197 Catherine Cowey: Everything you need to know about hypermobility

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Katherine: Hey Everyone, welcome back. Today, I am having a conversation about hypermobility and everything related to hypermobility with Catherine Cowey.

This is such a great episode. We’ve kind of covered hypermobility a little bit in other episodes. And I think hypermobility is an important topic because it affects a lot of people and it’s been talked about a lot over the last three to five years, especially in the yoga community.

I think that this is all really well-meaning. But sometimes the information that’s shared is not completely accurate. I super appreciate Catherine Cowey’s work. She knows more about hypermobility research than anyone I have ever come into contact with.

She really, really knows her stuff. She is hypermobile herself. She’s a personal trainer. We talk a lot about strength training and creating tension in the body, especially for folks who have hypermobility or fall somewhere on that spectrum.

We talk about the spectrum and just everything involved. I know that you’re going to super duper love this interview and I encourage you to share this interview with other people that you think could benefit from it.

I want to thank everyone. I haven’t said this in a long time, but I really do want to thank everyone who’s left us a review on Apple Podcast. If you are listening to this podcast right now on your iPhone, I encourage you to press pause and then scroll down to the bottom where you see our five-star rating. Give us a star rating and also write up a little review.

All of these reviews just help us so much, get the message out, get the podcast in front of more eyeballs. It just helps us boost the podcast in the Apple Podcast stats. Thank you so much to everyone who’s left us a review. I go in and read them all. Super, super useful.

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Alright, Everyone. Here is my conversation with Catherine Cowey.

Kathryn Bruni-Young: All right, Catherine, welcome to the podcast.

Catherine Cowey: Hey, how are you doing?

Kathryn Bruni-Young: I’m so good. I’m so glad that we’re finally doing this. We’re sitting down together to talk about hypermobility. I have heard so much about your work from our mutual friend Jules.

And I have heard that if you want information about hypermobility and research, you are the person to talk to. So I’m so pumped that you’re here. Do you want to take a couple of minutes and tell the listeners a little bit about who you are and the type of work that you do just to give them some context for our conversation today?

Catherine Cowey: Definitely. I am also super excited to be doing this because I love to just educate people on hypermobility. Some of the stuff we’ll talk about is that there is a lot of misinformation out there about it.

I do personal training and I’ve been doing it for a little over 20 years, a little more than over 20 years working in the Bay Area. My background was kind of in rehab and I did the athletic training, sort of the projects in college working out with athletes. I did a little bit of physical therapy side 20 years ago. I didn’t really like the way physical therapy clinics were run, and I was always doing personal training when I was in school.

I just found I could really educate people and I really liked personal training and I kept doing it and still doing it. Then about five or ten years ago, I started to realize for myself I had to deal with a lot of injuries, which is why I went into rehab helping people with injuries.

I recognized that “Oh, you know that you’re Gumby, right?” I did some yoga, did gymnastics, did all the stuff that be folks love to do because we’re good at it and recognize that how there’s this thing called hypermobility and hypermobility spectrum disorders A thing called EDS, which we’ll probably talk about. I realized that there was not a whole lot of information about how to help folks with hypermobility really passed the physical therapy world.

I just dove into the research trying to find as much information as I could and then sort of extrapolating other research that I looked at of how to help people. A lot of research isn’t done specifically in terms of training protocols of what to do with hypermobile. I kind of use the science and try to figure out best practices and best strategies to help this population out. That’s what I’ve been doing the last five to 10 years.

I’ve been doing my training but definitely trying to get out as much information as I can on this subject. That’s kind of my deal.

Kathryn Bruni-Young: What types of modalities do you use in your personal training practice? Like weights?

Catherine Cowey: Yeah, so. Right, because I do personal training. The people come in, they’re like, “OK, we’re going to do weights”. I find strength training and getting strength…because people just have a really hard time holding tension in our bodies. How do you create tension in the body? Get strong, right?

Get those muscles that are going to pull those bones together because we don’t have our ligaments and all that tissue, the collagenous tissue in our body are moving, doing such a great job of holding us together. I got to use the muscles.

