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.

Gender

Females are more likely to be more hypermobile than men.

Age

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.

References

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.