Understanding Hypermobility

​What is Joint Hypermobility?                                                                                                                                  
Joint hypermobility refers to greater than normal range of motion in a given joint. Excessive range of motion can be attributed to factors such as bone shape, hormonal influences, impaired proprioception, reduced muscular strength, and decreased collagen strength (Knight 2012). Collagen is a structural protein within connective tissue. Fascia, ligaments, joint capsule, tendons, skin, blood vessel walls, gastrointestinal lining, and respiratory tracts contain connective tissue. Defects in connective tissue proteins contribute to joint laxity and can result in widespread symptoms (Hakim 2015).

What are hypermobility disorders?
Hypermobility disorders refer to a group of conditions involving symptomatic joint hypermobility. Some hypermobility disorders such as Ehlers-Danlos syndrome are caused by abnormal structure and function of collagen and connective tissue proteins. Hallmark features of connective tissue disorders include stretchy skin, loose joints, and fragile tissues (Simmonds 2007).

What are common signs/symptoms of Hypermobility disorders?   

• Frequent joint dislocations
• High injury rate
• Fatigue
• Difficulty sleeping
• Chronic pain
• Frequent headaches/migraines
• Dizziness
• Orthostatic hypotension
• Gastrointestinal pain
• Anxiety
• Delayed healing
• Decreased proprioception and strength

Joint hypermobility is common among dancers and rhythmic gymnasts because of the flexibility demands in both disciplines. 

How do we screen for Hypermobility?
The 5-point hypermobility questionnaire, Beighton scale, and Brighton criteria are useful screening tools for hypermobility. Two positive responses on the 5-point questionnaire provides a sensitivity of 84% and a specificity of 85% for detecting joint hypermobility (Kumar 2017).

How is Hypermobility diagnosed?
Joint hypermobility is identified through a comprehensive patient history as well as a variety of clinical tests.

How can Physical Therapy help?
Physical therapy can play a vital role in providing treatment strategies for individuals with joint hypermobility to improve joint stability, reduce pain, and improve function. Treatments may include:

• Muscle Strengthening: Increasing muscle strength is vital for improving joint stability to counteract underlying joint laxity. 
• Education on safe flexibility: Understanding how to improve tissue mobility safely helps to prevent injury and protect the integrity of the connective tissue. 
• Endurance: Increasing cardiovascular and muscular endurance is important for reducing fatigue which is a common symptom in hypermobile individuals.
• Balance and Proprioceptive Activities: Increasing proprioception and improving postural control is key for increasing stability to reduce further pain or injury. Taping or bracing may be utilized to improve joint awareness and aid in further stability. 
• Manual Therapy: Hands on treatment such as soft tissue mobilization may be used to reduce myofascial pain and calm down the nervous system. 

 
References: 

1. Isobel Knight MSc, Moira McCormack MSc, 7 Howard Bird MA MD FRCP .Managing Joint Hypermobility – A guide for Dance Teachers. March 2012. https://www.onedanceuk.org/wp-content/uploads/2018/05/Managing-Hypermobility-for-the-Dance-Teacher-FINAL.pdf Accessed May 20, 2021. 
2. Hakim, Alan. What are Hypermobility Syndromes? May 2015. https://www.hypermobility.org/what-are-hypermobility-syndromes accessed May 23,2021.
3. Simmonds, J. V., & Keer, R. J. (2007). Hypermobility and the hypermobility syndrome. Manual therapy, 12(4), 298-309.
4. Kumar, B., & Lenert, P. (2017). Joint hypermobility syndrome: recognizing a commonly overlooked cause of chronic pain. The American journal of medicine, 130(6), 640-647.

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