Hypermobility

What is it?

Hypermobility is a term used to describe joints that have more movement than normal. This is also frequently referred to as being ‘double jointed’. Many people will have at least one joint that is hypermobile, however if a number of joints are affected this is referred to as Generalised Joint Hypermobility.

Joint hypermobility can be caused by a number of factors:

  1. Weak or overstretched ligaments
    Ligaments are soft tissue structures that connect two bones together. Collagen is a type of protein that provides the strength component to ligaments. Genetic variations causing abnormal and weakened collagen fibres can be passed on at birth, resulting in increased movement and reduced stability of joints. Consequently, joint hypermobility is often hereditary.
  2. The shape of bony structures
    In some people the sockets in their hips or shoulders are shallower than normal – this allows extra movement to occur in the joint.
  3. Muscle tone
    Muscles add stability to joints. If a person has reduced tone of their muscles they may have increased movement in their joints.

Who is affected?

Joint hypermobility is very common, particularly in children/adolescents and tends to decrease with age. Women are more likely to be affected than men and it is more prevalent in Asian and Afro-Carribean races. A small portion of the population may have an underlying connective disorder such as Marfan’s or Ehlers Danlos syndrome.

How is it diagnosed?

The Modified Beighton Score is used to determine if an individual has Generalised Joint Hypermobility.

  • Able to stand with straight legs and put both palms flat to the floor? 1 point
  • Able to bend little finger backwards to 90 degrees? 1 point for each hand
  • Able to bend thumb forwards to touch the forearm? 1 point for each hand
  • Elbows that bend backwards past straight? 1 point for each side
  • Knees that bend backwards past straight? 1 point for each side
  • If the total score is 4 or more out of a possible 9 points then it is an indication that a person may have hypermobility.

What does this mean?

In the majority of cases this extra flexibility is not any cause for concern, many people are asymptomatic and will not require any treatment. In certain sports such as dancing and gymnastics, joint hypermobility may actually be advantageous.

A small percentage of people can experience symptoms associated with weak collagen fibres. When joint hypermobility is symptomatic it is referred to as Joint Hypermobility Syndrome.

Symptoms may include:

Muscle/Joint pain
Recurrent sprains
Partial or full dislocations of joints
Fatigue
Hernias
Varicose veins
Digestive problems (constipation/irritable bowel syndrome)
Thin/stretchy skin
Dizziness/fainting
Urinary incontinence or prolapse of pelvic organs

What are the treatment options?

If symptoms are present they can usually be managed with a combination of appropriate exercise, physiotherapy and pain relief if required.

Maintaining a healthy weight is important to reduce the load on joints and ligaments. Low impact exercise is recommended over high impact as there is less stress on the joints. Good options include cycling, swimming, walking and pilates.

Exercises to strengthen muscles can help to reduce the risk of joint injury, improve stability and balance. Pelvic floor muscle exercises (Kegel’s) are also important to reduce risk of developing incontinence.

Physiotherapy can help by assessing which joints are hypermobile, offering advice, treating specific injuries and developing an individualised exercise program to build strength around the joints. Other modalities including taping and bracing may be beneficial as well for recurrent sprains or dislocations.



References:

Beighton, P., Solomon, L., Soskolne, C.L. 1973. Articular mobility in an African Population. Ann Rheum Dis. 32. 413 – 418.

Ferrell, W.R., Tennant, N., Sturrock, R.D., Ashton, L., Creed, G., Brydson, G., Rafferty, D., 2004. Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility. 50 (10). 3323-3328.

Hypermobility Syndromes Association, 2004, Accessed 18th October 2018, <http://hypermobility.org/>

NHS, 2017, Joint Hypermobility Syndrome, Accessed 18th October 2018, <https://www.nhs.uk/conditions/joint-hypermobility-syndrome/>

NHS Inform, 2018, Joint Hypermobility. NHS. Accessed 18th October 2018, <https://www.nhsinform.scot/>

Norton, P.A., Baker, J.E., Sharp, H.C., Warenski, J.C. 1995. Genitourinary prolapse and joint hypermobility in women. 85 (2). 225 – 228.


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