Hi, I'm hypermobile. And if you're listening to this,
I'm guessing you might be too. Hello, my name is Alex and
welcome to help Ryan. Hypermobile we're gonna have to
sit for and today we're talking all about exercise, and I don't
know if you can hear the enthusiasm in my voice but
exercise is one of my favorite topics.
It's one way which if it's safe for patients to to do exercise
we can help support hypermobile people and having really
profound jizz in their health. Now again I want to stress every
hypermobile individual is different.
It's not exercise is not possible or even safe for every
hypermobile patient. And this is why I as always,
it's so important that you speak with your qualified and trusted
health care, provider to make sure that you are doing what is
safe and correct for you. Now, before we get any go any
further, I do want to give a little shout out to somebody
took the time to send some feedback in.
I actually received a lot of feedback from the first three
episodes it was The response was overwhelming quite frankly.
Thank you to everyone who's taking the time to subscribe.
Download like share, follow or right in and Vicki.
Thank you so much for taking the time to say to leave.
This comment Vicki said, I'm leaving a 10 star review here
because I couldn't find the review bit.
I think we can only have five stars on Spotify but I'll take
ten. Thank you so much Vicki.
Brilliant information. I used this in a recent medical
consultation and it couldn't have helped me more.
Follow the advice Vicki I'm so So happy you found this
information helpful except what I'm trying to do.
I'm trying to make some or just provide everything I wish
hypermobile people knew about a bunch of different topics.
So I'm so happy that you actually found it useful.
In today's episode, we're going to talk about a few different
things when it comes to exercise.
So firstly we're going to talk about exercise just in general
why it's important. You already know it's important
so we won't spend too much time on that.
We're going to talk a little bit about my personal journey and
the role that exercise has played in terms of my body and
how I'm able to live my life. Then go on to talk about eight
things that you need. Your healthcare provider to be
thinking about when they're working with you, to help you
develop an exercise strategy for your unique body.
So these are 8 really, really key points.
I can't wait to get into them and finally, we're going to be
talking a little bit about how to tell the difference between
the pain of re-injury and the pain.
And I said that in quotation marks because it's not shouldn't
really be pain of healthy muscular fatigue, and these are
two entirely different things. And it took me decades to figure
that out so I hope I can help you figure out.
I figured out a bit faster than I did exercise is important.
If exercise was a pill, everyone would take it.
The benefits are undeniable. In fact, if you are in the
strongest, third of the population at midlife, you are
two and a half times more likely to live to 100.
And I like this statistic and you can look in the show notes
for all the research that I'll mention in today's episode.
But I like the statistic because it highlights the fact that
firstly Your size does good things for you, which we know it
does. But secondly, you don't have to
be that Olympic gold medalist. You don't need to be in the top
1% of people to get the benefits of exercise.
You just need to be in the top third and that's something which
although, it's probably it's not going to be achievable for
everyone. If it's achievable for you,
that's a great goal to work toward okay.
Now here, I'm referencing Professor, Keith bar, and he'll,
he says, we do strength exercise.
So we can have a long and happy. Happy life.
And we do strength exercise in particular because it improves
longevity and the ability to do things.
So if you are strong, you are going to be able to go up and
down stairs, you're going to be able to lift objects.
And this is literally you interacting with the world
around you physically. And for people who have never
had issues doing this, you don't appreciate how amazing it is
just to be able to interact with the world around you, until you
lose that ability. It's something that I think so
many people take for granted. And exercise is one way that you
can try again, if it's possible for you to protect or even
improve your ability to do that. Now Professor Keith Bar, goes on
to say that we do endurance exercise because it feeds the
brain and as someone who's talking from a hyper mobile
perspective, I am hyper about myself.
But also in the UK registered osteopath and I work with
hypermobile patients, I want you to think of exercise is also
feeding the body. So with conditions involving
high permeability. For example, high quality
Spectrum, Disorder or hypernova. At least I know syndrome.
We see a lot of dysautonomia and this means altered function of
something called the autonomic nervous system and the autonomic
nervous system in really simple terms.
You can think of it as the part of your nervous system that does
all the stuff. You don't have to think about.
So I'm breathing right now and I'm not having to think.
Inhale exhale it's my body's just doing that thank goodness.
