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Tags: flexible, hypermobility
What are hypermobile joints?
If you have hypermobile joints, you’re able to extend them easily and painlessly beyond the normal range of motion. Hypermobility of the joints occurs when the tissues holding a joint together, mainly ligaments and the joint capsule, are too loose. Often, weak muscles around the joint also contribute to hypermobility.
The joints most commonly affected are the:
- knees
- shoulders
- elbows
- wrists
- fingers
Hypermobility is a common condition, especially in children, since their connective tissues aren’t completely developed. A child with hypermobile joints may lose the ability to hyperextend as they age.
Having joint hypermobility may also be called:
- having joint laxity, or hyperlaxity
- being double-jointed
- having loose joints
- having hypermobility syndrome
Most commonly, hypermobile joints appear without any underlying health conditions. This is called benign hypermobility syndrome since the only symptom is hypermobile joints. It can be caused by:
- bone shape or the depth of the joint sockets
- muscle tone or strength
- a poor sense of proprioception, which is the ability to sense how far you’re stretching
- a family history of hypermobility
Some people with hypermobile joints also develop stiffness or pain in their joints. This is called joint hypermobility syndrome.
In rare cases, hypermobile joints occur due to an underlying medical condition. Conditions that could potentially cause hypermobility include:
- Down syndrome, which is a developmental disability
- cleidocranial dysostosis, which is an inherited bone development disorder
- Ehlers-Danlos syndrome, which is an inherited syndrome affecting elasticity
- Marfan syndrome, which is a connective tissue disorder
- Morquio syndrome, which is an inherited disorder that affects metabolism
Usually, people with hypermobile joints don’t have other symptoms, so they don’t need treatment for their condition.
However, you should see a doctor if you have:
- pain in the loose joint during or after movement
- sudden changes in the appearance of the joint
- changes in mobility, specifically in the joints
- changes in the functioning of your arms and legs
If you have joint hypermobility syndrome, treatment will focus on relieving pain and strengthening the joint. Your doctor may suggest you use prescription or over-the-counter pain relievers, creams, or sprays for your joint pain. They may also recommend certain exercises or physical therapy.
You’re more likely to dislocate or injure your joints through sprains of strains if you have hypermobile joints.
You can try the following to decrease your risk of complications:
- Do exercises to strengthen the muscles around the joint.
- Learn what normal range of motion is for each joint to avoid hyperextension.
- Protect your joints during physical activity by using padding or braces.
- See a Physical Therapist to have a detailed joint strengthening program developed for you.
Introduction
Most children are very bendy compared to older people, as children get older their joints become less bendy. Hypermobility refers to an increased range of movement in multiple joints, for their age. It is extremely common in children, having being reported in 25 to 50% of those younger than 10 years of age. The older you are the less likely it is you will be hypermobile. It affects 7 – 10% of school age children in the UK. Hypermobility frequently runs in families. Most young people do not know they are hypermobile, you cannot catch hypermobility it’s just how you are made. It affects girls more than boys (Beighton 1973).
The term Joint Hypermobility can describe a wide range of children with flexible joints. At one end of the range are children who are hypermobile and may benefit from their flexible joints. They may be able to use their hypermobility to excel in areas such as gymnastics, dance, swimming, athletics etc. Most children with hypermobile joints do not need support with everyday activities. At the other end of the scale are people who experience pain and their joints may dislocate.
For further information see: Symptomatic Hypermobility
What are the main symptoms?
Hypermobility can be associated with recurrent pains at the end of the day or at night in the knees, feet and/or ankles. It might affect the fingers and hands. Rarely mild joint swelling may come and go but does not tend to persist.
Everyday Life
Hypermobility often improves with age. Families should be aware that its main risk comes from preventing children to live normal lives. Children should be encouraged to maintain a normal level of activity, including playing any sports they are interested in. Keeping active and strong is important and helps reduce joint pain as fitness and balance improve over time.
Cracking Joints
Research studies have shown that cracking joints does not cause arthritis in the joints. For example, Dr Donald Unger cracked the knuckles of his left hand every day for 60 years, but did not crack the knuckles of his right hand. At the end of 60 years both hands were the same with no arthritis. He won the Ig Nobel Prize for Medicine in 2009.
Sports and Activities
Keeping active and strong is important and helps reduce joint pain as fitness and balance improve over time. Make sure you warm up and cool down when playing sports. It is good to encourage children to have a variety of different sports and activities rather than concentrating on just one sport.
Joint Protection
- The stronger you are the more your muscles can protect your joints, get active, get physical, find a hobby you love and have fun!
- Avoid doing "party tricks", showing friends and family how much you can bend, as this may over stretch your joints.
- Think about ways to protect your joints. E.g. To avoid knee pain - stand with your knees straight - not in the over extended position.
- Use your body to push open doors and not using their hands if wrists and elbows are painful.
Writing
It is easier to use thicker style pens/pencils or buy pen/pencils grips as this relieves pressure on fingers and thumb joints and can help to prevent hand pains.
The triangular pencil grip is thought to give better control of the pen or pencil whilst allowing your hand to relax more.
Stabilo Easy Graph pencils are designed for both right- and left-handed users. The triangular shape and moulded grip zones are great for encouraging children to hold the pencil correctly.
Ergonomically friendly pen/pencils can ease writing stress and fatigue e.g. PenAgain / Twist ‘n Write Pencils.
Writing is easier with a gel pen as the ink flows easily over the paper, avoid scratchy ball point pens which will take more effort to write with.
Writing on a sloping surface helps to relieve pain and achiness in the wrist and hand. This will also help your posture and shoulder position in writing. It may be useful to try this at home as well as at school. You can buy writing slopes to go on top of tables from a number of different suppliers. An empty arch lever file serves the same purpose and is light and easy to carry and will not make you look any different from your friends at school. However, buy one with a matt surface as a glossy surface will make your paper slip on it as you are trying to write.
Posture
Good posture is important at all times. A slouched posture may hurt your back and leads to weak muscles around your central core. This then affects the way you can use your shoulders and hips. Think about sitting and standing “tall”.
For further information see: Choosing the Right School Bag
Footwear
Children should try to wear supportive trainers and shoes, especially when their feet or knees are achy. A good foot position can help to relieve knee and leg pain. It may be helpful to wear trainers for PE instead of plimsolls (school pumps). The trainers should have a firm back at the heel, and offer good support. A good shoe cannot be bent in two. Slip on shoes may be too big. You may benefit from a fastening shoe which offers a deeper style and more support for your feet.
For further information see: Choosing Footwear in Children
Flat Feet
This is very common in children with or without Hypermobility. Some children complain of their flat feet having an achy pain. They would benefit from supportive shoes described above. However, in the home they should be encouraged to walk in bare feet (or slipper socks with the grippy soles) as this will strengthen their feet.
For further information see: Flat Feet in Young Children
Paediatric and Adolescent Rheumatology Team Royal Hospital for Children Glasgow 2019