Hyper-mobility Syndrome (Double-Jointed)
What is it?
Hypermobility Syndrome (what often people refer to as being “double-jointed”), is when your joints can move further than average due to the ligaments being too lax. Hypermobility affects around 30% of the population. 10% of these have symptoms that range from mild to debilitating (Hyper-mobility Syndromes Association, 2023). Here is a video from our clinic director.
How is hyper-mobility Syndrome diagnosed?
Often, a score is attributed following Beighton’s scoring system (see below) when each part of the body, each side testing individually, gets you a point on the scale.
In correlation with this, the clinician can use the 2017 diagnostic criteria for hyper-mobility spectrum disorders (HSD) which amongst the confusion existing in the diagnosis of the conditions, tries to come up with additional methods to assess the presence of generalised joint hypermobility. It also tries to list the signs and symptoms to be on the lookout for (The Ehlers-Danlos Society, 2023).
The criteria for HSD can only be met when other conditions involving joint laxity have been excluded like Marfan’s or Down’s syndrome. This classification was also made for people who fail to meet the criteria for hypermobile Ehlers-Danlos syndrome (hEDS).
The HSD criteria are as listed below (taken from Hypermobility Syndromes Association 2, 2023), associated with secondary musculoskeletal manifestations which your clinician will look for in your medical history:
· “Generalised hypermobility spectrum disorder (gHSD): is assessed using the Beighton Score, along with secondary musculoskeletal manifestations (listed below)
· Peripheral hypermobility spectrum disorder (pHSD): Joint hypermobility of the hands and feet, and 1 or more musculoskeletal manifestation (listed below)
· Localised hypermobility spectrum disorder (lHSD): A single joint or group of joints is hypermobile, with one or more secondary musculoskeletal manifestations (listed below)
· Historical hypermobility spectrum disorder (hHSD): Symptoms of gHSD are reported, but the individual is no longer as hypermobile as joints have stiffened with age, injury, surgery etc.
· Asymptomatic hypermobility: hypermobility is present but without symptoms.”
In terms of the secondary musculoskeletal manifestations, they would be as follows:
· Pain
· Musculoskeletal soft tissue trauma like recurrent dislocation, sprain, and strain.
· Impaired proprioception “being clumsy”.
· Other orthopaedic or musculoskeletal factors like flat feet, misaligned bones, or curvature of the spine.
Hyper-mobility Syndrome - Beighton’s Scale
Even though this article focuses on Hypermobility Spectrum Disorder, there are other health conditions that can cause or have hyper-mobility as part of the symptoms. The management of those conditions, whether accompanied by a connective tissue disorder or not, have similarities.
The reference section will be linked with extra reading as well as the website for the Hypermobility Syndromes Association which is full of useful lifestyle advice and support if you ever need to reach out.
Sadly, the classification is a little blurry, and science is still catching up, making it difficult to give the patient an accurate diagnosis. “… until science moves on and we can reliably identify different conditions and risk factors within this group, and understand the differences between them, we will continue working to educate professionals and support patients so everyone within this group can get the support they need to live well in the body they have, whatever their diagnosis.” (Hypermobility Syndromes Association 3, 2023).
What are the different types of hyper-mobility syndrome (HMS)?
· Hypermobility Spectrum Disorder, and hEDS, which this article focuses on. They are the most common syndrome.
· Ehlers-Danlos syndromes, genetic conditions that stem from alteration in the collagen (there are 13 types including hEDS)
· Pseudoxanthoma elasticum, joint hypermobility and skin laxity
· Osteogenesis Imperfecta, a cluster of conditions that cause hypermobility and bone fragility.
· Marfan Syndrome (MFS), where Fibrillin is not enough in the connective tissue. It causes characteristics body type and facial features.
· Stickler Syndrome, a connective tissue disorder that results in a specific facial appearance.
How to live with hyper-mobility?
It is believed that everyone that falls under hEDS and the HSD group requires the same symptoms-based treatment and management. The potential for a connective tissue disorder to be present and manifest over time should also be kept in mind (Hypermobility Syndromes Association 4, 2023).
What to do?
Manual therapy and exercises
Manual treatment like osteopathy or physiotherapy can be of great help to release tight muscles and help the body go back to a better state of alignment as well as create a pain management pathway.
Exercising is also a great tool to improve your joint stability and increase proprioception. Because of the extra joint movement, however, there are certain things you should keep in mind:
· Certain exercises, upper or lower body based, might be better done sitting down, to avoid overcompensation of your other joints and be able to focus on the specific movement that you are doing, without worrying about the rest.
· Core strengthening is a must and should always be the first point of call when you start exercising. It, of course, needs to be maintained and be a part of your training/rehabilitation journey. Your core should always be engaged when you exercise your other joints as it will provide overall stability and protect your spine.
· Any movements that are completed with control and purpose can be classed as exercise; housework is a good example of that.
· During strengthening exercises, especially with using weights or resistance, it’s important to not go to the end range of movements of your joint. Because there is too much movement within it, it could lead to more damage over time. Always stop before the end range (like you could still go farther if you wanted) and work in that range.
In general, contact sports, high-impact activities and twisting movements are to be avoided if possible. Or we can devise an exercise plan to best facilitate high-impact sports/exercise if that is your desire.
Here is an exercise regime based on simple hypermobility exercises, link below.
Hyper-mobility Strengthening Exercises
Anxiety and hyper-mobility
There is a lot of literature that has highlighted the relationship between anxiety over the years. An article by Bulbena et al. in 2017 reviews some of those papers and show the correlation between hypermobility and hypermobility Ehlers-Danlos syndrome to anxiety and panic disorders.
Because of all the related issues that can arise from what can seem at first, only like a slightly increased range of movement in the joints, it is essential that care and patient handling is done in a way that encompasses all of those aspects. You should be tested/questioned about all those issues and referred appropriately.
Always seek professional help if you are struggling with your mental health.
When to seek additional medical help (on top of, or outside manual therapy)?
Try and seek help if, on top of the hypermobility, you experience:
· High levels of fatigue and poor healing (blood test might be required)
· You experience recurrent dislocations, ligament sprains, and tendon injuries.
· Have noticed that you bruise or bleed easily (and for longer than normal), have fragile skin, and have abnormal scarring after an injury.
· You feel like some of your joints are unstable.
· Are experiencing rapid and irregular heartbeats.
· Have a history of hernias, reflux, sluggish bowel, constipation, and haemorrhoids.
· Have an overactive bladder.
To summarise, hypermobility is quite common in the population and sadly under-diagnosed, most of you will not suffer from any issues apart from the occasional joint pain or ankle sprains. Others will show other symptoms that would require a little more support.
If you question whether that might be you, never hesitate to reach out for professional help to get the proper care.
Hypermobility Syndrome (Double-Jointed)