And it does things like digest your food, for example.
So autonomic nervous system does a lot of things.
Autonomic nervous system also Is in charge of how your body gets
in nutrition and oxygen and other things to the bits of
tissue and you that require it. And one system that really
requires a lot of oxygenated and nutrient-rich blood is your
musculoskeletal system. And if you're hypermobile person
a good example of dysautonomia might be that youth have really
cold fingers and toes. Even when it doesn't make sense,
that's your autonomic nervous system, likely being a little
bit weird, as always, if you're concerned, go see your doctor
but we see See that people who are hypermobile have altered
delivery and altered like flow of nutrients of nutrition of
blood. Sometimes a fun product food,
Etc, around their body and exercise in particular endurance
exercise or aerobic cardiovascular exercise.
So that type of kind of lower intensity exercise done for a
slightly longer period of time. That's a way that you can get
your cardiovascular system working a little bit to try and
deliver nutrition to those tissues.
Now as we age and this is For everyone, it becomes harder to
maintain muscle mass. So your musculoskeletal system
is in some ways, a luxury, if my body's trying to protect me in
the present moment and the analogy.
I like to use here is thinking of the body as a bioeconomy.
And if we're trying to protect Alex, we're going to prioritize
my brain, my heart, and my respiratory system, because I
will die very quickly. If those are not functioning
things, like my hair, and my nails, and my muscles and
Joints, those come a lot further down the list.
So, as we age some of, Our processes, especially those
involving metabolism, which is how we kind of, we get things
actually into our body. Those processes become less
efficient and they start to work differently or not work at all
sometimes. And that's why we start to see a
decline in tissue quality, in people's, for example, bones.
You'll hear of a lot of people as age, starting to get
osteoporotic or have osteopenia. They're having changes in the
quality of their bones. We see the same thing and muscle
and connective tissue. We see a decline in quality and
one That we can try and counter that decline in quality.
Is we can say that we can use movement to stress the tissues
physically and support the idea that we need those tissues.
When you're exercising, you're saying actually, I know I'm 80
but I need to be able to go up and down stairs.
All right, I know I'm 35, but I need to be able to pick my
toddler up because they need me to help to raise lawmen to do
things with them. So by using a stamp out, an
appropriate stimulus of some kind, we can try and counteract
this Decline. Now, people who have issues with
collagen and other aspects of their connective tissue, there
had a huge disadvantage here because from the moment, they
were born. They've had issues with the
function of that system. So at a disadvantage, however,
in some cases and for some patients, we can use exercise to
try and address some of those those changes there and to try
and prevent these negative changes long-term.
Additionally, for hypermobile patients, one big benefit It of
doing strength training is that for some patients, they can
actually in a way build their own braces if they get enough
muscle mass. So, because I started my career
working in sports and now I recommend me with hypermobile
patients. We do see these, these muscley,
hypermobile patients, and these are these will be people who
generally just through sheer luck.
Managed to find a way of exercising that works for them
and they've been able to maintain some muscle mass and
that muscle mass helps their joints to feel stable.
It helps to prevent some of the if the injury that happened as a
consequence of that instability due to the high permeability
that other hypermobile patients struggle with.
So if it's possible for a patient to build muscle mass,
they need to be supported in that in every way.
Because this is a way that we really establish a positive and
hugely beneficial tissue change. And although it's not possible
for everyone, for those patients who it's possible for, we need
to make sure that they're getting that really good
clinical outcome because it is life-changing.
Long-term. Now, before we go any further, I
do want to mention again. There will be some people 94 and
not possible for. And if you want other people
listening to this, I want to tell you.
That's okay. We will talk in future episodes
about what can be done in your situation and looking at ways of
improving quality of life and protecting function.
But this episode today is particularly targeted at the
people who've been told it's safe for them to exercise and
they just they're hitting a wall and they're not sure what to do
and they're not making progress. So, speaking of hitting walls,
let's, uh, let's talk about my journey.
So I started as a swimmer growing up because we were told
that. So mean Was like the safest and
best thing I could do. So I was swimming and I started
to have shoulder pain like a lot of swimmers and that shoulder
pain led to chronic neck pain as someone who was I was in my
early teens when I was having those symptoms I was maybe 13,
maybe even younger and chronic neck pain in children.
