What is Joint Hypermobility?
Joint hypermobility refers to greater than normal range of motion in a given joint. Excessive range of motion can be attributed to factors such as bone shape, hormonal influences, impaired proprioception, reduced muscular strength, and decreased collagen strength (Knight 2012).
Collagen is a structural protein within connective tissue. Fascia, ligaments, joint capsule, tendons, skin, blood vessel walls, gastrointestinal lining, and respiratory tracts contain connective tissue. Defects in connective tissue proteins contributes to joint laxity and can result in widespread symptoms (Hakim 2015).
What are Hypermobility Disorders?
Hypermobility disorders refer to a group of conditions involving symptomatic joint hypermobility. Some hypermobility disorders such as Ehlers-Danlos syndrome are a result of abnormal structure/function of collagen and connective tissue proteins. Hallmark features of connective tissue disorders include stretchy skin, loose joints, and fragile tissues (Simmonds 2007).
What are Common Signs/Symptoms of Hypermobility Disorders?
| Frequent joint dislocations | Higher injury rate |
|---|---|
| Fatigue | Difficulty sleeping |
| Chronic pain | Frequent headaches/migraines |
| Dizziness | Orthostatic hypotension |
| Gastrointestinal pain | Anxiety |
| Delayed healing | Decreased proprioception |
| Decreased strength |
(Kumar 2017)
Joint hypermobility is common among dancers and rhythmic gymnasts because of the flexibility demands in both disciplines.
How do we Screen for Hypermobility?
To screen for this condition we use the 5 point hypermobility questionnaire, Beighton scale, and Brighton criteria are useful screening tools for hypermobility. Two positive responses on the 5 point questionnaire has a sensitivity of 84% and a specificity of 85% for detecting joint hypermobility (Kumar 2017).
How Is Hypermobility Diagnosed?
Joint hypermobility/hypermobility syndromes are identified through a thorough patient history as well as a variety of clinical tests.
How can Physical Therapy Help
Physical therapy can play a vital role in providing treatment strategies for individuals with joint hypermobility to improve joint stability, reduce pain, and improve function. Treatments may include:
Muscle Strengthening: Increasing muscle strength is vital for improving joint stability to counteract underlying joint laxity.
Education on Safe Flexibility: Understanding how to improve tissue mobility safely is important to avoid injury and protect the integrity of the connective tissue.
Endurance: Increasing cardiovascular and muscular endurance is important for reducing fatigue which is a common symptom in this population. Educating patients on proper pacing and safe progression will help avoid over-training.
Balance and Proprioceptive Activities: Increasing proprioception and improving postural control is key for increasing stability to reduce further pain/injury. Taping or bracing may be utilized to improve joint awareness and aid in further stability.
Manual Therapy: Hands-on treatment such as soft tissue mobilization may be used to reduce myofascial pain and calm down the nervous system.
(Knight 2012)
Our Approach
Progressive Physical Therapy takes a caring, personalized approach with each patient, focusing on manual techniques for pain relief and a strong education and home program foundation to ensure long-term benefits. We understand that this is more than just hypermobility for most patients. We can help figure out what is the best combination of rehab techniques that works for each individual.
Because of the uniqueness and complexities involved, when needed, we are happy to coordinate with a patient’s medical care team to ensure each patient receives the best care possible. We have additional expertise with the unique challenges faced by dancers and gymnasts. We are proud of the reputation we have earned treating these athletes and helping them achieve their goals to stay as healthy as possible while competing. Click to learn more about our dance program. This specialized physical therapy treatment is offered exclusively in our Costa Mesa clinic. We can be reached at 949.631.0125.
References:
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Isobel Knight MSc, Moira McCormack MSc, 7 Howard Bird MA MD FRCP .Managing Joint Hypermobility – A guide for Dance Teachers. March 2012. https://www.onedanceuk.org/wp-content/uploads/2018/05/Managing-Hypermobility-for-the-Dance-Teacher-FINAL.pdf Accessed May 20, 2021.
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Hakim, Alan. What are Hypermobility Syndromes? May 2015. https://www.hypermobility.org/what-are-hypermobility-syndromes accessed May 23,2021.
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Simmonds, J. V., & Keer, R. J. (2007). Hypermobility and the hypermobility syndrome. Manual therapy, 12(4), 298-309.
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Kumar, B., & Lenert, P. (2017). Joint hypermobility syndrome: recognizing a commonly overlooked cause of chronic pain. The American journal of medicine, 130(6), 640-647.
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