Melissa Hawkins-Holt, MD (my wife) recommends an OTC pain reliever just prior to vigorous activity. (Remember that as a trainer, you cannot directly suggest this to your client, though.)