We should not be normalizing that but anyways, I was told it
was, you know, stop complaining. Stop being so sensitive
etcetera. And he got worse and worse, and
worse. And eventually I saw a
physiotherapist when I was about 16 or so, and the
physiotherapist ride. Tell me did some treatment.
It didn't work, you know, people were not aware that my shoulders
are really high from about the time the Physiotherapy and
exercise. I was given and they made my
shoulders feel worse, not better.
So I was eventually told by the exasperated physiotherapist that
my that I had simply worn my shoulders out.
I will never forget those words. I was told I had worn my
shoulders out and that I needed to just not raise my arm above
90 degrees anymore because that was where I had pain.
It's a really common presentation.
Patients will have pain raising their arm above 90 degrees, and
I was told just to stop doing that.
So, at the age of 16, I quit. So I mean and I stopped raising
my arms above 90 degrees. I didn't realize that this at
the time. But that was a very, very
problematic thing for me to do because I lost the muscle mass
that I had, which wasn't that much to begin with and my joints
became even more unstable. My low point was in my early 20s
and it's I always thought 20 want to be the best year of my
life. It was the absolute worst.
So if you're someone you're early 20s and you're listening
to this you couldn't pay me to be 21 again.
It's But I was in, I was in my early 20s and the low point was
going home from Christmas in the car with my family and going
over speed bumps and literally trying not to cry as we went
over a speed bump every time because of the agony in my
shoulder, just from the, the Jocelyn motion of the car going
over the speed bumps. So that was the low point for
me. I also had headaches that had me
in bed for days at a time. I would have a pillow over my
face, and I would just lie in the dark, just hoping it would
end and not sure when we're gif, It would.
And that if you're someone who gets those headaches, they
really really suck. Anyways, through some trial and
error. My degree studying all these
things. I talked a little bit in episode
one about that, but I started to kind of try to figure out what I
could do to improve my shoulder on my own because I was done
with physiotherapy at that point.
And I was, I was done with manual therapy in general.
So, I went to the gym, I couldn't afford a personal
trainer, I couldn't afford more treatment, to be honest, I was
just on my own and I made these little programs and I was trying
to find Is to move safely and not feel pain and do something.
Because I felt like I wanted more muscle mass because I would
make my shoulders feel more stable, and more safe, and
eventually and very carefully over time.
I managed to exercise without injury which that that's the
trick here, right? So for all of you who've been
told, oh yeah, just build muscle mass, there's nothing just about
it. If you're a hypermobile person
and you're at a high risk of injury and on top of that,
you're not gonna be able to feel your body in space, probably
that. Well, so it's really hard to
move with good technique. Technique, especially if you're
on your own, it's so hard to exercise and not get injured.
Like it's hard for the average person to build muscle mass, let
alone a hypermobile person. So if you've struggled with
this, you're not alone in that, but I managed to achieve that
magic combination of not getting injured and exercising and I
built up some muscle mass over time.
And the point where I felt better, the point where I felt
like my life had changed and you know what it would have been
okay? If I just stayed here forever.
This is the point. I felt like I made a big
Improvement was when I was able to run for 10 minutes without
shoulder pain. I remember I was on the
treadmill at a mall in West London.
I remember looking down at the screen and watching it Go nine
minutes, 46 seconds, nine minutes, 47 seconds.
You know, getting into that nine minutes, 52 seconds and then
nine minutes 59 seconds and 10 minutes.
And I couldn't believe that I had run ten minutes without my
shoulder hurting, because I was literally listening to my
shoulders waiting for them to have that horrible horrible.
In Spain, they would have and they didn't hurt and I couldn't
believe it. And actually I didn't Instagram
post that day talking about how thrilled I was because that was
a life-changing Improvement for me.
Now, if you've looked any of the other content online you'll know
I've gone to a lot more sporty things.
Some of them have different degrees of risk and that is risk
that I've chosen to take on because I decided it was safe
for me. And I've gone on to do things
like for example, developer really heavy snatch, so that's
the type of Olympic weightlifting move.
Where you left the bar overhead. And I got up to 52 and a half
kilograms, which is, I think it's around like 115 pounds,
which is huge. Like, I have a video of doing
that lift and it's probably one of the happiest moments of my
life because I never thought that would be possible for me.
