Hypermobility and Physiotherapy

Hypermobility and Physiotherapy

While we often admire the extreme range that some people with hypermobility can achieve, many hypermobility conditions can cause joint pain, tiredness and even dislocating joints.

Maria Yee, one of our physiotherapists was a dancer and still keeps fit with dance. She personally understands the challenges of hypermobility.

Maria consults with many young dancers and children in general with hypermobility syndromes. Many of these children and adolescents are training hard under her supervision in our Pilates studio at Quay Street, Bulimba to develop strength and control. Many are dancing at high levels and performing well due to her great management of their conditions and their strengthening programmes. She also has a number of adult clients managing their hypermobility conditions with regular specific Clinical Pilates. Here is her research into this condition.

What is joint hypermobility?

Joint hypermobility is the capability of a joint to move (passively or actively) beyond normal limits. The term generalized joint hypermobility is used to describe someone with hypermobility in multiple joints. An easy test is via the Beighton scoring system, where a score above 5 is indicative of the presence of generalized hypermobility:

What are the causes of hypermobility?

There are different contributors to hypermobility, a few of which are listed below:

Training habits

Certain sports such as dance and gymnastics dedicate significant hours of training to increasing flexibility. Such flexibility training can stretch ligaments, joint capsules and other connective tissues and render a joint hypermobile. Traumatic injuries or recurrent sprains can also lead to a hypermobile, unstable joint. People with hypermobility often tend to choose dance and gymnastics as their sport as they can easily move into the flexible joint positions they require.

Genetics & Ethnicity

Genetic differences in collagen quality can render connective tissues such as skin, ligaments and joint capsules weaker and more elastic than normal. Africans, Asians and Middle Easterners also have a higher prevalence of hypermobility compared to other races.


Females are more likely to be more hypermobile than men.


Collagen fibres are more elastic in children which means they tend to have more predisposition for hypermobility. Connective tissue becomes less stretchy and hydrated with age.

Symptomatic generalized joint hypermobility

The presence of generalized joint hypermobility is in itself not a medical condition, and can be asymptomatic in some cases. However, it can also exist as part of a more complex connective tissue related conditions, such as Ehlers-Danlos syndrome, Marfan syndrome, Osteogenesis imperfecta, and Downs syndrome. Consult your healthcare professional if you also have:

  • Chronic multi-joint pain
  • Chronic muscle pain
  • Thin, stretchy skin
  • Recurrent joint dislocations
  • Fatigue
  • Anxiety-type disorders
  • Pelvic and bladder dysfunction
  • Gastrointestinal disorders

These can be symptoms of hypermobile-Ehlers Danlos (h-EDS) or Hypermobility Spectrum Disorder (HSD) and can impact seriously on quality of life. Prompt recognition and management by a team of health professionals is required.

A physiotherapist will be able to assist in prescribing suitable exercises for core, upper and lower limb strengthening. Pilates, swimming and a walking program are usually prescribed to strengthen muscles, build muscle tone and reduce recurrences of joint pain and dislocations.

Children and adolescents with hypermobility should be guided into sport and exercise pursuits that are smooth and don’t have sudden stopping and change of direction. Avoid contact sports , netball, martial arts.

Choose sports like swimming, walking and recreational jogging. Dance is usually fine if accompanied with strengthening exercises. Avoid doing lots of stretches if you know you are hypermobile.

Find a physiotherapist who understands your condition and can give you the individual advice you need to manage hypermobility.

We have a great team of sports and dance physiotherapists at our 130 Quay street, Bulimba practice and at our other practice at 188 Nudgee Road, Ascot who can help.


Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A., 2017, “A framework for the classification of joint hypermobility and related conditions.”, Am J Med Genet Part C Semin Med Genet, 175C:148–157.

Engelbert RH, Juul-Kristensen B, Pacey V et al., 2017, “The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome.” Am J Med Genet Part C Semin Med Genet 175C:158-67.

Malfait F, Francomano C, Byers P et al., 2017, “The 2017 international classification of the Ehlers-Danlos syndromes.”, Am J Med Genet C Semin Med Genet, 175(1): 8-26.

Shockwave Theraphy

Shockwave Therapy

Shockwave Therapy is a non-surgical and non-invasive method of pain relief and mobility improvement. Also called Extracorporeal Shock Wave Therapy or ESWT, Shockwave Therapy is used around the world in physiotherapy, sports medicine, orthopaedics, podiatry and urology.

