Understanding Joint Hypermobility

Identifying symptoms and effects of hypermobility

Joint hypermobility can be a symptomless condition but can also be associated with much more widespread symptoms as is the case with EDS.

Some possible symptoms and manifestations of joint hypermobility include:

• Joint instability
  • This can be due to the laxity of the tissues surrounding the joint. This can be inherited or acquired. Remember, instability is not the same as hypermobility, a joint can be hypermobile and move beyond its range of motion but still be stabilized by muscles and tendons.
• Joint injury or trauma
  • This may be due to excessive joint injury and accumulated micro-injuries that may predispose a joint to early arthritis.
• Pain
  • Occasional and recurrent pain
  • Chronic pain (pain lasting longer than 3 months)
    • This can lead to pain sensitization
• Impaired proprioception 

Diagnosing joint hypermobility

Joint hypermobility is more of a descriptor rather than a diagnosis. However, if you have more extensive and body-wide concerns such as digestive issues, easy bruising, frequent sprains and subluxations, chronic pain, delayed wound healing, and more – in addition to joint hypermobility, it would be worth being assessed for a connective tissue disorder such as hypermobile Ehlers Danlos Syndrome (hEDS) or hypermobile spectrum disorder (HSD).

A note on HSD

In 2017, the diagnostic criteria for EDS, and specifically hEDS, was made more strict to assist in research in finding genetic markers, categorizing it as a body-wide and inherited connective tissue disorder. This led to the categorization of HSD, which includes joint hypermobility that still has clinical symptoms (symptomatic hypermobility) but may not fit into the strict hEDS diagnostic criteria.

HSD is the diagnosis when people with “symptomatic joint hypermobility do not have a rare type of EDS and do not meet the criteria for hEDS.” In practice, many people with HSD have just as many symptoms of hEDS and can be treated the same.

There are 4 types of HSD

• Generalized HSD (G-HSD)
  • Generalized joint hypermobility or hypermobility throughout the body. This is likely the category that many who do not meet the strict hEDS diagnosis fall into.
• Peripheral HSD (P-HSD)
  • Hypermobility in the hands and feet
• Localized HSD (L-HSD)
  • Hypermobility is only present in a single joint or group of joints
• Historical HSD (H-HSD)
  • History of generalized hypermobility throughout the body

Managing and treating joint hypermobility

There are many ways to manage joint hypermobility and reduce pain associated with hypermobility. Examples include:

• Physiotherapy or physical therapy can help build strength and stability around the joints.
• Joint protection strategies like avoiding high-impact sports or activities that may put strain on the hypermobile joints.
• Orthotics for shoes can help reduce foot pain and improve posture and joint alignment.
• Using braces or splints on hypermobile joints can help avoid strain and injury.
• Pain management: speaking to a health professional about pain medications may be helpful for many people.
• Posture and body mechanics: working with someone to improve overall movement patterns and an integrated posture can really help manage hypermobility.
• Occupational therapy can be very helpful as a hypermobility management plan.

Physical therapies and exercises

We know that appropriate exercise and movement practices that are adapted for hypermobility are important to the long-term management of symptomatic hypermobility.

My Integral Movement Method (IMM) for hypermobility has six guiding principles that allow for safe hypermobility exercise. These are Breath, Relaxation, Proprioception, Stability, Balance, and Posture.

Movement does need to be tailored for hypermobility. It needs to include isometric, eccentric, and concentric exercises. People with hypermobility sadly often do not do well with traditional physical therapy approaches and it does need to be adjusted.

Living with joint hypermobility: daily life and long-term strategies

You may need to adopt new strategies to manage symptomatic hypermobility.

If your child is struggling with hypermobility, please ensure their school is aware of the school toolkit. This can help provide schools with useful information on how to adapt school requirements.

Overall, it helps to learn as much about hypermobility as possible and ensure people are aware of your condition. We know the following can help with long-term management:

• Regular exercise
  • this can be little and often. Check my YouTube channel for plenty of ideas and classes. I also offer The Zebra Club app for a comprehensive program for hypermobility management.
• Pacing
  • We may need to adjust our daily activities to ensure we do not overstrain joints or push through joint pain.
• Stress management
  • we know stress can make many conditions worse. Pain is one of them, gentle breathing exercises or meditation can help.
• Emotional support
  • Being able to connect with other people who have hypermobility can be really helpful. The Zebra Club offers a supportive online community.

Sources:

1. Castori, et al. (2017) A framework for the classification of joint hypermobility and related conditions. American Journal of Medical Genetics.
2. Nicholson, et al. (2022) International Perspectives on Joint Hypermobility: A Synthesis of Current Science to Guide Clinical and Research Directions. Journal of Clinical Rheumatology.