Why traditional PT may not help
I hear often: “I don’t have access to a hypermobile specific PT in my area. How do I advocate for myself?”. I’ll give you my tips down below, but don’t forget that a provider-patient relationship should involve working together. If you communicate your needs & are not listened to, this is where you may need to get another provider.
We’re taught really generic cues in school. I actually didn’t learn a lot of “exercises” in physical therapy school, but rather, how different parts mechanically move and activate. Knowing what movement is “supposed” to happen at each joint helps me know when someone is going farther or less than the “normal” range. These norms are a box inside of a textbook, but can be found in a google search if you’re curious.
Traditional physical therapists tend to think that if someone has more than the listed range, that this isn’t problematic. Although it won’t be problematic for everyone (asymptomatic hypermobility also exists), this is usually where PTs don’t know what to work on. Add in insurance guidelines making it impossible to make a living wage without treating more than one person at once, stretching just seems the easiest.
For insurance based PT, we have to bill a certain number of minutes with certain activities, so stretching often defaults to one of them. I’m not opposed to some stretching, depending on how it feels to your body, but my recommendation is to ask if you can spend more time doing strengthening and less time stretching. My general rule of thumb is to always follow stretching with something active (a strengthening exercise usually).
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3 examples of ways I’d communicate with my provider if I were in your situation again:
“I suspect I’m hypermobile. I think I’m tight because I have less stability in this area. I’d like to skip stretching. Can you teach me some nerve glides and strengthening for this area instead?”
“I’m in a lot of pain the day after I do this exercise. The pain I feel is more than what I’d expect with soreness. I think my shoulder blades may actually be moving too far. Can you help me make sure my range is smaller so I’m in less pain after?”
“Just a reminder that I’d like to skip stretching today, can we spend some more time strengthening?”
It all comes down to communication which is HARD. But having a few phrases to tell your provider can go a long way, even if they aren’t a hypermobile specific provider. When they aren’t willing to meet you halfway or at least explain why they chose the exercises they did, then on to the next!
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