Kathryn Bruni-Young: Before we go any further, could you just define hypermobility?

Catherine Cowey: That’s a big question. I sort of thought about this question.

I like to sort of answer it in such a way of how the research looks at hypermobility and also sort of how a layperson…if you asked some guy off the street, “what do you think hypermobility is?” They would say, “oh, it’s that person that’s loose Gumby flexy, bendy, stretchy, all those things”. That’s what you see first.

And scientifically we’d say laxity in the tissues. Right? So that laxity in the tissues and that’s inherent in the word hypermobility. You’re hypermobile. You really stretch.

The complexity comes…what the research and doctors in the 50s started seeing was that they have this laxity. They’re also getting again, what you would kind of think. You think, “yeah, they’re going to get some subluxation, dislocations, injuries, pain, all that kind of stuff”. But then as they started looking even deeper, they said, “oh, well, this might be a thing going on with collagen. Collagen happens to be everywhere in the body.

They started to peel back these layers of things that are happening in people with this what the medical term called hypermobility spectrum disorders. Long story short a definition would be people with laxity in their tissues. Some have a collagenous disorder that also comes along with several other systematics symptoms that can affect many, many systems and create a lot of sort of “disorder”, “condition”, “syndrome”. All the stuff that it’s called.

Kathryn Bruni-Young: Yeah. So does hypermobility always happen at the level of the collagen?

Catherine Cowey: Again, good question. They don’t have a great answer. The hypermobility spectrum disorders, there are folks definitely have what’s called Ehlers-Danlos Syndrome. Those are just two Danish and French dermatologists back in the day in the 50s who termed it after themselves. If you have Ehlers-Danlos, you are seen as having an inherited collagenous disorder. Definitely, stuff going on with your collagen.

These first alpha fibers that make up the collagen, there’s a little kind of kink in it. The integrity of the collagen is not so great. That’s what’s going to happen with your EDS folks. They definitely have a collagenous issue going on.

With your people who are deemed joint hypermobility syndrome. Yes, they at first were saying, “you know, there’s no issue with collagen”. But I would say they are basically on a spectrum of, say, you have a group class and you have guys who are super not bendy and bendy. In the whole population, we have not been bendy and bendy. The guys who lax there, if you looked at the college in which they actually have done, you can see slides of the collagen is just not as dense. Are you going to say that’s a problem with that collagen? It is the sort of the makeup of the collagen is a little different.

I don’t like to say it’s bad or that it’s a disorder. It’s just different. So, I mean, you would say that: “Yes. I mean, it is. It is. The tissue is slightly different, but again, it’s always tricky when you say you have a cauldron disorder”. People can get a little scared. Creating nocebo effect.

Kathryn Bruni-Young: With J.H.S and EDSS is the difference people are existing on different parts of the spectrum.

Catherine Cowey: Yes, pretty much. And again, EDS if you look at the literature, they’ll say, could you tell the difference between and an EDS and a JHS. It is not a blood test they can do. They can’t. It’s based on symptomatology. A parent has to have it. You know, a doctor will decide whether you have EDS and JHS maybe you don’t have one of the criteria of the diagnostic criteria. Their symptomatology might be very, very similar. But they’ll be like ” yeah, I don’t think you have EDS”, but they’re still having a slew of issues. So, again, it’s very complex. It can get a little tricky.

Kathryn Bruni-Young: How much of the population, like what percentage of the population generally has some type of hypermobility, and how might someone find out if they have hypermobility?

Catherine Cowey: What the research shows are 15 to 20 percent of the population has some degree of hypermobility, the big umbrella being hypermobility spectrum disorders. About three to four percent of that total will have EDS. That’s what the literature says.

And then in terms of finding out, the diagnostic process is a little arduous. Usually, you have to have a primary care physician. You have to kind of know, possibly know about hypermobility. The medical community is becoming a little bit more aware. They might be able to tease it out with the symptoms the patient is talking about. But usually, it’s most often it’s the client or the patient that will say, “I have this, I heard about hypermobility. What do I do about that?”.

