By Jennifer Gamboa PT, DPT, OCS
So what IS a hypermobile spine? Officially, it is excessive joint flexibility in the spine. It means that some or all of your joints have a greater range of motion than usual, allowing them to move beyond the typical limits. Unofficially, you have a slinky for a spine.
I think about spine types like Goldilocks, too stiff; too loose, and just right. To be clear, most people have spines that are “just right” or “too stiff.” The “just right” spine is like a bed spring: it has just the right amount of stiffness to provide appropriate support while still having nice mobility in all directions so that we can run, jump, and play to our hearts content. The bedspring spine also returns to homebase, or neutral spine, easily.
The “too stiff’ spine is like a ladder; pretty good at support, not so good at mobility. People with ladder backs need stretching and like mobility exercises. Perhaps you’ve heard of the functional strength pyramid, where mobility is the movement foundation upon which stability then strength then power and performance are built. That functional strength pyramid is custom-made for the folks with ladder backs. It also works beautifully for the “just right” bedspring spines.
And then there are the slinky spines! Having a slinky spine is like wearing a loose seat belt. There is not enough passive restraint from the ligaments and capsules to protect the spine or to help each segment know where end range is and when to return to homebase. Slinky spines require a lot more active muscular control to remain healthy. Back to the seatbelt image: if the belt is too loose, you have to use a lot more muscle activation to stay upright and not fall over.
So how do you know if you have a slinky spine? Unofficially, people with slinky spines usually don’t like to remain in one position for long periods. Whether it’s sitting, standing, or even lying down, the joints in a hypermobile spine start to creep out of alignment because the seat belt isn’t tight enough. That creep causes discomfort or pain, which triggers the desire to change positions.
Officially, one way we can test for hypermobility is using a scale called the Beighton Score. This 9-point scale helps detect hypermobility throughout the body, assessing excessive motion in knees, elbows, thumbs and pinky fingers as well as the spine. The higher your score, the more likely you have hypermobility throughout your body (or hypermobility syndrome). Your hypermobility might be limited to your spine or there might be a more systemic cause. Either way, your physical therapist can help you suss out what type of hypermobility you may have.
Why do people with slinky spines often feel stiff? As mentioned above, people with slinky spines do not like staying in one position for long periods, and they report feeling pain and stiffness. They like stretching and feel like they should stretch all the time. While stretching may feel good at the moment, the benefits do not last. Back to spring analogies for a minute: if you hook a slinky to the end of a bedspring and pull on both ends, which spring will distort first and fastest? The slinky (at the joint level)! In fact, the bedspring (which in this example represents the tight power muscle) may never even move.
What a conundrum! The tight power muscles acting over many spinal segments that are too loose, feel stiff (and they are) AND their force distorts the slinky causing pain and discomfort in the joints. BUT, stretching those tight power muscles also distorts the slinky.
So what to do if you have a slinky spine? Shut off power muscles and train the local controllers.
Without getting too nerdy, the power muscles are the ones we are used to strength training: quads, hamstrings, the six-pack abdominals, biceps, triceps, etc. These power muscles help us run, jump, and play. When we flex them, we can typically see them in the mirror. Power muscles are awesome, but they act over long distances. Without sufficient underlying stability, power muscles will distort the structures they cross over and cause injury.
Underlying stability comes from deep postural muscles that are designed to create appropriate stiffness within our trunk so that our arms and legs can move without causing harm. I call these local controllers and they act to “snug the seatbelt”. These local controllers attach from one slinky ring to the next so that when they get stronger and have more endurance, the slinky rings are drawn closer together which give the underlying structure appropriate stiffness. While training local controllers may not create a bedspring, your slinky will get stiffer and be able to withstand more forces. Central stability from the local controllers will send a signal to the power muscles that they don’t have to work as hard, and they will stop overworking and feel less “tight”.
So how do you train local controllers? First, these are subtle exercises. You are not going to feel the burn. Second, the sequence of events is important.
- Turn off the power players: most people with slinky spines overuse their power players because they don’t have the local control, but the local controllers will not wake up if the power players are overactive.
Exercise Strategy: Bouncing on a big therapy ball for 5 to 10 minutes
2. Wake up the local controllers: this should be done to wake up the local controllers, before we challenge strength and endurance.
Exercise Strategy: Sidelying pelvic rollouts with upper leg supported on a foam roller.
- Train the local controllers: this focuses on sustained activation against gravity to build endurance of the local controllers.
Exercise Strategy: Quadruped Series with big therapy ball against the wall.
Don’t hesitate to come into see us… we love helping people become better owner’s of their hypermobile spines.