Incorporating Proprioception Training for Hypermobility: Building Strength and Awareness

By Russell Wolfe, MSc PT

If you’re hypermobile and speak to a doctor, physiotherapist or personal trainer, chances are you’re going to hear some variation of “you need to build strength”, “you need stronger muscles to protect your joints”, or in some unfortunate cases, “you’re too weak”. This can be incredibly frustrating to hear, because lots of hypermobile people know this already, and exercise-related pain is often the thing that brought them to the appointment in the first place!

Now, let me preface by saying that YES, it is of vital importance that you try to build as much strength as safely as you can. The “you need to build strength” advice isn’t wrong, but it doesn’t show the whole picture. Something that’s often neglected in the equation is incorporating proprioceptive exercise in addition to simple strength exercise.

As stated in my blog post Hypermobility and Proprioception: Understanding Your Body’s Movement Awareness:

Proprioception is a scientific term that refers to our innate and subconscious awareness of where our body is in space, and how our body is moving. It’s what allows us to reach for a light switch, even when we’re in a pitch black room and can’t see where our hand is going. It’s what helps us stay balanced on a bike, even if we’re looking over our shoulder at a car riding a little too close for comfort. Basically, it’s a useful perk of having a neuromuscular system and allows us to move, balance, and act on our environment without the need for conscious attention.

Understanding Proprioception Challenges in Hypermobility

The scientific community has understood for quite a while that proprioception is impaired in hypermobile individuals (Carroll, 2023). This often presents itself as clumsiness, difficulty acquiring new movement skills, and poor proprioception can even lead to reduced strength! One of the prevailing rationales here is that reduced proprioception leads to less efficient movement patterns, which wastes energy and leads to reduced force output.

How to Incorporate Proprioception into Your Training

So what does this elusive proprioception exercise look like? Well, there are numerous ways to go about it, but I like to start with the foundation of our musculoskeletal system: the spine. If we can organize our spine and understand where neutral, as well as end range, lies for all directions of movement of the spine, we are one step closer to creating a stable foundation for our limbs to work from.

In other words:

No matter how strong we make our arms, if the spine that the arm attaches to is unstable, we’re opening ourselves up to potential joint pain and reduced performance.

So, step one is gaining an intuitive sense of neutrality for our spine. A go-to exercise here would include the classic cat-cow, but it can’t stop there. We want to be able to find neutrality in a variety of positions (sitting, standing, kneeling, supine, prone, on one leg, etc.) The more the better! Then we need to be able to incorporate neutrality into exercise. This is where pushups, pullups, rows, presses, squats and deadlifts come into play. Yes, we can use these to get strong, but we can also use them to create an improved mental map of what our body is doing!

Often, people will jump to the strength exercise with no mind for proprioception, and that’s one of the ways joints can get overloaded and become cranky. So next time you’re in the gym, try some of this out before and during your actual workout! It can be awkward or boring at first, but repetition is key! The goal is to eventually make a lot of this stuff become subconscious.

Incorporating proprioceptive work into your routine isn’t just a bonus—it’s a foundational piece of the puzzle for hypermobile folks. Strength is important, yes, but how you move and how well you feel your movement can make all the difference in protecting your joints, reducing pain, and building long-term resilience. Start small, stay consistent, and remember: building awareness is just as valuable as building muscle.

If you’re ready to put these principles into action with a structured, physiotherapist-designed program, check out Stable Foundations—a training plan built specifically for hypermobile bodies.

References

Carroll, M. (2023). Hypermobility spectrum disorders: A review. Rheumatology and Immunology Research, 4(2), 60-68. https://doi.org/10.2478/rir-2023-0010

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