That primary care physician would then send the patient probably to a rheumatologist and then that rheumatologist would most likely do the diagnosis. And then there’s a slew of other things. They make a dysautonomia clinic. They might go to several clinics to then finally reach the final decision on whether they’re happy or not.

Kathryn Bruni-Young: OK, so I have to ask you this. There is that test that people do. It’s like a handful of stretches like does your thumb bend like this? Can you touch the floor? What do you think about that?

Catherine Cowey: I have this in a lot of presentations. I have that slide because I sort of like to have it as a….then I say, “you know, this is a piece of information. It’s information, not diagnostic”. And because in the exercise world and yoga world, they always bring up the Baten Score. It’s actually from research done in 1973 in South Africa. I think on kids. That’s where I came from was ages ago still.

Again, it’s, it’s a piece of information. The problem is that for folks who are thirty-five and older, as we age hypermobile people if you don’t work on your flexibility, older hypermobile people will lose their flexibility just like anybody else. I have a sixty-five-year-old client who is definitely when she talks about her history, I’m like “you’re definitely hypermobile”. She can barely touch her toes now. Right? If she did a Baten Score, she’d get a zero out of nine, right.? That’s one caveat with Baten Score.

They have sort of changed the criteria. They’ve said if the score is greater than six for pre-puberty…they’re recognizing that most of your laxity is happening when you’re young. Pre-puberty greater than six would be a plus sign on the Baten Score.

If they’re over six or even I think they should have a caveat of over thirty-five. Right? Maybe even if they get a three or above, they can be considered. And then also it only does certain joints. It looks at your thumb, your elbow, your toe touch, your ragdoll is what you would call it in yoga. Then the knees and the elbows. It’s looking at certain joints but they might have laxity in their shoulder and their ankle and their fingers. Not in their thumb and their wrist.

It just depends on…it’s a piece of information. But a lot of people are like, “oh yeah, you didn’t get anything on that Baten score. So never mind”. It’s a piece of information. It’s one portion of the diagnostic criteria.

It used to hold more weight in the diagnostic criteria. They’ve sort of…it’s still in there, but it’s definitely not weighted as heavily.

Kathryn Bruni-Young: OK, great. That’s really good to know because I think that test is circulating around, in particular like yoga teacher training programs quite a bit. There is a lot of concern about hypermobility within yoga teacher training programs.

Yeah, it’s just interesting to hear your perspective, given that you’ve literally probably looked at all of the research on this stuff. Thank you for sharing that, OK.

Catherine Cowey: Definitely. If they’re doing it, just recognize that…if they’re looking at older, older folks and older, I’m saying thirty-five. Right? They might not pop up anything. Right? Six or above or five or above, used to be..because it’s a point for each limb and then one point for that ragdoll position.

Kathryn Bruni-Young: What is the difference between being hypermobile and being very flexible? Is it possible to be very flexible but not be hypermobile?

Catherine Cowey: Are you kind of seeing hypermobile as a condition or a disorder? Is that what you’re saying?

Kathryn Bruni-Young: Yeah. Yeah.

Catherine Cowey: OK, if you looked at it that way, if we’re judging hypermobility as like a disorder condition or something to be sort of worrying about…In general, it’s again, that spectrum.

The spectrum. I have a slide that talks about this. What spectrums and syndromes like we all know autism and spectrum…anything that’s a condition that’s on the spectrum, that comes from all of the craziness in science fiction of genetics. Right? There’s a fancy term called pleiotropy. This is basically your genetics, plus the genetics of the condition, plus the training that you do, maybe trauma that you had as a child, plus any other stimulation that you can put, the type of physical training that you do…

Do you work out? Do you not work out? Do you smoke? You’re going to turn genes off and on; that epigenetics that you’ve heard of, if you know anything of medical stuff. A lot of stuff is being looked at with epigenetics. How we sort of impact our genes will create each different little snowflake. Right? So each person is going to be very unique in the way that they present with their flexibility.

Some folks can be super Gumby and have very little symptomatology, or better said is their body has figured out how to manage any of the issues or problems that most hyper mobiles will have. A lot of hypermobile people can have GI issues, maybe they have the genetics of the iron stomach. The people who can eat anything. Maybe they have a little bit of those genetics in their stomachs and maybe they have a family of high blood pressure. The low blood pressure that comes with hypermobility, maybe they don’t have to deal with that. Right?

