229 Safety Considerations for Hypermobility and Yoga: Interview With Libby Hinsley

Today's guest is Libby Hensley. She is here to help you understand the impact of EDS and hypermobility on your client's nervous system and mental health. She will help you understand the type of yoga practices that can best help these clients, as well as how to cue effectively and create a yoga experience that empowers rather than overwhelms.

Listen in for expert insights and actionable tools that you can use in your therapy practice on today's episode of Yoga in the Therapy Room. Podcast. Stay tuned.

So whether you're here to expand your skills, enhance your self-care, or both, you are in the right place. Join me on this journey to help you be one step closer to bring yoga into your therapy room.

Welcome to the Yoga in the Therapy Room podcast, the non-traditional therapist guide. Integrating Yoga to your therapy practice. I'm Chris McDonald. In today's episode, we're shifting to a topic that I've received many questions from listeners and those in my yoga basics class about safety considerations for hypermobility and yoga.

Our guest today is Libby Hensley, a doctor of physical therapy, yoga, teacher, trainer, and personal trainer, specializing in the treatment of hypermobility syndromes and chronic pain. She wrote a book. Yoga for bendy people optimizing the benefits of yoga for hypermobility. She also teaches anatomy for yoga teachers through her program called Anatomy Bites.

Can you share with listeners how you first discovered yoga?

Libby Hinsley: Sure. I first discovered yoga when I was in college, and there was a one credit college class, and I took it yes and loved it, and so I loved my first yoga teacher. I think it was mostly about her, you know, that's what really got me. She created such a warm and welcoming space, and it was really the first time I'd ever experienced an embodied practice of that nature.

So I was really pretty much hooked from the beginning.

Chris McDonald: Yeah. And what has been your journey with hypermobility and EDS in, in your personal experience?

Libby Hinsley: Well, it's been my whole life growing up, I was very active in sports, especially tennis, and played competitive tennis through college. And I was chronically injured.

I could do some weird stuff with my body, but never really thought much about it beyond that until much, much, much later. When I got more heavily into yoga and became a yoga teacher, and then from there became a physical therapist, and from there started treating injured yoga people primarily, and yoga teachers, and seeing that all of their wide ranging issues, not just their hyper-mobility, but all the other things that go along with hypermobility syndromes that I really wasn't aware of until then.

Wow. I, I remember having probably a couple slides on Eller Danlos syndrome in PT school, and I remember thinking in my mind this was very, very severe, very rare. I would probably not see it much, and if I did, it would be someone who was dislocating all of their joints all the time and couldn't get across the treatment room.

Like I just thought of it as something that was so far extreme. Yeah. Yeah. So extreme and never in a million years would I have thought that I actually have that, you know, I would find out much later. Yeah.

Chris McDonald: Can we rewind and go into what is EDS and hypermobility?

Libby Hinsley: Yeah. Well, hypermobility by itself is not pathological.

Hypermobility in their body, and it doesn't have to be a problem, but oftentimes it is symptomatic and when we start to see symptoms associated with hypermobility, whether it's joint pain or myofascial pain or dislocations or all the other systems that can get involved, which is pretty much every system of the body, because this basically, that's when it becomes.

A hypermobility syndrome. That's just a very general way of saying you have symptomatic hypermobility, but those symptoms we now know can show up really in any system of the body because it stems from a, a genetic difference in the structure and or function of connective tissue. And connective tissue is everywhere.

Chris McDonald: Yeah. Impacts so many parts of the body.

And then there's one of them that is not rare, and that's the hypermobile type. So that's hypermobile, EDS. Unfortunately, it's also the one that is the, the only one that we don't have a genetic marker for yet. So you can't get a blood test to diagnosis. It's diagnosed through a, a clinical set of criteria that, uh, is also a moving target.

So that diagnostic checklist that exists now. Is under revision. So you know, it we're, it's sort of like in general not well understood. So if people listening are like, I don't really understand this, you can also know that nobody really does that much. We're learning more and more about it all the time.

And it is not a lesser diagnosis. It doesn't mean your symptoms are less severe than someone who has Eller Danlos syndrome. It just means that right now as the diagnosis is written, the criteria are written. You don't check all the boxes. But that may change over time, right? And what, you know, people who are, you know, in this space and experts in these conditions, essentially treat those things as the same thing clinically.

