I have always been flexible, as a child it is actually quite normal. As you hit your teens maintaining flexibility may depend a lot on your chosen sporting activities, for me it was suggested I try gymnastics as I had some much natural flexibility. However, I had already always had trouble with my joints, I couldn’t run for toffee as my ankles would just give way causing me to fall to the floor and I was forever spraining or straining my ankles
I did try the gymnastics for a while, but ended up having lots more sprains and strains so I gave it up. My problems continued into adult hood but it wasn’t until this year whilst having yet another bout of physio that I was finally given some information that would help explain at least ‘some’ of the problems that kept recurring. I was told I had Hypermobility…
What is Hypermobility?
Hypermobility itself is actually quite common, but when you experience problems related to having hypermobile joints then it is referred to as Hypermobility Syndrome – as in my case.
Hypermobility (without symptoms) can be beneficial to gymnasts and sports people. It can be fun, for example being in my mid thirties and still able to bend like this –
Hypermobility means that you can move some or all of your joints more than most people can. It’s often known as being double-jointed and doctors sometimes refer to it as joint hyperlaxity.
Hypermobile joints are very common and most people won’t have any problems. It can be an advantage for some people, such as dancers, musicians and gymnasts. However, a minority of people with hypermobile joints experience pain or other symptoms, and this is called joint hypermobility syndrome.
Source: Arthritis Research UK
Connective tissue proteins such as collagen give the body its intrinsic toughness. When they are differently formed, the results are mainly felt in the “moving parts” – the joints, muscles, tendons, ligaments – which are laxer and more fragile than is the case for most people. The result is joint laxity with hypermobility and with it comes vulnerability to the effects of injury.
Symptoms of Hypermobility Syndrome.
The most common symptom is PAIN, in or around the joints caused by the muscles around the joint having to work much harder than normal…
- Joint Stiffness
- Foot Pain
- Injured/dislocated joints
- Weakened collagen fibres
- Joint instability
- Clicking joints
Causes of Hypermobility Syndrome
The shape of the bones, muscle tone, proprioception (joint movement) and weakened or stretched ligaments
Diagnosis of Hypermobility Syndrome
Diagnosis of Hypermobility is based on the Beighton Score (as illustrated in the diagram above). A point is allocated for each of the movements a person can achieve. For myself I scored 9 out of 9 possible points being able to bend each joint beyond 90 degrees, although my elbows and knees are no where near as flexible as some I have seen. I seem to be more affected at other areas, wrists, fingers, ankles, toes and shoulders.
Diagnosis of Hypermobility Syndrome is most commonly achieved via use of the Brighton Criteria, which extends the Beighton Score (which only covers flexibility) to include pain/symptoms weighted to determine diagnosis –
REVISED DIAGNOSTIC CRITERIA FOR THE BENIGN JOINT HYPERMOBILITY SYNDROME (BJHS)
- A Beighton score of 4/9 or greater (either currently or historically)
- Arthralgia for longer than 3 months in 4 or more joints
- A Beighton score of 1, 2 or 3/9 (0, 1, 2 or 3 if aged 50+)
- Arthralgia (> 3 months) in one to three joints or back pain (> 3 months), spondylosis, spondylolysis/spondylolisthesis.
- Dislocation/subluxation in more than one joint, or in one joint on more than one occasion.
- Soft tissue rheumatism. > 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
- Marfanoid habitus (tall, slim, span/height ratio >1.03, upper: lower segment ratio less than 0.89, arachnodactyly [positive Steinberg/wrist signs].
- Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring.
- Eye signs: drooping eyelids or myopia or antimongoloid slant.
- Varicose veins or hernia or uterine/rectal prolapse.
The BJHS is diagnosed in the presence two major criteria, or one major and two minor criteria, or four minor criteria. Two minor criteria will suffice where there is an unequivocally affected first-degree relative.
BJHS is excluded by presence of Marfan or Ehlers-Danlos syndromes (other than the EDS Hypermobility type (formerly EDS III) as defined by the Ghent 1996 (8) and the Villefranche 1998 (9) criteria respectively). Criteria Major 1 and Minor 1 are mutually exclusive as are Major 2 and Minor 2.
Treatment of Hypermobility Syndrome
Rest, physiotherapy,exercise and pain management with typical analgesics (paracetamol, codeine) and NSAID‘s (Ibuprofen) are the main treatments, surgery is generally advised against.
Related and Co-morbid conditions and possible complications.
There are numerous potentially related or co-morbid conditions and possible complications of Hypermobility Syndrome including:
- more supple collagen in other parts of the body as well as the joints. This may be linked to a number of other symptoms including mild asthma, irritable bowel syndrome (IBS) and urinary stress incontinence.
- Blood pressure may also be lower than normal, so people who are hypermobile may be more prone to fainting.
- heart valves can be floppy – though this may not cause any symptoms and may only be discovered by accident when a medical examination of the heart is carried out.
- osteogenesis imperfecta, which causes bones to become fragile
- Marfan’s syndrome, which involves the heart, eyes and blood vessels
- Ehlers-Danlos syndrome, which is the most difficult to diagnose because there are many different types. The most severe form causes weakness of the major blood vessels, which may swell (this is called an aneurysm).
- Early-onset osteoarthritis
- Increased nerve compression disorders
- Do not respond well to normal doses of anaesthetic or pain medication
- rheumatoid arthritis
- chronic fatigue syndrome
Thank you for reading! If you have enjoyed reading this post please share it with others who may be interested and I always enjoy receiving feedback and comments 🙂
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