Their genetics, combined with their laxity and their collagen they are able to handle it very well. And that’s all your gymnasts and ballerinas who are pretty asymptomatic. You can definitely have someone who’s Gumby and is flying high. Jenn Crane, she’s a circus physiotherapist. She’s pretty darn high functioning. And that’s what she’s always just saying, gain strength. She’s really helping the circus community and keeping them going.

Kathryn Bruni-Young: Mm-hmm. Do you think that these types of people who present as quite flexible and might not have additional symptoms like you’re mentioning…Do you think that if those people went for hypermobility testing…like collagen testing…they would probably show up on the hypermobility spectrum?

Or do you think it’s possible other people with quote-unquote normal collagen and just happen to have a lot of range of motion naturally?

Catherine Cowey: I suspect, again, this is totally theoretical because they haven’t done it…there is this one study by Nielson et al. He looked at the tendon and you’re looking sort of at a cross-section and you look at the cross-section of muscles and you see all those bundles. You see the little you know…theirs just look less dense. There are just not as many bundles in the collagen.

If you look at somebody with JHS and then EDS it looks even less. They have a little more things going on because there are several different types of EDS. There’s a lot of complexity if you haven’t noticed. But I think actually anybody who is lax, probably has slightly different collagen.
I think it’ll probably have to be a little less dense to create that laxity.

Unless their morphology, just completely…like their bony structures, make them able to move in that way and their ligaments and they’re a little bit. But I have a feeling if you looked at a thousand, a thousand people, I think you’d be able to answer that better. But the article was done, I don’t know, fifty people or something. I can’t remember what the value was in that study.

Kathryn Bruni-Young: The reason I ask you this is because one thing, one trend that I see happening, especially over the last 10 years in the yoga community, at least that I’m a part of, is people have become aware of hypermobility. Then a lot of people, I think, who are flexible start to identify a lot with hypermobility. Then people start to say, “well, I’m hypermobile”. Then they start to look at their students and they’re like, “oh, you can do that. You’re hypermobile”.

I’m wondering if you’ve seen this happen a little bit as well. What do you think about all this?

Catherine Cowey: In terms of: do they sort of like to pathologize it?

Kathryn Bruni-Young: Um. I think so. Or not necessarily pathologize it. But like “I’m hypermobile, so I shouldn’t do these stretches or I shouldn’t do pigeon pose anymore or…”.

Catherine Cowey: Oh yeah, I see what you’re saying. Yeah, I deal with a little bit more of a population that is more symptomatic. So I will post like “do this, do that”. But I try to say like for some folks you could be straight leg like crazy hyper-extending and be totally fine. Maybe nine years old being super bendy.

If they have no pain and they’re not feeling anything tweaking out of place or getting injured, then will they get more strength by bending and putting a little more attention and not hanging on the ligaments? Most definitely.

I’m biased. I think that’s better to do than hanging on ligaments and getting those big old bad stretches. For folks who are contortionists. They are earning their living by doing those extreme ranges that, you know, they can do it. You know, there is no consensus yet on whether how many of these contortionists, how they are going to fare when they are 50, 60, 70 years old. Some of them will probably be fine, some of them won’t be so fine.

I mean, I’m thinking I would love for them to do research on some X gymnasts X contortionists, X circus folks to see how they fare as they age. Again, as I said, some folks I think would be totally fine, some not so much. I don’t think.

Kathryn Bruni-Young: Yeah. When you say hanging on your ligaments, like, what does that mean?

Catherine Cowey: It’s kind of hard. I think that folks…when you’re hypermobile, it would just literally be that you go to your complete end range and you’re not putting any tension into it. You’re basically trying to relax into all of it and hang on to your structures, OK? That’s how I would sort of deem it.

Kathryn Bruni-Young: OK, so that happens at the furthest range of motion that the person can go.