They look exactly the same, basically, and they're treated in the same way. So I do think it's important that people understand that just because they might not meet the criteria for EDS, it doesn't mean that they don't have a thing that can be quite severely impactful on their quality of life.

Chris McDonald: What are symptoms of.

EDS or if, if people are having more difficulty with these, is there some symptoms that are, they can be aware of?

You know, gymnastics, something that really exploited your natural ability to move in, uh, excessive ways. And, and then perhaps you also have struggled with chronic aches and pains. You tend to just get injured really easily, whether it's. Tendonitis Ligament sprains, chronic ankle sprains, uh, TMJ headache, sacroiliac joint pain, uh, roving, like I said, tendonitis.

So we know from some interesting research that people with hypermobility tend to have some differences in brain anatomy that are part of what likely leads people to struggle with these issues. More so, they are shown to have a, a larger amygdala in the brain of a fear threat detection center that mounts a sympathetic re.

Response to perceived threats. That area of the brain is larger in Bindi people, it's also more reactive. So we tend to see just at baseline, a bit of a more hypervigilant nervous system that runs a little high on sympathetic arousal and is hard to put the brakes on that. So for the mental health professionals out there, probably very familiar with vagus nerve functions, we also know that bendy people have.

It's accompanying sleep disturbances and, and things like that. Beyond the mental health realm, we also see a lot of neurodevelopmental differences. We know that bendy people are four to seven times more likely to have a DHD or beyond the autism spectrum, which can compound things and. Also, we see a lot of immune dysfunction and autonomic dysfunction.

Rashy skin also can go along with a lot of GI symptoms, so, which we also see IBS type symptoms anywhere from the chronic diarrhea to the chronic constipation and everything in between. So really the list is long actually, and a lot of times people might have identified as being hyper hyperflexible or hypermobile.

But really not connected the dots between that and say their food sensitivities or, you know, sensitive guts and their anxiety and all these other pieces that, when they put that together, can really help them understand their own condition and then in turn help them understand how to manage it.

Chris McDonald: Because it is a lot, it's very impactful on the whole system and it's, I think it's really helpful for mental health therapists to be aware that, again, it's hard to diagnose, right?

It takes a long time for people to get diagnosed with this. And some of your clients may not even be aware that this is something that they're experiencing.

You know, there's not. There's not a, a specialty that owns connective tissue. So these people are passed around from specialist to specialist, depending on their system involvement. And usually everything's sort of like, eh, kind of is. Normal tests are always normal. Imaging's usually normal labs are usually normal because it's very hard to catch, uh, the indicators for this and many of.

Of the indicators are just clinical, right? And so that requires a practitioner to actually believe what the patient is saying. And so we know that the vast majority of people who suffer from these conditions are women. And we already know that medical practitioners don't hear the symptoms of women in the same with the same ear, that they hear the symptoms of men for all kinds of different reasons that aren't always intentional, right?

So I think restoring someone's agency and their ability to really trust their own experience is absolutely primary.

Chris McDonald: Yeah. So that's really something to think about too with clients that we're seeing. I've heard from some people that there's a misconception that bendy people should not do yoga.

Libby Hinsley: Well, yes, and I wrote a whole book about that.

I know.

Chris McDonald: That's why I had to bring that up. 'cause I had one person that I saw that was just like, no, not at all. We can't do any kind of yoga practice. I was kind of taking, I was

Libby Hinsley: like, whoa. I know. I know, right? Well, and that's often, there are often all these blanket statements about what bendy people should or shouldn't do, and it's, it's often based on a lot of fear about the bendy body and a lot of misunderstanding about it.

We, the same is true for the body and the tissues in the body. They adapt according to how we dose our activity and allow time to. To create, you know, that adaptive response that then grows our capacity. So when it comes to things like yoga practice, well the question of whether yoga is good or bad for bending people really depends on what you mean by yoga.

Chris McDonald: Like that, that elusive def definition right, is different, right from different people.

But from a movement standpoint, yoga can be. So good for Bindi people, especially when it's approached in a, a slower way, a slow paced asana that is done in a smaller range of motion. So those would be the two main principles of movement. I would advocate for smaller movements and done slower. Those two things.