And I've gone on to do things like for example, long-endurance
pieces like a half marathon row on a rowing machine.
Holding a pretty fast pace on that too.
So because I love sports and because my body lets me I have
gone on to do a bit of an overcorrection and What I want
to say to anyone out there is if you're someone who wants to, you
have those big dreams and you want to do the sporty things,
keep them find a find a qualified healthcare provider
who can help you talk in realistic terms but what's
possible for you or what's not possible and find the the
smallest steps. First you have to find those
little steps along the way. So for me, step one was
literally just being able to raise my arm overhead without
shoulder pain. So you have to find the steps in
your journey. I promised you get into some
really useful information today and the first thing I want to
get into is how I think about exercise.
I actually called My Philosophy of exercise, I'm half Greek and
I maybe I've always wanted to philosophy, I don't know.
But this is how this is my mental framework of how I think
about exercise or My Philosophy. So there are three reasons why
people exercise people exercise, either to look a certain way.
So they exercise for Aesthetics, they exercise for the body to be
able to do certain things. So it's exercising for fitness
and And there's that third reason, which is exercising for
tissue Health. They want their body to feel a
certain way and most of the patients that I'm working with
these days, they are patients who are looking to exercise for
tissue Health. Now, if we look in that category
in particular, there are three ways that people can exercise
for tissue Health. You can do strength training,
and of course, within each of these broad categories or
subcategories. So, for strength training, you
can do free weights, you can do resistance training, etcetera,
you can do balance or proprioceptive training.
And there are, of course, different ways of doing that.
Or you can do cardiovascular training and there are kind of
two main ways you can do that. You can do an anaerobic
cardiovascular program, where you're kind of doing those
Sprint pieces, you're out of breath, it's short, it's intense
or you can do more aerobic style training where your heart is
going to be a little bit lower it slightly longer sessions.
I like to think of it like different gears in a car.
So it is working in a different gear.
That's all it is but it's still affecting your cardiovascular
system. Now, this standard advice
typically What hypermobile patients are told is that That
they have to firstly. Safety is important, which it
is. You have to do it safe for you?
I'm not saying it's not but they're told that they have to
do certain things. So they'll be told oh, you can
you have to do resistance training only?
And I've always found that recommendation, really weird
because the world is made of free weights.
So although there's nothing wrong with their bands.
I think that any program needs to whenever possible support the
patient in being able to safely navigate free weights, because
that's what the world is made of a coffee.
Weight is a free weight. Phone is free weight.
So that's my brief thought on strike 3 will have a separate
episode on all of these different types of exercise, but
that's my quick little thought there when it comes to, you
know, bounce proprioceptive training.
Again, that is hugely valuable. I like to think of it as you're
making the, you're making the race car driver, better able to
drive the car. So if the hyperbole body is not
the best car, it's not working. So well maybe those ankles are
rolling all the time, it might make sense to start with balance
and proprioceptive training because you're working.
With that person to make them a better driver of their body.
So even if the the ligaments have been injured and they're
not behaving the same way and we have some hyper building the
ankle. If you can make that person
better able to balance on that on that tissue on that joint and
to avoid those ankle sprains, then you're going to prevent
injury. So sometimes balance and
proprioceptive training is the right place to start.
However, I tend to have my patients, start whenever
possible and safe on something called a low-intensity steady
state training program for my patients with an athletic
background. And it may be a steady state
training program, but typically it's going to be a low-intensity
steady state training program. And I do this simply because it
gets them feeling better. Faster, we're getting some as we
talked about at the start of the episode about those dysautonomia
issued, so way you can address some of those.
So you're getting some blood flow, to those tissues, you're
getting some endorphins and for patients who are stressed about
going to the gym, it can be nice sometimes to not have to worry
about doing all these different movements using these different
weights or finding these machines.
It's a way that I can almost control.
Variables more precisely. Even for example, if you're
doing a strength program with the patient and they're having
to jump from a 6 kilo dumbbell to an a kilo, that's a huge
jump. Whereas, if you're doing a
steady-state style program or something that's, you know,
reusing a Time domain, you can be a lot more precise in how you
scale it. You can say, Okay, instead of
doing three rounds of three minutes, we're going to do three
rounds of three minutes and 10 seconds.
