Introduction

Hypermobility (HM) – is a condition where there is excessive mobility of one or more joints.

This is a common finding in many people, and in most it does not present any problems. Some sports people and musicians have very lax (loose) joints, and may therefore be prone to injury, but this does not necessarily mean they have hypermobility syndrome. This is a condition where there is excessive laxity of joints and symptoms ranging from minor sprains to more persistent widespread joint pain and chronic pain to such an extent that it can affect quality of life.

HM is usually a genetic condition, and is more common in females than men. It is associated with the characteristics of the collagen fibres in tissues such as ligaments, tendons and joint capsules. These tissues – and sometimes other tissues such as the skin – are more elastic. They are more prone to injury and take longer to heal.

 Consequences of Hypermobility

• Frequent injuries such as ankle sprains, tendinitis.
• Generalised HMS where there is diffuse pain, mostly in joints but also in other tissues. This pain frequently does not respond well to pain killers, and injections.

Are you hypermobile?

There are many ways of testing for hypermobility and you may need to seek advice from a clinician. However, the hypermobility may be just on one set of joints or a number. For example:  

1. More than 10º hyperextension of the elbows
2. Passively touch the forearm with the thumb, while flexing the wrist.
3. Passive extension of the fingers or a 90º or more extension of the fifth finger.
4. Knees hyperextension greater than or equal to 10º
5. Touching the floor with the palms of the hands when reaching down without bending the knees.  

There are other features of hypermobility that do not affect the joints. For example, varicose veins, prolapses, herniae, easy bruising, joint swelling, stretch marks on the skin.

 
Aggravation of symptoms can be associated with  

• Unaccustomed physical exercise
• Posture
• Poor ergonomics at work or repetitive movements
• Hormonal changes such as being premenstrual, or in pregnancy
• A sudden gain in weight
• Weakness in muscles, unbalanced flexibility
• Injury to one joint may exacerbate symptoms in another
• Unsupportive shoes

Hypermobility in children and adolescents

 

Symptoms are commonly seen in a growth spurt  - but they can occur much earlier. They may be associated with activity or with prolonged sitting,

Some children have associated dyspraxia/clumsiness, but others are selected into sports such as gymnastics and ballet because their joints allow movements, but they will be more prone to injuries.

What should you do if you think you have HMS?

 

If you are having problems with joints and think you may be hypermobile, you should see a doctor who is familiar with the condition to discuss. Investigations such as xrays or blood tests may be ordered, although these are frequently not required.

 

Treatment starts with having a full understanding of the condition. A careful exercise programme to improve the strength and stability of joints is very important; initially you should be closely supervised by a good physiotherapist to ensure you have a regime that suits you.  This will include a combination of strengthening, flexibility work (still important to keep all joints balanced), aerobic activities and postural work such as Alexander Technique and Pilates. Yoga may also be suitable.

 

If you have an injury, seek advice early as you will take longer to heal than most.

 

Podiatry

Putting special insoles or orthotics into the shoes can be beneficial to support joints.

 

Medication

The usefulness of drugs in controlling pain in HM is limited. You should discuss this with your doctor.