Catherine Cowey: Yes, and a lot of yoga that’s what is sort of…I think the classes are much different than they were 20 years ago, fifteen years ago, even; where they would push you into the ranges and it was promoted to go all the way into the extreme end range that you have. It’s just hanging on the structures instead of holding the pose with the muscles.

Kathryn Bruni-Young: Do you think this hanging on the structures in the context of asana, so like these body weight, slow, static, sometimes quite deep, but definitely slow, static and not done with external resistance like weights or bands…Do you think hanging on the ligaments and those types of shapes could do something bad to the joints?

Catherine Cowey: That’s again, it depends. Again, the research isn’t there on what it’s doing for different people.

I think for certain folks it will because if they…there’s another researcher…they’re starting to look at…they looked at x rays of folks. They were in the splits. They were I forget what it’s called, it’s the pancake split; It’s a ballet pose.

Normal hip joint space will be about four millimeters of space in the femur head as opposed to the acetabulum. Right. The hip joint, the socket. In hypermobile people, it might start at like nine millimeters. That’s where it starts. They go into the split and then it pulls out even more. Almost sort of going into this sublux position.

In the picture, they show a 13 millimeter like suction. They call it a vacuum sign because it’s literally just kind of coming out of the socket a little bit to achieve that split. Again, the research is just not out there. Is that going to be bad for that person 30 years down the line, five years down the line? It’s always it depends just because we do not have the research into it.

For me personally, I’m just always like I’m not a ballerina and I’m not a contortionist and in the circus where you will have some folks that say, “no, this is totally fine. And if you strengthen that joint, if you have strength in those ranges, you can do it. And it’s totally fine”. There’s definitely that camp that for sure thinks that that is totally fine. They’re doctors and physical therapists. There’s a camp that says it’s completely fine.

But I think for some folks if they have no strength and I don’t know that it’s that great. But that’s my bias.

Kathryn Bruni-Young: Yeah, yeah, yeah. You know, it’s interesting to hear you talk about this because I think a lot of people who don’t know a lot about hypermobility and joints and exercise science and all that stuff, would just immediately jump into like, “of course, that’s going to be terrible for your joints. You’re like pushing to the end range and hanging in your ligaments. And of course, that’s causing damage”.

I think that is the assumption. I think that’s what gets taught a lot. It’s interesting to hear the wheels turning in your brain even about like, “well, this research and this idea and that idea and where do I land?” Because this, I think, is like critical thinking about hypermobility; where what I see so much of is like, “no, don’t do that”.

Catherine Cowey: Yeah. It’s that one-to-one; you inform the people of what’s going on, inform them that that is one thing. The PTs and docs who do maybe say that hyperextension is fine, they are definitely talking about you need to strengthen at that range; that active mobility instead of passive mobility. Where I can pull my leg up, you know, up to my nose, but can I take my arm away and hold my leg there? That’s the end-range strength. That’s the FR and Spina control yourself, whatever, control your ranges or whatever.

And if you can do that and have that insane strength…you know, you see some of these dancers…they have so much strength, some of them at these end ranges. I would say that is more protective and that’s OK. Right. I can see that you have some good strength there in that range. That’s probably again, that’s going to be a little bit better. It just always depends on the person.

If again they’re hanging in that position and they don’t really have any strength training…but then again, you could say that floppy person…maybe they’ll be ninety and will be fine again. It depends like, we need the research. I’m always willing to listen to somebody else’s experience or opinion.

Kathryn Bruni-Young: I’m not hypermobile. When I started getting into strength training, I had some pretty incredible coaches right out of the gate, which I think was extremely helpful.

I had a couple of coaches who were teaching me to do exercises like the leg curl, for example, through a full range of motion as I could maintain. That engagement and maintaining some level of strength. When I first started spring training, I had been doing a lot of a lot, a lot, a lot of stretching, and asana practice for a number of years. I didn’t have any strength through any range of motion, basically.

It started to build. My knees hyperextend a little bit. When I was doing a lot of yoga practice, I was always told to never go into that range of motion, always bend your knees a little bit, always micro-bend them to protect the joint and protect the hamstring, and whatever. Then I started working with these coaches and they were like, “well, let’s see if you can actually create tension through that entire range of motion and we’ll just build you up over time”.

