Hypermobility:

How far is too far? Will I grow out of it? Am I double jointed? Can I fix it?

Hypermobility is where the joint range of movement is beyond what is considered normal. This may occur in one or more joints and is commonly, though not exclusive to, the elbows and knees. 5% of the population has at least one hypermobile joint and it is a little more prevalent in females, younger people and those with Asian backgrounds.

Hypermobility is caused by:

• shallow bone ends leading to poor joint congruency
• poor joint proprioception
• hypotonia (low tone in muscles)
• protein deficiency and hormonal changes causing structural changes in the collagen that build the ligaments requiring proteins such as elastin and relaxin
• connective tissue disorders such as Mafan’s Syndrome, Ehlers Danlo’s Syndrome and Osetogenisis Imperfecta)

Of concern with the more extreme cases of hypermobility are recurrent strains, dislocation and subluxation and possibly damage to joint capsules, labrum or cartilage. There may even be increased anxiety associated with the fear of recurrent dislocations leading to abnormal movement patterns. A study in 2003 indicates that there is an association between hypermobility and orthostatic intolerance, leading to chronic adrenalin release and increased anxiety levels. (Gazit et al American Journal of Medicine 2003).

Due to the increased neutral zone at the hypermobile joint, the intrinsic muscles are relatively inefficient in maintaining a level of joint control. As a result, the extrinsic muscles tend to be overactive and global guarding may occur. This can lead to muscle fatigue and possibly connects to Chronic Fatigue Syndrome.

Benign Hypermobility Joint Syndrome is a common condition in children where they report pain and discomfort. It is where they experience daytime soreness, night-time awakening and discomfort after exercise. It is commonly described as growing pains. The discomfort often reduces as the child ages and their soft tissues shorten, becoming relatively tighter and thus helping to stabilise. The condition is described as benign to differentiate from hypermobility conditions that involve organs such as ears and heart.

The tests for hypermobility include:

• fingers flex back beyond 90 degrees;
• the thumb can be pulled back to the forearm;
• the elbows and knees extend beyond 10 degrees extension;
• the hands touch flat to the floor in forward bend, and
• the lumbar spine hyperextends.

Treatment options for the hypermobile client include stabilising the joints, thus Pilates is ideal. We can also offer taping, bracing and splinting. Medication such as anti-inflammatories are useful for symptom relief.

In extreme cases, prolotherapy, also called proliferation therapy may be prescribed. Proliferation therapy is when saline, glucose or protein rich plasma is injected into the joint space and ligaments of tendons, to create an irritant and set off a sticky inflammatory process thus stabilising the joint. Chris Lavelle’s article in this newsletter looks at the clinical approach of prolotherapy for hypermobility.