Joint Hypermobility

Joint Hypermobility

Children and adolescents with “joint hypermobility” have joints which move beyond the normal limits. Many famous gymnasts, musicians, trapeze artists and dancers have been able to achieve fame due to the flexibility of their joints. Generalized Joint Hypermobility is where multiple joints in the body are affected, and this is normally something an individual is born with. Most Children and adolescents with flexible joints do not have any symptoms, but some individuals may need to take additional care to protect their joints from injury. Sometimes people with flexible joints can have soft tissue injuries, joint subluxations (slipping out slightly) or dislocations (slipping out completely), and they are more susceptible to sport injuries (strains and sprains). Occasionally people with joint hypermobility can develop recurring pain in multiple joints, pain in muscles, or fatigue, which can limit their ability to participate in daily activities like attending school or participating in sports or physical activity. Until March 2017, this pattern of symptoms was known as Joint Hypermobility Syndrome (JHS). It is now classified as Hypermobility Spectrum Disorders  (HSD), or sometimes Hypermobility Ehlers-Danlos Syndrome (hEDS) which is closely related. HSD is treated with a rehabilitation program comprised of physical strengthening, reconditioning and programs to manage pain including psychological therapies. For people with hypermobile joints, the task of looking after their joints and the task of maintaining their physical fitness needs to be integrated into their lifestyle, so that they can maintain a healthy and long lasting life.

 

Genetics and Joint Hypermobility

Most people with Joint Hypermobility can identify other family members who are “flexible,” as the condition generally runs in families. Joint hypermobility is more common in females than males. Some genetic syndromes such as Down syndrome or Marfan syndrome can be associated with hypermobility, which is why it is important that everyone with hypermobility in four or more joints is seen for an evaluation by a geneticist, or other specialist in hypermobility. In the vast majority of people with hypermobility, a genetic cause will not be identified.

 

Musculoskeletal and Joint Pain

Some children and adolescents with hypermobile joints may experience joint pain. Most commonly, this happens during and after physical activity. Typically, this pain will subside, however, for a small number of individuals, exercise-induced joint pain may become a chronic problem. For individuals where pain is ongoing or frequent, therapy involves improving joint strength and stability, and preventing strain that leads to pain symptoms. Physiotherapy with a particular focus on core and postural muscles helps protect joints and prevent pain symptoms. Because joints support our bodies, individuals who are overweight suffer from increased joint pain, so a healthy diet is important. A 6-8 week physiotherapy exercise program is effective in reducing chronic joint pain by 30-40%. Passive treatments such as ice, massage, electrotherapies, bracing and splinting may be useful at times of pain exacerbation but should be avoided as long-term strategies. Management of complex chronic joint pain should include a multidisciplinary approach including physiotherapy and psychology for pain-focused cognitive-behavioral therapy.

 

Fatigue and Dizziness

Although most children and adolescents with joint hypermobility have normal levels of energy, fatigue can be a problem for some individuals, and is more common in children and adolescents with HSD. The cause of fatigue is thought to be multifactorial in nature. Fatigue and physical deconditioning is associated with poor sleep, muscle weakness, low aerobic fitness and dizziness in children and adolescents with joint hypermobility. Fatigue symptoms can be helped by increasing physical fitness, psychological interventions which strengthen emotional resilience, and education on pacing. The goal of pacing interventions is to avoid “boom and bust” cycles where periods of excessive activity result in worsening musculoskeletal symptoms and are followed by periods of inactivity which in turn, worsen fatigue and dizziness symptoms.

 

Anxiety

Children and adolescents with joint hypermobility have an increased incidence of anxiety, panic attacks and depression, all of which can be effectively treated with psychological interventions and promoting physical wellbeing. The journal Frontiers in Psychology released a study that found people with hypermobile joints to have increased activity in the anxiety regions of the brain. Patients with anxiety are 16 times more likely to have hypermobile joints due to generally having a bigger amygdala, the part of the brain that is responsible for processing emotion.

 

Physical Activity

Physical activity is important for the health and wellbeing of all children and adolescents, including those with hypermobile joints. Pacing of activity levels—both at home and at school—is important if children are experiencing pain or fatigue, and some sports may need to be modified if they cause frequent injuries. Advice about specific sports and physical activities for you/your child should be discussed with your physiotherapist or doctor. Care should be taken with contact sports, which should be avoided if the child is hypermobile in their cervical spine (extension range 90 degrees or more). Swimming, pilates, bike riding, walking and other water based activities are excellent activities to increase physical strength and joint stability.