It was so interesting to have that completely different relationship with my knee and with that range of motion…and sensation and then building it to the point where my leg and my knee and my hamstrings could feel quite strong, even as my knee locked out; that was really powerful for me in particular and really got me to, like, rethink the body and potentially its capacity.

But again, I will say that, like, I’m not a hypermobile person. I’m definitely would say I’m a dense collagen person. I have those genetics.

I’m wondering what you think about this whole idea of progressively training potentially into hyperextension under progressive loads for folks who might be hypermobile.

Catherine Cowey: Yeah, exactly. You were very lucky to find great trainers, that’s sort of key in someone’s sort of going through strength training.

You were lucky they were slow graded progressions, slow with it. The difference that for someone who is hypermobile…one, it will probably take longer. two their hyperextension will probably be a little bit more; such that even if they were trying to gain strength in those ranges, some folks will still have sort of proprioceptive issues trying to sense that hamstring.

Your eyes probably bugged out when you realized “oh my God, I can feel the hamstring and feel like my knee is…” Is that kind of sensation that you had?

Kathryn Bruni-Young: Yeah.

Catherine Cowey: That’s sort of what I got. Can I get that when they’re super hyper-extended? A little less so because if you have issues with the collagen and literally the laxity that occurs…the sort of transfer of sensation to the mechanoreceptors and proprioceptors in the joints, it takes a little bit longer for the signal. That sort of weakens our proprioception a little bit.

There’s also a theory that the sort of loss in integrity of that collagen makes the interface between the nerve endings and that collagen….again, the message sort of gets garbled. Those are some of the theories on why they have some proprioception issues. They’re all sort of theoretical. They don’t quite totally know.

If you have collagen that’s working totally fine, your mechanoreceptors and proprioceptors in the joint will be like, “yeah, OK, we got this”. For a hypermobile person, it might be a little different. I used to have no sensation in my hamstrings with a dead left. “I’m like, what, what, what are you talking about?’ And I was just starting with a straight deadlift because then I could feel a hamstring.

I had to go to sort of an extreme range to get any sort of pull on the hamstring. That was the only sensation. I couldn’t create a sensation through contraction. I only knew the sensation via stretch. Right? So, yeah, the proprioception stuff is sort of fascinating and creating…the ability to create tension, I think it’s just you have to work at it a lot. The training age might be a little…it’s going to be a little while before they can feel stuff.

Kathryn Bruni-Young: A person who doesn’t have hypermobility when they stand up, for example, they’re just standing at the front of their mat doing a very basic standing pose. They’re not thinking about engaging any muscles. They’re just standing there. Certain muscles are engaged, obviously. Even if they’re not thinking about it, they have to be, or else the person would just be crumpled on the floor.
Do you think that people with hypermobility…I don’t know how to say this…have less of that resting-state tension or engagement?

Catherine Cowey: For sure. This is one of the two biggest symptoms that a lot of hypermobile people have are pain and fatigue. One of the contributing factors and this happened with a client of mine. When I describe it, she’s like, “oh my God, I feel so much better. I was always thought I was just being lazy”. I describe it as we all know, that the person on the plane that kind of cock their head a little bit and they fall asleep.

You see those people, right? Hypermobile people will look at that person and just go, “Oh, I hate you”. Because for a hypermobile person, if we cock our head, it’s going to just start to go all the way over, and then our body will go all the way over. We just sort of collapse. There’s no tension. In my presentation, sometimes I use the little kid’s toy and put it under tension and then you push. You take the elastic out and the toy crumples.

That’s sort of a hypermobile. We have no tension. For us to stand…actually a lot of them, they don’t like standing, one because of the low blood pressure. Long-term standing isn’t so super joyous and then two standing or keeping any sort of upright position…like a long meditation practice, just in a seated pose can be very difficult because we can’t hang on any sort of ligaments or tendons or any stiffness. There’s no stiffness to rely on to sort of cheat with, to keep you up.

We can try to like stack the skeleton to make it so, you know, sort of like a Jenga. It’s like, “can I sort of stack on those bones a little bit?” We have to basically hold ourselves up a lot more with our muscles instead of using tendons.