So it gives you a much smaller increments you can work with but
again I want to stress at the end of the day it comes down to
the individual patient. Patients.
Who see me? We start with strength training,
I've patients who see me and we start bouncing preceptor
training and this leads into the 8 things.
You must make sure your healthcare provider is
considering when they're making an exercise program for you.
The first thing, it's a tie for first.
So you've heard me say safety a million times in this episode,
safety is important. We don't want people having bad
things happen to them when they're exercising and stop.
His diaper will people time. So I guess we'll put safety at
number one, but coming in very, very close.
At number two, is Stability. And I'm talking about
accessibility in terms of money. So for example, say that
reformer pilates is this? Perfect cure all for hydro all
patients, say all of them should be doing reformer pilates,
that's not possible. We've a cost-of-living crisis in
the UK there are people struggling to afford food, and
their homes. And for some patients, they're
not going to be able to afford that type of training.
So, you have to look at what's possible.
In terms of financial ability for that individual.
We also need to look at accessibility Terms of time,
everyone has different commitments, some people, our
parents, some people have jobs where they have to be there for
a certain amount of hours, we need to look at what's possible
in terms of time, for individuals, because even if I
make the most perfect amazing program, if it's not impossible
in terms of time or money, it's absolutely pointless and it's
just going to lead to the patient feeling bad.
So that's really, really important.
Of course, in terms of accessibility also need to
think, you know, geographical location.
We just think of just literal ability.
That can the patient like get to the place that were talking
about. Are they able?
All to use their body in that space.
Is it a place where they feel safe and comfortable?
So accessibility even in in that almost literal sense is
important as well. So accessibility is a is almost
number one and it's certainly number two, in terms of things.
I think people should consider. Number three is, what does the
patient want to do? I've seen patients where I would
have preferred in some ways for them to begin with low intensity
steady-state style training program, or some cardiovascular
exercise. But the patient's told me, you
know, what I love have lifting I want to get back into it.
Lifting weeks, me. So, you know, I want to be
strong. It makes me feel happy and I
will take that into consideration when helping them
make that clinical decision about what exercise program is
right for them. It's important, especially when
people feel down and they're tired and most chronic pain,
hyper will help patients, feel exhausted and sad.
It's important to think of what makes that person feel happy and
incorporate it into their program.
I cannot stress how important this is.
I think it's something that's overlooked.
We're always looking for what What's best for, what does the
research say, or what, protocol, what you know, what does it say
for this? This type of person what's best
for them. You know what, they're an
individual with thoughts and feelings and preferences and we
need to think of what's best for them as individuals.
I actually had a patient. This was, this was quite a while
ago, but this patient really wanted to rollerblade
rollerblading made her heart. Sing is rollerblading, High
injury risk. Absolutely.
We re starting from the bottom with this patient where this was
there. A lot of stuff going on.
Yes, there was You know what? I told the patient you want to
rollerblade. These are all the things we need
to get to do that. I'm not sure if it'll be
possible, but we can try and that patient ended up getting to
the point where through, you know, they I made sure that they
acknowledge the risks and we did everything we could to reduce
them, they were able to rollerblade.
So again, it's about thinking of individual patients, and doing
that risk assessment, but always making the decision and
supporting the patient and making the decision.
That's right for that patient. When it comes to risk, a quick
note, there are risks with exercise.
Eyes of all kinds there, different risks.
There are also risks, though, from not exercising.
So again, it's about taking out a holistic risk assessment,
people will say, like, Pilates is safe, and yoga is bad, and
that's simply not true. It's all about how it's done.
It's all about the individual patient.
So, again, there are, there are patients, I know of who get
injured doing Pilates, because they struggle with lifting
their, their head off the mat. Even if they're in a really
using perfect technique that happy one-to-one coaching their
neck is just too long to hypermobile and it injures them.
So for them, they would have to do it.
Pilates program or just avoid that kind of crunch type
position and there may be another form of exercise that's
safer for that patient. So it's always about what's
right for that patient. We look at principles here.
We don't just look at arbitrary. This is good or this is bad
because it doesn't achieve anything.
