Hypermobility and Musicians
Updated: Jan 16
Have you ever wondered why Paganini's music was so dang hard? It's possible, and widely accepted, that he suffered from hypermobility. And... that he showed off many of his hypermobility "party tricks," in his compositions.
Ask anyone with a hypermobility disorder, and they can rattle off a list of fun "party tricks" they can do. It could be anything from jumping into a split without ever having practiced flexibility a day in their lives to popping joints in and out of place for the heck of it.
Paganini's party trick? Bending his thumb so far back that his thumbnail touched the back of his hand.
What is Hypermobility?
At the very basic level, hypermobility means some or all of your joints bend or move more than they should. Sometimes this is described as double-jointedness, joint laxity, excessive range of motion...the list really does go on and on.
Some examples of hypermobility disorders include:
Ehlers Danlos Syndrome
Hypermobility Spectrum Disorder
Hypermobility and Me
I remember being in orchestra rehearsal and often having to stop playing to pop my right wrist back in place. I thought this was a normal part of playing the clarinet. As it turns out, it's not.
In 2015, I was working a major gymnastics meet in Dallas, TX. I was in the hotel bar talking to one of the gymnast's parents (who just so happened to be an orthopedic surgeon) about my joints popping in and out of place. So in the middle of the bar, he had me stand up and do something called the Beighton Scale. It's a 9-point scale to measure joint hypermobility. I met all nine points.
After seeing a doctor back in Michigan, I was officially diagnosed with Ehlers Danlos Syndrome, and as I would find out over the years, it affects much more than just your joints.
What all does a Connective Tissue disorder affect?
Connective tissue is found in the tendons and ligaments which helps explain why joints move more in people with hypermobility disorders than in those who don't have a hypermobility disorder. But connective tissues are also found in the skin, gut, and heart, among others.
Because of this, connective tissue disorders are much more than just being extra flexible. Symptoms can be increased food sensitivities; common sensitivities include dairy and gluten. Gut issues can be present because the connective tissue in the gut can stretch out over time. This means passing stool can be more difficult which can lead to constipation and bloating. Below is a bulleted list of common problems that go hand-in-hand with hypermobility.
Science, Hypermobility, and Musicians
Overall, there is a severe lack of research on this topic. There is conflicting evidence on whether or not hypermobility is helpful, detrimental, or neutral to musicians' health. There need to be randomized controlled studies to really grasp the prevalence of hypermobility among musicians and how/if it affects pain. I encourage caution in interpreting any of these studies!
In a study of flutists with hypermobility, all of them had pain while playing the flute compared to the control (Artigues-Cano & Bird, 2014).
In a study of male and female musicians, female musicians exhibited more hypermobility than men. (Note men (n=6); women (n=22). (Clark et al., 2013).
Musicians with hypermobility in the wrist had less pain than those who didn't. However, those with hypermobility in the spine had more pain compared to those who didn't (Larsson et al., 1993).
41 out of 43 musicians with hypermobility had upper extremity problems (Brandfonbrener, 2000).
In a study of over 1,000 musicians, 9% had hypermobility (Parry, 2004).
There was no significant difference in joint laxity between musicians and non-musicians (Sims et al., 2015).
Joint hypermobility is common in musicians (Quarrier, 2011).
This is really resonating with me. Where do I go from here?
1. If you feel like you might have hypermobility, seeing a physical therapist or general practitioner who can watch you perform the Beighton Scale can be a great place to start.
2. If you are experiencing pain while playing, there are assistive aids that can help. Some include neck straps for woodwind players, modified thumb rests, shoulder rests, and more!
3. Join the Musicians' Health Lab Community! It's Free! And, each week you'll get a newsletter on a new musicians' health topic. It's an easy way to stay informed and find like-minded people working together to advocate for healthier music careers!
Artigues-Cano, I., & Bird, H. A. (2014). Hypermobility and proprioception in the finger joints of flautists. JCR Journal of Clinical Rheumatology, 20(4), 203–208. https://doi.org/10.1097/rhu.0000000000000109
The Beighton Score: How to Assess Joint Hypermobility. The Ehlers-Danlos Society. (n.d.). Retrieved from https://www.ehlers-danlos.com/wp-content/uploads/Beighton-Score-2017.pdf
Bird, H., & Knight, I. (2012). Joint Hypermobility in Musicians. South West Music School, 1–6.
Brandfonbrener, A. G. (2000). Joint laxity and arm pain in musicians. Medical Problems of Performing Artists, 15(2), 72–74. https://doi.org/10.21091/mppa.2000.2014
Clark, T., Holmes, P., Feeley, G., & Redding, E. (n.d.). Pointing to performance ability: Examining hypermobility and proprioception in musicians . - RCM Research Online. Retrieved October 2, 2013, from https://researchonline.rcm.ac.uk/
Ehlers Danlos Syndromes. The HMSA. (n.d.). Retrieved October 2, 2022, from https://www.hypermobility.org/ehlers-danlos
Grahame, R. (1993). Joint hypermobility and the performing musician. New England Journal of Medicine, 329(15), 1120–1121. https://doi.org/10.1056/nejm199310073291512
Grahame, R. (2000). Hypermobility--not a circus act. International Journal of Clinical Practice, 54(4), 314–315.
Larsson, L.-G., Baum, J., Mudholkar, G. S., & Kollia, G. D. (1993). Benefits and disadvantages of joint hypermobility among musicians. New England Journal of Medicine, 329(15), 1079–1082. https://doi.org/10.1056/nejm199310073291504
Moran, F. (2017, December 1). 16-year-old musician Kitty Richardson releases New Song "hope" for Ehlers-Danlos Awareness Month. The Ehlers Danlos Society. Retrieved October 2, 2022, from https://www.ehlers-danlos.com/kitty-richardson-hope/#:~:text=16%2Dyear%2Dold%20Musician%20Kitty%20Richardson%20releases%20new%20song%20%E2%80%9C,for%20Ehlers%2DDanlos%20Awareness%20Month&text=Kitty%20is%20a%2016%2Dyear,Cure%E2%80%9D%2C%20at%20age%2012.
Quarrier, N. F. (2011). Is hypermobility syndrome (HMS) a contributing factor for chronic unspecific wrist pain in a musician? if so, how is it evaluated and managed? Work, 40(3), 325–333. https://doi.org/10.3233/wor-2011-1239
Sims, S. E. G., Engel, L., Hammert, W. C., & Elfar, J. C. (2015). Hand sensibility, strength, and laxity of high-level musicians compared to nonmusicians. The Journal of Hand Surgery, 40(10). https://doi.org/10.1016/j.jhsa.2015.06.009
Types of HMS: The Hypermobility Syndromes Association. The HMSA. (n.d.). Retrieved October 2, 2022, from https://www.hypermobility.org/types-of-hms
Wynn Parry CB. Managing the physical demands of musical performance. In: Williamon A, ed. Musical Excellence Strategies and Techniques to Enhance Performance. Oxford, U.K.: Oxford University Press, 2004: 41-60