If we just did that, we would change, uh, a lot of the negative responses to yoga that we do see among Bendi people. I experienced it myself again, which is why, you know, it really led me to write this. Book. I wanted to give people a way to approach yoga Asana. You know, not just avoiding the common injuries we see in yoga, which that's important, but it's actually not nearly as interesting as asking, well, what is the type of yoga practice that would actually support this person?

Um, helping us develop body awareness. I. And motor control, you know, controlling our movement and our stability, joint stability, all these things are available through a yoga practice. But again, you know, thinking about the mental health challenges, it's really about developing that positive relationship with the body and developing, um, some more confidence ability to not be so afraid of the sensations that that are happening that.

Are hard for us to understand and I, I, I would see that as a really key way that mental health professionals, you know, can play a big role for the this population.

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Step into the therapy room with confidence and transform your sessions today. Go to HC podcast.org/build confidence. That's HC podcast.org/build confidence. Can you give an example of queuing, like, because I know you said that maybe not as far with range of motion. So even just if we do like sun breasts lifting arms up.

So would it be less,

Libby Hinsley: less that we

Chris McDonald: less. Okay.

Chris McDonald: Less is more. More

Libby Hinsley: so much in, you know, traditional or, I don't know. I wouldn't say traditional, I would say modern. Popular yoga settings, the queuing is the opposite of what we would actually wanna see.

Exactly. Yeah. So that's what it's all about. Let's cue that. Less is more, slower is better. And you might cue percentages. So often we know zero and a hundred. We know the starting and the finish point, but the bulk of every movement or posture is on the way there and on the way back. So let's explore that part of each movement.

In greater detail. Let's see how it feels to go halfway into the posture. We, so if we inhale

Chris McDonald: like halfway, see how that feels? Just halfway. See how that feels.

Libby Hinsley: See how 25% feels, see how 75% feels okay. We never really bring a, a magnifying glass to the inbetweens, and that's what we need to start doing.

Chris McDonald: Yeah, absolutely.

Mm-hmm. So really breaking it down, it sounds like.

It is, it has no interest whatsoever in where you're going with your movement. It has interest in you going inside into your own experience, and the Austin is our tools to help us do that. That's it. They are not ins in themselves. They are tools. So you can do them however you wanna do them. Right. We have to figure out a way to do them that, yes.

Is not injurious and even better feels great for our people, you know, and helps them cultivate that inner relationship, which is in yoga's interest

Chris McDonald: or that interception. Yeah, so I guess so people with hypermobility or EDS, they struggle with that more. I. Interception. They

So they tend to be, um, a bit more intercept sensitive, we would say. And um, so kind of having a safe space to turn inward and observe those sensations and start to. Lean into them and try to interpret them, understand what they mean, understand that they are turned up, that volume dial is turned up higher and that leads us to, you know, a lot of fear about what's going on.

But anyway, having that safe space to explore that and to start to understand it differently, tease it apart, can be really helpful. We also struggle with proprioception, which is different. That was my next question. Yeah. Which is our sense of like where our parts are, you know, and, and body awareness.

They don't have to control things as well. But that proprioception tends to be less accurate. We have a harder time getting the information from the body to the brain about. Movement and position, the velocity, all those things. Uh, because, well, in part a couple reasons. One, the brain differences I mentioned earlier include a little less real estate for body mapping.

So our somatosensory cortex tends to be smaller and a little blurrier. It's like we're running on, uh. Blurry maps of the body that actually get differentiated and get clarified through mindful movement so we can change those body maps in the brain through how we pay attention to movement. But just know that we're generally starting out with some blurry maps and some smaller real estate for mapping.

So those mechanoreceptors don't really get. Stimulated to send that information up until we are out at end range in some big stretch. And finally we feel something and that feels good to feel something. So part of the challenge with the bendy body is giving it an opportunity to feel what's happening in the body.

Before it gets way out to this sometimes pathological end range that can be injurious or irritating or stimulate a pain response because it's very important that we have a sense of embodiment, that we can feel that we are in a body. That's often what these people are seeking. They're kind of, they tend to be sensory seekers in some ways because they do need more sensory input so that their brain understands their body better.

