Hypermobility Syndrome31st December 2020
What is hypermobility, and what can be done about it, if anything?
This article looks at hypermobility in the general population. Parents of children with symptomatic hypermobility can refer to the whole article, and specifically the section for children at the end.
Hуреrmоbilitу Syndrome is a very common condition where joints can move beyond their ‘normal’ range of motion. We have all seen those people with the party trick of being able to bend a thumb back to their forearm, or ‘pop’ a shoulder. Yuck! Sometimes it is known as being double-jointed but there are in fact no ‘extra’ joints – just more available movement AT a joint, and that can be a very painful problem for some.
It is estimated that 10%-15% of people have some hypermobile or ‘loose’ joints and in most it doesn’t cause any issue at all. They may have bendy thumbs, turn their elbows ‘inside out’ or stand flat-footed with knock-knees or with their legs locked straight.
Hypermobility Syndrome is generally considered to be a hereditary disorder of the body’s connective tissues, particularly the articular joint ligaments. Simply put, these strap-like tough fibrous bands are largely responsible for limiting the available movement at a joint, and where they contain too much collagen or elastin they’re not tough enough to control the joint under the force to which it is exposed. This is known as joint laxity.
So when does a playground novelty or party trick become a problem causing discomfort, pain and a very real risk of injury?
The problem tends to arise when there is hypermobility in many joints, or extreme range at a particular joint. Those with symptomatic Hypermobility Syndrome can suffer persistent laxity (loose ligaments), resulting in chronic pain and joint instability, sprains and potentially joint degeneration.
A common example is that of ‘flat feet’ where one or all of the arches of the foot are unable to absorb load and produce the force required for walking (and running), leading to postural changes and additional demands further up the biomechanical chain. People with flat feet may not just experience pain in the foot and ankle, but the knees and lower back too. In fact, a grumbly lower back may me the first or only pain sign that they know of.
A flat foot becomes an unstable and therefore unreliable base of support for the whole body, and from this there is the risk of an acute trauma too.
What can be done about hypermobility?
There are specific clinical tests used to diagnose and grade hypermobility, but if you suspect that you’re hypermobile then you probably are. Some people with hypermobility naturally drift towards activities where additional joint range is advantageous, such as gymnastics and dance. Others may not, and instead just become that person with the party trick!
The consideration therefore is whether you are experiencing pain or dysfunction because of your hypermobile joints, or if you are at risk of acute injury or progressive joint issues.
If you’re in pain or you’re concerned, or if you carry out activities such as standing for long periods, heavy lifting, running or jumping sports, then you would benefit from understanding how best to support your body and reduce your risk of injury.
Assessment, education, and rehabilitation
In the first instance a Physiotherapist can grade the extent of your hypermobility both locally at a joint or joints of concern, and globally throughout your body. They will look at both your conscious and unconscious ability to control movement, and your strength. They can perform tests to ascertain whether there is inflammation or degeneration to a joint, if there are areas of particular stiffness as a result of excessive movement elsewhere, and they will discuss their findings with you.
These findings can inform a treatment and rehabilitation pathway. The biggest element of that being education. A physiotherapist’s role in your rehabilitation is to help you understand how to consciously control movement so well that with consistent training it becomes autonomous and therefore unconscious. This should be accompanied by progressive muscle strengthening and stability exercises, balance activities, and possibly supports such as orthotics, taping or bracing if needed.
Sometimes a surgical intervention is required but non-invasive, progressive physiotherapy and education should be utilised first. It should be noted that there are some more significant medical conditions for which hypermobility is one symptom. Those being EhlеrѕDаnlоѕ ѕуndrоmе, Marfan syndrome and Dоwn’s ѕуndrоmе. A physiotherapist will be aware of these considerations, which are of particular importance in the assessment of children.
Hypermobility in children
Parents may notice any of the following problems associated with hypermobility in their child; clumsiness, frequent falls, clicky joints, delayed milestones, reluctance to walk long distances and pain. But the message from Little Steps Paediatric Physiotherapist Erin Oakman is that it isn’t the hypermobility itself that causes these issues, it’s muscle weakness, reduced muscle stamina, and poor movement control, all of which physiotherapy can assess and help with.
The Association of Paediatric Chartered Physiotherapists (APCP) has a very useful free leaflet on symptomatic hypermobility in children:
Physiotherapy for Hypermobility Syndrome with us at the Rehab Hub