Benign Joint Hypermobility Syndrome
1. Introduction
This condition, more commonly known as ‘hypermobility’ or ‘hypermobility syndrome’, is usually characterised with excessive movement of joints. You may at some point in the past, or currently, have been able to bend your joints a lot, or carry out certain ‘party tricks’ like ‘doing the splits’.
Frequently Asked Questions
- Hypermobility means above normal movement or flexibility. It is a condition that exists on a spectrum, meaning you can have mild to extreme levels of hypermobility.
- It is quite common to have hypermobility; low-level cases have been shown to be present in 8%-39% of school-age children, with girls more commonly affected than boys (1).
- Extreme cases of hypermobility are very rare.
- Hypermobility tends to get better as you get older.
- No.
- With the right rehabilitation approach this condition is often well managed.
- Only in extreme cases will medical management be necessary.
- Children and younger adults more typically.
- Those with a family history of similar conditions affecting joints/soft tissues (1, 2).
- Bendy joints, ‘double-jointedness’.
- Joint or muscle pain.
- Regular strains/sprains.
- Fatigue.
- Stretchy or fragile skin.
- Poor balance or co-ordination (1,2,3,4).
- Seek advice from your GP/physiotherapist.
- Strength exercises.
- Heat therapy.
- Aerobic/fitness exercise.
- Pain-killers.
- Unfortunately, this is a long-term condition and is not curable, however there are many things you can do to manage it and limit its effect on your daily life.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Many people do not have symptoms or associated problems and hypermobility may be advantageous in some situations, for example, sports people and dancers (3).
Some people do have symptoms, features include joint hypermobility with muscle/joint pain and fatigue, especially in the evening after an active day. In the case of toddlers/children, other signs may be:
- Late walking with bottom shuffling instead of walking.
- Poor handwriting and ball-catching skills.
More rare signs include easy bruising and joint clicking, abdominal pain which may be associated with bladder and bowel dysfunction, postural orthostatic tachycardia syndrome (POTS), hernia and joint sprains or dislocations. In more severe cases, there have been shown to be links to other conditions such as developmental co-ordination disorder, movement delays, chronic fatigue syndrome and fibromyalgia (1, 2, 3, 4). Information on some of these conditions can also be found on our website or by asking your physiotherapist.
Often people only find out that they have hypermobility after they are suffering pain. They may attend an appointment with a GP or physiotherapist complaining of joint pain and assessment shows an increase in mobility in the joints.
3. Causes
A joint can be hypermobile due to a change in a collagen make up in the soft tissues (ligaments and tendons); it can also be due to a change in the shape of the bone.
Despite hypermobility having a tendency to run in families, the underlying genetic cause is unknown (2). A first degree relative (parents or siblings) may have a similar condition which affects their joints. Your physiotherapist may ask you about this in more detail.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing hypermobility. It does not mean everyone with these risk factors will develop symptoms.
- Females are more likely to suffer from the condition.
- You are more likely to be diagnosed with the condition in your teens and 20s.
- Being involved in activities that require extremes of motion such as gymnastics and dance.
5. Prevalence
It is quite common to have hypermobility; low-level cases have been shown to be present in 8%-39% of school-age children, with girls more commonly affected than boys (1). Extreme cases of hypermobility are very rare. The exact prevalence in adults in unknown.
6. Assessment & Diagnosis
Your physiotherapist will take a detailed history of your symptoms and will perform a comprehensive physical examination. Benign joint hypermobility syndrome is diagnosed based on the Beighton score, which is a simple system to quantify joint laxity and hypermobility. It uses a simple 9-point system, where the higher the score, the higher the laxity. The threshold for joint laxity in a young adult ranges from 4-6. Thus, a score above 6 indicates hypermobility, but not necessarily true Benign joint hypermobility syndrome (see below).
| Movement | Score |
| Can place hands flat on the floor without bending knees | 1 |
| Can bend right knee backwards into hyperextension | 1 |
| Can bend left knee backwards into hyperextension | 1 |
| Can bend right elbow backwards into hyperextension | 1 |
| Can bend left elbow backwards into hyperextension | 1 |
| Can touch right thumb onto the back of the forearm | 1 |
| Can touch left thumb onto the back of the forearm | 1 |
| Can bend right little finger past 90 degrees towards the back of the hand | 1 |
| Can bend left little finger past 90 degrees towards the back of the hand | 1 |
7. Self-Management
If you have hypermobility, it is important that you look after your joints. Your physiotherapist will most likely advise that you avoid stretching the joints beyond normal limits or doing ‘party tricks’ with your joints. If the pain levels are high then your physiotherapist can recommend pain reduction techniques such as anti-inflammatory medication, ice and/or heat, rest and gentle movement.
8. Rehabilitation
Hypermobility is a condition that needs managing in the long term. It is essential that you stay strong and fit as there is no cure for hypermobility. If you have greater strength and stability, it will counteract the risks and subsequent issues that can develop as a result. At Pure, we would use techniques such as graded exercise, massage or other pain-relieving methods to ease symptoms.
When the pain has settled it is important to establish an exercise programme that allows you to strengthen your muscles within pain-free limits. Our physiotherapists are specialised at grading the exercises for you and will prescribe you an individualised plan that will help you achieve the goals important to you. Regular reassessment will ensure you are making progress and make certain that suitable modifications can be made to ensure your programme is optimal. Your physiotherapist will provide ongoing support and advice so that you can continue to self-manage.
9. Benign Joint Hypermobility Syndrome
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme is aimed at helping to develop better strength and stability to reduce the effect of the condition. Pain should not exceed 2/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This programme is a progression of the earlier programme. These exercises are more challenging and aim to assist with overall strength development. Pain should not exceed 2/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
It is only in very rare and extreme cases of hypermobility that medical management is necessary. This is typically where the organs and connective tissue are involved. It is likely that you will be referred to a specialist who works exclusively with this condition by your GP.
References
- Castori, M. and Hakim, A. (2017). Contemporary approach to joint hypermobility and related disorders. Current opinion in pediatrics 29, 640-649.
- Smith, E.M. and Ramanan, A.V. (2013). Fifteen-minute consultation: A structured approach to the management of hypermobility in a child. Archives of disease in childhood. Education and practice edition 99, 212-216.
- BSPAR .(2013). Guidelines for management of joint hypermobility syndrome in children and young people. British Society for Paediatric and Adolescent Rheumatology. http://www.sparn.scot.nhs.uk
- Ross, J. and Grahame, R. (2011). Joint hypermobility syndrome. 342.
- Beighton, P.H. and Horan, F. (1969). Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg. 51, 444-453.
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