So there are a lot of ways we can give that sensory input. Yeah, that's healthier, but helps the brain. Learn the body better, map the body better, and improve that proprioceptive sense. It's very unsettling. It's unsettling. But people often, like they report, they're like kind of having an out-of-body experience.

They, they feel untethered from their body and it's, it's extremely unsettling. So from a mental health standpoint, I think that sense of containment and embodiment is. Super important.

Chris McDonald: Yeah. And I wondered if that was a good place for a therapist listening to start is trying to, even just like you mentioned, some body scans and breathwork some of the, some of the other limbs of yoga to start there.

I can feel my edges. I know where I end, and everything else begins. Establishing those boundaries in our awareness. Is a great starting point.

Chris McDonald: Yeah, I think that's so helpful. 'cause I think that that is, the struggle is really understanding, but you make everything so clear and I really appreciate that with understanding more about what, what it's like with the body mapping.

Libby Hinsley: Yeah, yeah. I mean I had, I've had patients describe it and I've had this experience too, but as like a bobblehead toy, you know, they feel like they're a bobblehead. One person described it as being like the, um. Out of the car dealership, that wind sock the balloon. That's like a wind sock. They feel like that.

Yeah.

Libby Hinsley: Well, I think the biggest risk is for kind of nagging aches and pains, unless they have a, a history of, of dislocation, especially of their shoulders.

Yeah. That's the thing that's gonna, that's a big one that is gonna go most sideways in yoga practice. But aside from that, we're probably not looking at really serious injuries, but we're looking at life quality, limiting, nagging, chronic things that occur like high hamstring strains. Si, joint pain, shoulder pain.

These are the most common things and the types of yoga practices that are most conducive to that would be fast pace asana, especially done in a very asymmetrical sequences. So this is really like our very popular. Vinyasa based types of practices. They're doing a hundred pushups basically in a practice.

It's easy answer. Move away from that and move towards a type of practice that is more symmetrical. Symmetrical. Okay. Okay. So that's a big concept. Symmetry, symmetrical postures done more frequently, so I wouldn't do more than a couple postures on one side before you come back and do the other side and do a symmetrical.

Posture, which means a posture you only have to do once and it's done right. It's just both sides of the pelvis are doing the same thing. Like chair pose is a good example, okay? Versus an asymmetrical posture being like triangle pose. You gotta do it on both sides. So that's a really important, uh, principle there with sequencing.

Best way I can describe it, it's like, is it gonna pull your joints apart? Probably not. But it's often an irritant for someone later on that day or the next day. They're just tweaky. They've just like, uh, things are achy. They've flared up that SI joint. They don't know how they did it, but it was somehow in that yoga practice, that's the most common thing they're gonna feel.

It doesn't have to be that way.

Chris McDonald: Yeah. And is there any props that could be helpful? I know you mentioned some of the weighted objects, maybe, or the wall, but any other props?

Libby Hinsley: All

Chris McDonald: the props. All the props. Bring 'em on. Yeah.

Libby Hinsley: Bring all the props because it helps you modify range of motion, you know, to put a block under something and experience a smaller range.

Nobody wants to be that person.

Chris McDonald: No. You know,

Libby Hinsley: but that's also not accurate because these people can do the real thing, quote unquote. Um, and the other thing is, it's all the real thing because these are postures that are just tools to help us practice yoga. They are the goal in and of themselves. At all. So that just is an absolute misconception.

It has to go completely out the window. People are very reluctant to let go of that idea of the quote, full expression, you know, or like whatever. Yes. Version of, or the

Chris McDonald: advanced ver version, the advanced

Libby Hinsley: version, and it's, it's literally nonsense when it comes to. Yoga's goals for you. For human beings, it is completely irrelevant.

They're all equally valuable. In so far as they help us practice the yoga, you know, so let's pick one that feels good, that feels supportive, you know? Um, and that gives us an experience perhaps, of containment, of groundedness, of embodiment, of stability. These are the qualities we really wanna help cultivate in our yoga practice.

Chris McDonald: Yeah, and I, I think that what, what you're saying too is the language, how we introduce these concepts and, and in yoga in the therapy room, we're not doing a full yoga class. We're usually integrating, which is helpful too. And, and as through this podcast, I've taught a lot of slow, mindful movements and I think that, that, that aligns very well.

