Clinical hypermobility is different than “being very flexible”
Extreme flexibility and movement instability often coexist.
Never allow self-proclaimed hypermobility to serve as an excuse for poor body control.
Hypermobility is a term often thrown around the pool deck and other training venues. Many will self-proclaim themselves as hypermobile, either to show off circus tricks their body can perform or as an excuse if unable to perform balance or stability tasks. Despite the inexact language often used to describe hypermobility, definite standards do exist. Such standards are important to ensure that training is individualized for each swimmer’s needs.
Clinically, hypermobility is often classified according to the Beighton score, which is a quick and easy movement assessment nearly anyone can perform. The Beighton score is generally accepted as useful and has been shown to have inter and intra rater reliability when screening females ages 15-45 (Boyle 2003). Each side is tested independently and one point is recorded for each positive result:
Forward bend with hands on the floor, back straight
R/L elbow bent backward
R/L knee bent backward
R/L thumb bent back to touch the forearm
R/L little finger bent back to 90 degrees
Any score of four or more is considered a positive under the major Beighton criteria. Joint pain in four joints for more than three months may also qualify as a positive finding. Minor Beighton criteria include three or fewer findings, along with several general health measures such as skin quality, vision, and a propensity for joint dislocation. In short, simply being very flexible does not qualify someone as being clinically hypermobile.
Note that if a young swimmer does demonstrate clinical hypermobility via a high Beighton score, it does not prevent them from performing basic movement tasks. Recently, Paszkewicz (2013) found no correlation between Functional Movement Screen scores and Beighton scores in a group of adolescent subjects. Now, anecdotally, hypermobile swimmers may have a slower learning curve for advanced dryland movements, but most are not fully precluded for satisfactory dryland performance.
In the water, hypermobility may be an asset at times, but it depends on the swimmer. As we have discussed before, extreme ankle mobility and knee hyperextension are both elite characteristics allowing certain swimmers to attain vast joint excursions. This alone will not lead to fast swimming, but combine freakish mobility with refined motor control (among many other qualities) and you have the makings of a potential elite swimmer.
Yet contrary to conventional wisdom, literature has shown that swimmers show no greater propensity for joint laxity than non-swimmers. Now, this may change within a specific subgroup of swimmers, but know that among a sample of age group swimmers, the swimmers were shown to be no more flexible than non-swimming, age-matched controls. (Jansson 2005) In fact, swimmers were shown to have reduced internal and external shoulder rotation compared to the control group.
You may ask, how do you deal with swimmers who seem hypermobile, but in reality are just unstable? Unfortunately, there is no simple answer, as everyone is different. Most important is to recognize who truly falls into the hypermobile category and who is simply flexible but perhaps with poor stability, as many different choices exist for intervention.
Know that a difference exists between true hypermobility and extreme flexibility. True hypermobility is often accompanied by other clinical symptoms, so don’t let your swimmers fool you into thinking they are “hypermobile” when they are likely unstable and/or weak. Though much of this discussion relates to keeping swimmers safe on land, always consider individual body characteristics when building a stroke in the water, as certain characteristics shared with clinical hypermobility may be advantages for swimming movement patterns.
Boyle KL1, Witt P, Riegger-Krugh C. Intrarater and Interrater Reliability of the Beighton and Horan Joint Mobility Index. J Athl Train. 2003 Dec;38(4):281-285.
Jansson A1, Saartok T, Werner S, Renström P. Evaluation of general joint laxity, shoulder laxity and mobility in competitive swimmers during growth and in normal controls. Scand J Med Sci Sports. 2005 Jun;15(3):169-76.
Paszkewicz JR1, McCarty CW, Van Lunen BL. Comparison of functional and static evaluation tools among adolescent athletes. J Strength Cond Res. 2013 Oct;27(10):2842-50. doi: 10.1519/JSC.0b013e3182815770.
Written by Allan Phillips is a certified strength and conditioning specialist (CSCS) and owner of Pike Athletics. He is also an ASCA Level II coach and USA Triathlon coach. Allan is a co-author of the Troubleshooting System and was selected by Dr. Mullen as an assistant editor of the Swimming Science Research Review. He is currently pursuing a Doctorate in Physical Therapy at US Army-Baylor University.