Now, we also want to look at the patient and think of what their
primary symptoms are or what do they wish to address.
So, for my patients who are having issues with dysautonomia,
you're having issues with fatigue or lightheadedness.
If it's safe. For them to do some form of
cardiovascular exercise and they want to, that's a fantastic
place to start. We cannot get them wearing a
chest. Our part rate monitor, they can
get that real-time feedback on their heart, we can train a
different parameters that are individualized to them and how
their cardiovascular system works.
And that's a really, really cool place to begin.
However, for a patient who, for example, they want to stop
rolling their ankle. We're going to start with
balance of proprioceptive training.
So again, it's looking at that patient's individual, physical
self and thinking. Okay, what does this one?
This patient want from their body right now.
What are they trying to achieve, how can I help them achieve
that? So that's a really important
point to consider as well, and of course, we want to think of
what is the goal. So it's kind of goes back to its
kind of similar to, what does the patient want to do?
What makes their hearts saying, what makes them happy?
But we want to think of what is the goal.
So sometimes I'll patients for example, at a patient once who
was struggling to hold his daughter and that was a goal
that we work towards in a very particular way with weights and
specific exercises. We wanted to help support him in
exercising in a way that would result in him being able to hold
his child. So we always want back exercise
program to be tailored, not only to the individual patient but to
what that individual patient needs to do in their life.
Maybe that patient needs to work to pay rent.
So again we're thinking of the exercise program and finding a
way to make sure that it's tailored to what that patient
needs to do with her body and that's why when I do a medical
history, I ask a patient. What's going on?
We get the whole picture, but I usually at somewhere near the
end of it, I'll say, what do you need?
Body to do for you and they'll tell me, you know, I need to
look after my child, I need to walk my dog, I need to pay my
rent, I need to, you know, see my friends or whatever.
They'll tell me what they what they need their body for to do
for them what they want their body to do.
So again thinking of those goals is key and and what that patient
really wants the outcome of the program to be.
Because if the patient feels motivated and feels inspired,
they're going to follow an exercise program perfectly.
And if it's a program that's been made in a way which is
informed by physiology and By what we know about tissue
Remodeling and giving that right stimulus to get those changes
and you're going to have a successful outcome for the most
part. And of course, we always want to
think, too. How will progress, be measured?
How are we going to know if the ship is heading in the right
direction? Emerson has a really lovely
essay on called self-reliance and he uses this image of a
sailboat and its trying to get to its end destination and I
don't know if any of you can saline but it's salable doesn't
go in a straight line from point A to point B attacks it goes a
bit to the right, a bit to the left and we get this almost mini
zigzag. And that's what this exercise
program for anyone is going to look like long-term, we're going
to we're going to use information that we gain from
that program to inform how we can improve it and make it
better for that patient and whatever their bodies.
Like in four weeks, or two months, or three months, or
whatever, going to be having regular check-ins to see how do
we tweak it, how do we make it more challenging or how do we
address this new symptom that's come up or whatever.
So that's extremely important again for patients.
It's nice sometimes to have some type of objective feedback so
that could be of course looking at At things like, are we able
to lift more weight? Are we able to do more
repetitions? Do we just simply feel better
doing the movement, and it can certainly be things.
Like, for example, biomarkers like a heart rate monitor and
getting that heart rate feedback in real time.
And seeing, you know, is that heart rate a little bit more
steady, are we able to keep it here with more control?
Is that, you know, how is that behaving?
So, I'm a big fan of data collection and looking at that,
in the context of exercise, also, because it feeds into
supporting patients, in developing body literacy and In
able to read and interpret the signs of your body.
So I've had so many patients who when they start, their
low-intensity steady state training program.
They're doing they're typically I'll start around like three
rounds of three minutes. It's a very low starting point.
That's I try to make exercise programs hard for people to
enjoy themselves. So it's kind of it's a
programmer trying to pitch the ball at the right speed and they
will find it. So interesting to how their
heart rate is entirely different on a day where they haven't
slept, or they've had like, five cups of coffee or they're just,
Really, really stressed. We're seeing how their body
copes with the heat right now. We have a heat wave in the UK
and people's heart rates. If they're exercising, are going
to be affected by that. So it's a way that you can get
patients, really involved in what's going on.
