3/4 Jan
Diagnosis
When you receive an unexpected diagnosis it turns your perception of the world upside down, shakes it, and resettles you with everything slightly skew-whiff. Most of the time I think we receive diagnoses we are expecting. We might even have been begging for them, to have our symptoms pinned down and accepted as real and valid and deserving of help. My diagnosis of PMDD was like that - it was such a relief to hear a GP finally say, yes this is real, after decades of debilitating physical and emotional disruption.
I was not expecting to receive a perception-altering diagnosis at the physiotherapist last week. I went in for referred pain in my knee that I thought could be IT band tendinopathy. I thought I had been silly with strength training, hadn’t been concentrating, had pushed myself too far. This would be normal and expected for me (note the narrative, we’ll come back to this later). An outstanding sports physio asked my a lot of questions, did a full body exam (much more thorough than I thought necessary but I am people pleaser and happy to smile and bend my elbows and knees as requested). She tested my range of motion, identified bone abnormalities in both hips (which I had always suspected) and then…floored me.
‘You are 5/9 on the Beighton Score’, she said. ‘You are hypermobile, noticeably so in your back and knees. Did you know you don’t actually stand straight?’
Um, no, I did not.
(apparently I list to the left, like a ship in dry dock, pretty much all the time)
I walked out of her office stunned (and with a fairly extensive list of exercises to do as the beginning of an aggressive course of physiotherapy). When I got home I switched on a podcast about hypermobility and yoga and ticked off all the symptoms - clicky joints, constant stiffness and uncomfortable muscular tightness, easy bruising, IBS, dysregulated nervous system, disrupted sleep, poor coordination, poor depth perception, dizzy when standing up suddenly, preferring to sit with crossed legs, low blood pressure, regular joint dislocation or displacement…
About 20% of the population are hypermobile, but it is much higher among yoga practitioners and dancers. The reason is likely that the constant tightness of the hypermobile body requires much deeper stretches to feel relief, so we gravitate to practices that encourage flexibility. Unfortunately, more stretching is precisely the opposite of how you treat hypermobility, which is a condition affecting connective tissues making them less stable and secure. You have to strength train, to increase the resistance of tendons and ligaments so that bones stay in place and blood can flow securely through the body. Thankfully I have outstanding teachers and an inherent nerdiness that has meant my yoga practice and teaching already emphasises stability and strength. But I have still overstretched, probably in Yin classes before Christmas, and now my hips are wobbling in their sockets and all the muscles are tensing up to try to hold the bones in place.
The thing is, being hypermobile isn’t a terrible thing. It’s a condition to be aware of, it means diligence about strength training and physio, especially as I age, and talking my clients through deeper stretches without doing them myself. What’s throwing me is the radical pivot in my thinking that this diagnosis entails. Because I grew up with certain stories about my body and my physical ability, stories that still sit with me now - I’m clumsy, I’m uncoordinated, I’m not athletic, I’m not the sporty type - stories that were given to me by others but wormed their way into my psyche as accepted personality traits, things to be mildly ashamed of if I’m honest. Now, I’m told they are the result of a physical condition, of unrecognised untreated hypermobility. So strong still are the stories for me that I am actually struggling the believe this diagnosis, even as so many little things - the clicking of my hips, the feeling like my rib would dislocate and compress my lung sometimes, the strange jerk of my wrist when doing the washing up that smashed so many plates, my weird lack of depth perception when going down slopes, the constant walking sideways into things - suddenly make sense. A core building block of my sense of self has been removed, and I feel like my floppy unsupportive ligaments - untethered.