We use a lot more energy just to hold ourselves up in a standing posture, in a seated posture, so that client needs to just choose to always slouch. We slouch a ton because we can and we also we’re just tired.

We just like we think it takes a lot to hold the body up so that can contribute to some of the fatigue. But yeah, any standing poses any like still poses where you have to hold just even holding just a straight position will take more energy. And the blood pressure thing is definitely an issue as well because they tend to have low blood pressure.

Kathryn Bruni-Young: OK, so this is really interesting. If somebody who’s hypermobile is standing, their muscles are working potentially more than someone else who isn’t hypermobile because they’re not able to rest into more dense other supportive structures to hold themselves up.

Catherine Cowey: Yes, exactly.

Kathryn Bruni-Young: It’s just so interesting because I know a little bit more now about hypermobility than I did, say, five years ago. But back then, I would have never made that connection. I would have never thought a hypermobile person, to do certain things, their muscles are actually working harder.

Catherine Cowey: Yeah. If you think of something that’s super tense or has some density and you can hold tension, you can hang on that. The person on the airplane just that one sort of I think because everyone knows that that person that can just kind of cock their head a little bit, fall asleep. They can be totally relaxed because all of the tissue on the side of their neck is holding their head up.

Their muscles don’t have to; their ligament and fascia. All of that tissue is holding the head up. They can just be relaxed and just the non-contractile tissues are holding him up. But in a hypermobile, all the non-contractile tissues just bloop and they just fall over.

Kathryn Bruni-Young: Do you think this is why…I’m about to make an assumption…my assumption is that a lot of people who are hypermobile get into types of movement like asana practice that are heavy on the stretching?

I’m wondering if you see that yourself and do you find that people who are hypermobile enjoy the sensation of stretching?

Catherine Cowey: Yeah. That’s another slide I have. We all like to go and be good at something, right? It self-selects for a Gumby body, a more mobile body. That’s part of the reason that they go to yoga. Right? Why a big beefy guy who puts on tons of muscles, he wants to go to the weight room. He’s like, “I’m strong. Look at me. I’m great”.

Same thing. We can go and we’re amazing in a yoga class. It’s sort of self-selects because we’re good at it. The second part of why we love doing all these stretches is because so I was saying there are no non-contractile out issues holding us up. To an extent. I’m being a little extreme there, but not a whole lot of tension going on. We have to use a lot more muscle.

Oftentimes we also don’t have great proprioception in our stabilizers and our shoulder and our hip rotators. Sometimes they’re not working so great. You get these long-levered muscles that try to do the job of a small, little, tiny muscle that has insertion and origin right close to the joint. That’s the way you’re supposed to stabilize a joint. Not big long muscles.

They end up using big long quads and lats and pecks to help stabilize the joints, so they get really tight. A lot of hypermobile people sit in these very stressed-out positions because they’re like, “oh, my God, I’m so tight, I’m so tight” because their lats are really tight; or their psoas, rec fem are big ones. You know, the big long levered muscles that tend to do a lot of guarding, embracing to hold on to a joint because the joint feels like it’s about to fall out.

Sometimes it might actually be falling out. I had a client whose ulnar nerve, just likes to slip out of place. I have clients who have shoulders that dislocate sublux on a fairly often frequent basis. It’s definitely a thing…usually you wouldn’t say like “oh it might just fall out of place”. In the case of an EDS person, it can and will sometimes. It’s definitely a thing that can happen.

Kathryn Bruni-Young: Yeah. Yeah. Listening to you speak kind of starts to make more sense to me, like why this population might really enjoy things like, you know, like long stretches.

I think oftentimes, at least in my community, we look at people who are hypermobile and you see that they like to do some stretching. Then a lot of people are like, “no, don’t do that because it’s going to make hypermobility worse”. And I’m wondering what you say to that.

Catherine Cowey: That’s, again, sort of goes back to that issue it depends. With some folks, I think it can. You can. Especially, if they’re going into the class because they have instability and all their big long levered muscles are super tight and they’re just trying to stretch those out. That is just going to be a vicious cycle. And it’s not helpful for them at all. They do. And it’s like, “no, stop doing yoga and strengthen yourself”.

