Muscle Tightness and Joint Hypermobility

One of my favorite lessons to teach—whether to new graduates, younger clinicians, or even patients—is the concept that someone can be hypermobile yet still experience tight and hypertonic muscles. It’s a fascinating contradiction that can change the way we approach treatment.

Flexibility Doesn’t Always Mean Freedom

Imagine this: I’m working in Chicago with professional ballerinas from the Joffrey Ballet. As you’d expect, they are incredibly flexible, with joints that seem to bend effortlessly. But here’s the twist—despite their extreme flexibility, many of these dancers also had tight, hypertonic muscles. This muscle tightness often led to pain and tendonitis.

At first, it didn’t make sense. How could someone so flexible also struggle with muscle tightness? But as I encountered this scenario more and more—not just in ballerinas but across all demographics, from athletes to sedentary individuals—the pattern became clear. People who are hypermobile can still have significant muscle tightness, often contributing to their symptoms.

Rethinking Assessments

In my earlier days, I might have dismissed the need to address muscle or joint flexibility in hypermobile patients. I’d think, “They’re already flexible, so that’s not the issue.” Now, I’ve learned to dig deeper. Even in hypermobile patients, I assess for muscle hypertonicity and evaluate how it might factor into their presenting symptoms.

Treatment Strategies for Hypertonic Muscles

When you identify hypertonicity in a patient, consider these approaches:

1. Deep Tissue Massage

   • Focus on areas of tightness and sensitivity. Whether it’s through your hands or tools like a foam roller, massage gun, or lacrosse ball, this can provide significant relief.

   • Educate patients on self-massage techniques so they can continue the work at home.

2. Stretching

   • Encourage patients to stretch, but don’t stress if they “don’t feel anything.” This often happens when their joints are too flexible to create adequate muscle tension. Instead, emphasize tissue massage as a primary intervention.

3. Customized Plans

   • Tailor treatments to each patient’s needs, ensuring that stretches and massages align with their specific conditions.

Real-World Implications

This muscle tightness and hypermobility combination often underlies common diagnoses like:

• Patellofemoral Pain Syndrome

• Osgood-Schlatter’s Syndrome

• Knee Osteoarthritis (OA)

For example, I’ve worked with many older adults diagnosed with “knee OA” who were told by their doctors to “just wait until symptoms worsen and we can replace it.” In many cases, their anterior knee pain stemmed from tight quads pulling on the quad and patellar tendons over years of use without adequate stretching or mobility work. By focusing on massage and stretching, their symptoms—and perceived “knee OA”—vanished. They often left saying they felt better than they had in 15 years.

Key Takeaways

1. Don’t assume joint flexibility equals muscle flexibility.

   • Just because someone’s joints are hypermobile doesn’t mean their muscles are equally flexible.

2. Always reassess.

   • Look for signs of hypertonicity and consider how it may contribute to their symptoms.

3. Adapt treatment strategies.

   • Use massage and stretching as needed, and tailor your interventions to the individual.

By keeping these principles in mind, you can deliver more effective treatments and help patients feel better, faster.