Chiropractic care involves the diagnosis and treatment of musculoskeletal disorders, primarily through manual adjustment or manipulation of the spine and other joints. For a person with typical joint anatomy, these manual therapies are often safely applied to restore normal joint motion and function. When excessive joint flexibility (hypermobility) is present, the relationship with chiropractic care becomes nuanced and requires careful consideration. The decision to apply manual therapy must be based on a thorough assessment of the patient’s specific joint mechanics and overall connective tissue health to determine when traditional high-force adjustments may be inappropriate or unsafe.
Defining Hypermobility and Associated Instability
Hypermobility describes a state where a joint moves beyond the expected range of motion. This excessive flexibility often stems from a structural difference in the body’s connective tissue, largely composed of collagen. When collagen is more elastic or “lax,” the ligaments and tendons that stabilize the joints are inherently looser.
Instability is the inability of a joint to maintain a healthy connection between its surfaces, leading to recurrent subluxations (partial dislocations) or full dislocations. This lack of secure joint alignment is why traditional high-velocity, low-amplitude (HVLA) manipulation techniques must be approached with caution.
Conditions like Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) feature this generalized laxity. For individuals with these conditions, the body’s attempt to compensate for loose ligaments often leads to chronic muscle tension and pain. The purpose of any intervention must be stability and support, rather than further mobilization of an already overly mobile joint.
When Manipulation is Absolutely Contraindicated
An absolute contraindication signifies a procedure that should never be performed because it carries an unacceptable risk of harm. For hypermobile individuals, this relies on identifying specific areas of structural compromise. High-force spinal manipulation is contraindicated in the presence of an acute joint subluxation or dislocation. Applying a thrust to an already misaligned or unstable joint increases the risk of tissue damage or injury.
Severe structural instability, particularly in the cervical (neck) spine, is another absolute barrier to traditional manipulation. Ligamentous laxity in the upper neck, known as atlantoaxial instability, is a serious concern because it can compromise the spinal cord and vertebral arteries. Connective tissue disorders are often considered an absolute contraindication for cervical manipulation due to the potential for serious complications, including vertebral artery dissection and stroke.
Any patient presenting with active neurological symptoms related to instability, such as progressive weakness or numbness, should not undergo manipulative therapy. A thorough history and physical examination, which may include specific orthopedic and neurological tests, are necessary to screen for these high-risk scenarios. If doubt exists regarding the stability of a joint, the procedure should be modified or abandoned entirely.
Modified and Safe Chiropractic Approaches
For hypermobile patients without an absolute contraindication, chiropractic care can be beneficial when the treatment approach is modified. The philosophy shifts away from increasing range of motion and focuses on enhancing stability and neuromuscular control. This requires avoiding traditional high-velocity, low-amplitude (HVLA) manipulation, which takes the joint to the end of its excessive range.
Practitioners utilize low-force, precision techniques that offer a neurological stimulus without stressing the joint capsule. These methods include instrument-assisted adjustments (such as the Activator), drop table, and blocking techniques. These approaches provide a controlled, gentle adjustment that works within the joint’s safe range of motion to improve alignment and function.
Safe care for hypermobility centers on therapeutic exercises designed to strengthen the surrounding musculature. Strengthening muscles provides a dynamic support system that compensates for the laxity of the ligaments, improving joint security. Targeted exercises often include core and hip strengthening, along with proprioceptive training, which retrains the nervous system to better sense the joint’s position and movement.
Soft tissue work is an important component, addressing the chronic muscle tension that develops as the body attempts to stabilize loose joints. Techniques such as myofascial release and trigger point therapy can relieve muscle tightness and pain without compromising joint stability. This multi-modal approach of low-force adjustments, muscle strengthening, and soft tissue therapy allows for safe and effective musculoskeletal support for most hypermobile individuals.