Libby Hinsley: A different way to do it. And it has equal value.

Equal value, yeah, equal value. And, you know, moving your limbs through the, the air as though it's honey or. Molasses or something that slows it down. Hmm. It's a nice visual that, you know, even the, the slightest like few minutes of a movement practice, it's like medicinal. It's potentially medicinal in the way that in that moment it can help someone land in their body.

It has edges. Do you feel that? Oh, my, I mean, it's huge for this

Chris McDonald: person. It's huge. It's huge.

Libby Hinsley: Yeah.

Chris McDonald: Yeah. Can you share a slow, mindful practice with listeners today? Is there anything that would be easy to do?

Libby Hinsley: Oh, sure, sure. So we can just sit in, uh, in the chair or whatever, on the ground, wherever you are, and let's find a breath and just feel an inhale and an exhale moving in and outta the body.

And as you continue to breathe in that way, see if you can notice that the breath already is creating movement in your body. You might feel that movement in your belly or your chest or your waist. So you can invite your trunk to, to expand with your inhale and kind of soften back with your exhale. And it's cool to first realize that breath is movement.

And we'll do that a few times. So my elbows are staying soft, they're staying bent a little bit, and I'm kind of scooping up almost like I'm holding a beach ball overhead. And then I'm bringing my hands down. In front of my face into the lap. And so we'll just link this movement with the breathing, the inhale, this inflating, inhale and exhale, softening the hands down.

And as you finish your last breath here, just pause and notice how you feel.

Chris McDonald: That was very relaxing. I like the concept of moving through honey, or you said, um, marshmallow cream I know. Reminds me of a fluffer nutter sandwich. Totally. But I think that helps to slow down too.

Libby Hinsley: It does. It's almost like, uh, you kind of create your own resistance in a way.

And one of the things. We're doing often in our movement practices and exercise realm is it's like we're trying to create our own tension. The the bendy body is one that really lacks adequate tension. It lacks passive tension, so we have to create it ourselves. And so resistance is one of the best ways to do that.

Yeah,

Libby Hinsley: The best ways are my website, which is libby hensley.com, so that's easy, and from there you can kind of fan out and find out about all the things I'm doing.

I'm most active in social media on Instagram at Libby Hensley pt. Those are the two best places.

Chris McDonald: And you have anatomy bites as well.

Libby Hinsley: That's right. You can go to anatomy bites.com. You can also find that through my website, but that's a specific anatomy education program that I have for yoga teachers and other movement professionals.

I. Which is a lot of fun. And that's online and the whole community of Yeah. Anatomy nerds the world over. So helpful. Yeah. Yeah, yeah. Especially therapists

Chris McDonald: interested in learning more about anatomy.

Libby Hinsley: Oh, for sure. Yeah. Be a, it'd be a great place, you know, and all the, you know, my style of AANA is very slow and breath centric.

Chris McDonald: we're in alignment with you, Libby.

Libby Hinsley: Yeah. Yeah, yeah. And then my, my book Yoga for Bindi People. Yes. It offers a good background, I think, on hypermobility syndromes as well as principles obviously for yoga practice, but principles that can be applied for any movement practice too.

Chris McDonald: Yeah, and we'll have all that in the show notes, listeners, so you can access that. But thank you so much for coming on the podcast, Libby, this was great.

Libby Hinsley: Good. Thank you so much for having me. I hope that listeners find it helpful.

Chris McDonald: That brings us to the end of another episode. Be sure to tune in next Wednesday when another episode drops.

This free guide is packed with tools to help you stay ethical and fully present with your clients as you take the first step towards transforming your therapy practice. Don't wait. Start integrating Yoga into therapy with confidence today. Go to HC podcast.org/build confidence. That's HC podcast.org/build confidence.

And once again, this is Chris McDonald sending each one of you watch light and love. Till next time, take care. Thanks for listening to today's episode. The information in this podcast is for general informational and educational purposes only. It's given with the understanding that neither the host, the public.

Assure or the guests are giving legal, medical, psychological, or any other kind of professional advice. We are not responsible for any losses, damages, or liabilities that may arise from the use of this podcast. Yoga is not recommended for everyone and it's not safe under certain medical conditions.