Here at Agility we use shockwave therapy to treat chronic painful tendon conditions such as: Achilles tendonopathy, patellar tendonopathy, plantar fasciitis, gluteal tendonopathy (hip bursitis), rotator cuff pain, tennis elbow and golfer’s elbow.

Shockwave Therapy offers several key benefits:

  • Fast, effective treatment
  • Minimal side effects
  • Speedy recovery

How Exactly Does Shockwave Therapy Work?

Shockwave therapy sends high-energy radial pressure waves to the site of chronic pain. These acoustic waves increase blood flow, stimulate muscle repair and regeneration, and increase metabolization at the cellular level.

Shockwave therapy is a safe, effective, treatment recommended for people suffering chronic pain – even at the highest level of sport. Clinical studies and literature reviews continue to prove the effectiveness of ESWT as a treatment method for tendon complaints and a raft of musculoskeletal issues.

What does Shockwave Therapy involve?

During shockwave treatment you may experience a small amount of discomfort, but your response is measured by our experienced physiotherapists to ensure you are not in pain. Because shockwave therapy creates an analgesic effect, you should experience immediate acute pain relief. The treatments also stimulate collagen production so you will benefit from increased mobility after 1 or 2 sessions.

Fast treatment

Generally we need to see you 4-6 times, about a week apart, for effective long-term pain reduction. Each session lasts around 20 minutes and most patients report a drastic pain reduction after the first treatment. Shockwave therapy is used as part of a tailored therapy pathway designed to address underlying issues in your body.

Limited side effects

Shockwave therapy carries a much lower risk of side-effects than surgery. Depending on your level of pain and overall health there may – in very rare cases – be side effects to ESWT:

  • Tolerable pain 2-4 hours after initial treatments
  • Mild discomfort during treatment
  • Mild bruising, swelling and/or numbness
  • No response to treatment (extremely rare)

Fast recovery

Shockwave therapy starts to alleviate pain and restore mobility after the first session. At most you will be restricted from high-impact activity for 48 hours following each session. Your physiotherapist will give more tailored advice, but in general the recovery periods following shockwave treatment are substantially shorter than surgery.

What to expect after Shockwave Therapy?

After 1-2 days you should experience reduced pain and improved mobility. Here at Agility, we design shockwave therapy plans that specifically address your pain points, to provide safe and effective pain treatment without surgery.

Contact us to learn more about Shockwave Therapy, book a shockwave therapy treatment, or speak with our team about treatment options tailored for you.

Knee Pain – Is It “Just Growing Pains”?

Knee Pain – Is It “Just Growing Pains”?

Does your teenager complain about pain in the front of their knees? Have you been told they have “growing pains” and it’ll just go away?  Have you been told you have arthritis in your knee and you should stop exercise?

This is just not true!!  Inaccurate advice like this can cost years of healthy activity and needlessly keep you or your loved ones from doing the things you love.

In a recent research update, world leaders in knee pain combed thousands of research articles to come up with updated clinical guidelines for Patello-femoral pain (aka runners knee, jumpers knee, netball knee etc).

Patello-femoral pain is felt at the front of the knee and hurts with sport, stairs, squatting and even sitting.


Some of the statistics are alarming:

  • It affects people of all ages and is extremely common
  • 29% of adolescents will get this condition
  • Half of them will struggle for 2 years to do the sport they love
  • Many will have niggling pain into their 20’s


The good news is that there are treatment options that are proven to help reduce pain, improve activity levels and get you back to sport. The ones with the most research evidence behind them are:

  • Hip and knee muscle strengthening exercises
  • Patellar taping
  • Inexpensive, off the shelf foot orthotics if you have flat feet
  • Patellar mobilisation and
  • Lower limb muscle stretching


The combination of these treatments should be tailored to you by a Physio skilled in treating Patello-Femoral pain. Treatments with no evidence to support them are passive choices like laser, electrical stimulation, needling, ultrasound and definitely not waiting for growth spurts to finish before going back to sport!

If you, or a family member has had enough of putting up with pain in your knee give us a call or book online to get started on the road to recovery and get back to doing what you love.  We are here to help!