And you can also help put that limit on their training.
So if they're at a certain point, you're going to say, you
know what, if you're seeing this type of data, you're going to
call it a day, you're going to leave the gym we're done or get
off your bike while you're on at home or whatever you're done.
Because long-term we want to help these patients develop
Independence, you want them to be able.
All to support themselves in their health as much as possible
and this leads into kind of my final Point.
Well, of how will good and bad days?
Be handled. Good and bad days are so
challenging when you're working with hypermobile patients,
because you'll have a patient who seems to be doing great and
then something will happen, and they will feel awful and we've
talked in previous episodes, but kind of the interaction between
inflammation and fibrosis, which is the technical term for Scar
Tissue. But we may have a patient who,
for example, eat something, which really irritates their gut
and that causes Mass cell reaction, or they have a
histamine, and Tolerance or whatever.
And that will make that patient feel potentially just really bad
on a day, and it will seem random unless, you know what's
going on, but having a promotion or demotion system built into
the program is key. So I, when I program for
patients off certain rules, and I'll say, look, if you're able
to do this, this exact exercise, this work, this work out.
Let's call to work out this workout, this training session.
If able to do this many times and you get this type of
biomarker feedback and we're looking, it's looking in this
way, then you're allowed. How to change this parameter?
You're allowed to add like 30 seconds or whatever you're
allowed to progress the program in this way, but I'll say to the
patient. However, if you go in and you're
feeling poorly and you're getting, you know, you can just
tell your body's not quite feeling its best, then you have
to make that call to demote yourself.
And you don't feel bad about it. You just say, you know what, I'm
not feeling good. Today we're going to change this
program or I'm just going to leave and I'm going to call it a
day. So patients, really need to be
supported in navigating good days and bad days.
And it's not easy, it's a skill. It takes time to learn over
time. But with the right support, this
is something that can really help a patient in so many
aspects of their lives. So, learning, how to cope with
a, how to cope with that almost. It's like a changeable weather.
If you think of the weather on a Caribbean Island how it can go
from, really sunny to thunderstorms all of a sudden,
that's like a hypermobile body, that's what it's like.
So patients need to become equipped.
They need their umbrella. Ready.
They need their sunglasses. They need everything with them
so that they feel in control and they're able to deal with.
These changes and have successful outcomes simply
through being able to deal with their body at an incredibly high
level, they almost become experts in their own body.
That's the outcome I want for my patients, at least.
Now, speaking of experts, being able to distinguish between the
pain of re-injury and the pain in quotation marks of healthy
muscular. Fatigue is incredibly hard.
It took me a very, very long time to be able to do this and I
think back and I cringe to when I was swimming and I I had such
intense shoulder pain and my coach was saying, push through
the pain or pain is fear, leaving the body and I was
trying so hard to push through it, but I wasn't pushing through
healthy muscular fatigue, I was pushing through pain of injury
and of re-injury and if you don't have someone to there to
support you and being able to distinguish the two, it can be
really, really hard. So I'm going to break down my
tips on how I help my patients and how I actually myself
distinguish between the pain of re-injury and the Pain or the
feeling of healthy muscular fatigue.
Now, if you're not aware exercise is traumatic.
Even for people who are going to the gym and they're doing,
they're you know, they're healthy.
They're perfect gym session. They are subjecting their tissue
to micro trauma and they're doing that because they're
trying to stimulate it to grow back in a healthier better way
that is how Exercise Works. So you are supposed to feel a
little bit like like you've worked on something after an
exercise program, that's okay. But the Problem with hypermobile
patients is because they are often people who had chronic
pain their whole lives, they don't know what pain feels like,
it's incredibly hard, it's not talked about enough, and on top
of that, we often do see different kinds of neurological
changes would make it hard for that person to even really feel
pain. So you will hear people who
like, walked home with a fracture and you're just like
what how would you do that? So so we see these two, this
type of altered pain processing. So working in the way that I do,
I like to make everything very systematic and very precise here
is how I distinguish In the pain of of injury and pain of healthy
muscular fatigue. So firstly pain of re-injury is
typically going to feel focal. It'll feel like a point, it'll
feel precise, it'll feel intense.