But I think Pat Davidson says all those beef heads should be in the yoga class and all the yoga people should be in the weight room. I think in essence, I think he’s right of that. Have a practice that’s sort of well-rounded. You can love and do yoga five days a week, but maybe put in…that’s a brilliant thing about strength training that I love.

You can definitely try to figure out how to do a minimal effective dosage of strength training because we deal with so much fatigue. You can get a lot of progress in a strength training just by doing like two times a week, maybe a 30 minute session each.

You got to be putting a lot in that 30 minutes. You can’t be waffling around, but you can gain a lot of strength with very little input. That’s what’s pretty awesome about strength training. Unlike running, you know, you’ve got to do that pretty regularly. Go a good amount, put in a lot of time to get benefits.

But strength training actually doesn’t take a whole lot to get just a good amount of strength in the system that can really create benefit for the person for the client.

Kathryn Bruni-Young: I agree. I agree about the thirty, thirty to forty minutes, a couple of times a week focus dosages and then consistency and then progressions over time. I think it doesn’t need to be as fancy as sometimes people say it needs to be.

Catherine Cowey: Yes. Yeah, super simple.

Kathryn Bruni-Young: When someone who is hypermobile starts doing strength training, how does that change their situation?

Does it change the way the muscles are able to generate tension at a resting state or change the way that muscle is able to generate tension during exercise or both? I mean, it’s probably going to be a little bit different for different people. I’m just wondering, like, what that progression could look like.

Catherine Cowey: Yeah, it’s sort of all of the benefits that normal folk will get, I think is still applicable to a hypermobile.

And in actuality, that’s what I’ve used a lot of the sort of tenets of strength training with normal population, because there’s just not there’s like two articles, on strength training for hypermobile people. They’re just not out there. The research isn’t out there for is it super different for JHS or anyone on the HSD spectrum.

But it is a bit like how you were saying that ability to create tension and then just literally the size of the muscle and the power of the muscle can help with the blood pressure; so it can help squeeze blood around to create better venous return. Just that fact is good.

The effect that is created in the tendon, which is some of that non-contractile tissue, those biopsies were done on tendons in those hypermobility folks.

And so the tendons, if you can bolster up those tendons, wow, that’s huge because this population definitely tends to have issues with tendinosis or any sort of tendinopathy. If you can strengthen up and sort of bolster up the tendons, which happens with strength training, all the things that are happening with anybody with a strength training program are kind of golden.

When then they also deal with panic and anxiety disorder stuff. A lot of these hypermobile folks and strength training…decreases anxiety symptoms. Just all the benefits of strength training, which there’s a million of them, and they also benefit hypermobile people. They’ll probably find that their yoga practice is actually better.

They can hold poses longer. They probably don’t feel fatigued by any of the factors that might be little…instead of going to like a hatha yoga class, maybe they can go to a little bit more about active class.
So, yeah. It’s all the benefits, I think. Just work for those guys as well.

Kathryn Bruni-Young: Amazing.

Catherine Cowey: And probably even more so; they are getting more benefit with strength training. They just have to do it very carefully.

Kathryn Bruni-Young: Yeah. Well, I’m so glad that we had a chance to have a chat about hypermobility. If people want to take a look at your work or maybe learn about some of the things that you’re doing, where should they go online to find that information?

Catherine Cowey: I have my website that’s just fitwizesf.com You can also just put my name in and I think that that website comes up. On Instagram, I try to post spam. I try to post as much as I can because some people do find it helpful. I try to just post stuff that’s sort of talking to this population and that’s just @catherinecowey. On the website, I have two online courses.

One, it’s Yoga for Hypermobiles. And then also just hypermobility course in general that just talks about all of the physiology that’s going on and then best practices to try to help help these guys.

Kathryn Bruni-Young: Awesome. Yeah, we’ll have all those links in the show notes. People can check it out. Thank you so much for coming on the podcast.

Catherine Cowey: Yeah, it was awesome. I love the questions. They’re great.