Someone on a tick tock video, I made described it as feeling a
high, they described him pitch and they said the pain of
re-injury is a high pitch and the pain of healthy muscular
fatigue is a low pitch. So I don't know if that'll make
sense to you but that's how they described it.
Also, if it feels that all like any of these words, if it feels
like Like ripping tearing. If it feels like grinding
pinching catching. That's not pain.
Have healthy muscular fatigue, that's pain of re-injury.
Additionally. It should make sense given the
exercise. So if you're someone who, for
example, is finding your neck is sore, when you're doing like
crunches or whatever. That's not the, that's not the
intended stimulus like of the exercise.
That's not what you're trying to achieve.
You're trying to maybe work on your core.
If you're doing conscious again, they're not something that I
would really do. Whatever let's say you're doing
that. Now, if you're feeling neck pain
there you will see. There are personal trainers and
coaches. Who will argue that you building
a strong neck? No, it's not that.
If you feel pain every injury during a movement, don't do it.
You can find different ways to strengthen tissues.
Just don't do that, okay? And it doesn't make sense in the
context of the exercise, because it's not the aim of the
exercise. So if, if what you're feeling
doesn't make sense. So you're feeling your neck when
you should feel your core or you're feeling your back when
you should feel your thighs, then, It doesn't, it's not
right, you're injuring something don't do it, find a different
movement, just try something else on that note as well.
If you're doing a two-legged exerciser to arm exercise and
you're only feeling pain on one side.
Then you're probably having a re-injury occur because you
should be physically exhausting your causing physical fatigue to
both sides. You're using both sides.
Why are you only feeling your left shoulder when you should be
feeling both? So again, that's another way you
can think about it. Additionally, you'll find that
The pain of re-injury. It's not going to typically
improve through training. So if you're doing the same
shoulder strengthening program and you're feeling intense pain,
in your right shoulder over time, it's not going to go away.
If anything, it's going to get worse, whereas, if it is quote
unquote, that sensation of pain, or that feeling of healthy
muscular fatigue, you would expect it to lessen over time.
If you're going back and doing those sessions that you did four
months ago, it shouldn't feel. You should be able to feel it
because you've become fitter, your muscles are able to cope
with that increase load. Now for thinking of what the And
of healthy muscular fatigue. Feels like typically will be
across a muscle group. It's not going to be just one
point. It's going to feel kind of
diffuse, people who are hypermobile, who have gone on to
be able to exercise safely and to experience the pain of
healthy muscular fatigue. They often report that it feels
actually Pleasant. It feels nice which goes to show
how pain processing. Alterations can really change
how you experience the world around you but they report that
it feels nice. So it'll feel kind of it will
feel exhausting, it will feel fatiguing but it's not.
Going to feel like that white-hot, intensity, painful,
re-injury. It's going to just feel like a
diffuse healthy muscular fatigue.
Now, what I like to say is if you're ever in doubt, err on the
side of caution and assume it's pain of reinjure, if you're in
doubt, err on the side of caution but learning to
distinguish between those two. Things is probably the most
essential skill that anyone who's hypermobile and trying to
exercise and trying to build Fitness can have.
And if I was a fairy godmother, it's something I would give to
to every single hypermobile person because it becomes
confusing. When you injure yourself from
things you shouldn't and you don't know how to feel and you
have coaches who are saying push through the pain and it's
important that we work on improving that patients,
internal assessment skills of what they're feeling in their
bodies. So listening to your body and
being kind to, your body is important and it's something
that can be improved with the right support.
We have reached the end of today's episode, it's certainly
not the last. We're going to be talking about
exercise, I have so much more to say on the topic but if you have
any questions, if you have any feedback, please write in.
I love hearing from you. And if you do want to take a
minute to leave a review, if you can leave a 10 star review, of
course, I'd love it. But if you want to leave a five
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Feel suits the show so far, please do that.
I would be so grateful for that type of feedback from you as
well. And I do want to stress.
Keep an eye out for the hyperbola.
THQ membership. Launch is happening this Friday
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You can find that in the link in my social media profiles because
there will be more information being released about that over
the coming days. But I'm so excited to be
beginning that and I'm so excited, of course to have had
you with me for today's episode. I wish you all the best and I'll
catch up with you next time. Take care.