Our joints are responsible for movements and stability (e.g ability to maintain and control movements in your knees). Different joints have varying degrees of inherent stability considering its function, the way it articulates, anatomical position, load-bearing capacity, strength and flexibility of the soft tissue structures (muscles, ligaments, and fascia).
Joint mobility, on the other hand, refers to the range of movement in a particular joint. Like stability, it is dependent on the strength and flexibility of the surrounding soft tissue structures. This means that any problems with the soft tissue structures would affect the stability and mobility, making the joint susceptible to injuries and dislocations.
You are said to be ‘hypermobile’ when you have the ability to move your joints beyond the normal range of movement. Sometimes it’s also called ‘double-jointed’. This condition is fairly common in the general population and might sometimes become an advantage for athletes or dancers.
Having said that, there are different problems related to hypermobility. The most important being the lack of stability in the joints. One may be predisposed to soft tissue structure injury and experience excessive muscular stiffness.
‘Hypermobility’ – How did I get so flexible?
- Genetics – Connective Tissue Disorder
The exact cause is unknown. Due to genetic problems, it can be seen among infants at birth with sometimes a possible decline in hypermobility during childhood, teens and adulthood. An improper gene resulting in joint laxity is due to the lack of collagen, elastin and fibrin proteins which usually help with the stability of joints, tendons and ligaments.
- Acquired hypermobility
Without having inherited laxity in the joints, many ballet dancers and gymnasts get hypermobile as they push the joints to the hypermobile range while working to get the flexibility to perform. Intense and excessive stretching of the muscles and soft tissue structures can also lead to hypermobility.
When do we say you have a Hypermobility Syndrome?
Joint Hypermobility Syndrome (JHS)
Individuals who suffer from chronic joint pain and other symptoms related to their hypermobility have a condition called joint hypermobility syndrome (JHS). As the name suggests the most affected part is the musculoskeletal system.
Due to hypermobility, the risk of injury to the joint structures, ligaments, tendons and other ‘soft tissues’ around joints are increased. In addition, the structure of the collagen fibres and the shape of the bone (articulating surfaces) both play a major role. Even a lack of neuromuscular tone and proprioception could be the contributing factors to this condition.
Aggravating factors, Symptoms and Common conditions associated with JHS
There is no specific activity that can trigger pain. For some individuals, repetitive movements, overuse, excessive weight bearing or even simple activities of daily living can cause pain.
- Incorrect posture and alignment of joints: During daily or sports activities incorrect movements due to faulty posture can affect the hips, shoulders, knees, and elbows joints. For example, hyper-extending the elbows can injure the tendons on the sides of the elbow causing conditions like “tennis elbow” and “golfer’s elbow.”
- Laxity in the soft tissue structures: This leads to increased strain, tearing and spasm causing pain and stiffness around the joint. Due to over extending and twisting flexible joints, partial dislocations or complete dislocation can also occur.
- Muscle imbalances: Pain due to injury causes adhesions withing the soft tissue structures (Muscles, ligaments and fascia) of one joint leading to imbalances in the mobility of other joints and surrounding structures. Pain and spasm of the hip muscles can pinch the sciatic nerve resulting in pain called as sciatica which can be felt radiating down the back to the leg. Sometimes it could also be because of the inter-vertebral discs (made of collagen) that has become too soft than normal and has impinged the nerve.
- High-impact exercises: Sports that involve running, jumping or physical contact predisposes lax joints to dislocate.
- Stretching: Incorrect technique or type of stretching that involve grabbing a joint and pulling or pushing on it to loosen it up.
- Heavy lifting, pulling and pushing: Odd-shaped weights and unusual angles often lead to injury due to excessive load on the joints.
- Recurrent Ankle sprains: Sprains may take very longer to heal because they tend to get injured repeatedly while trying to heal.
- Knee pain: This is most common in hypermobile. People because the cartilage between the kneecap and the knee get lax. Due to excessive mobility, the cartilage underneath the kneecap starts to wear down (a condition referred to as chondromalacia), causing pain and sometimes a crunching or grinding noise – while kneeling, squatting or climbing the stairs.
- Chest pain: A condition called costochondritis or inflammation of the rib cartilage causing pain and tightness.
- The jaw, or temporomandibular joint (TMJ): This is often affected because of loose structures.
Although pain and fatigue are the common complaints, the range of symptoms could be wider considering that cardiovascular and endocrine system could also be affected.
Are my symptoms related to Pain and Fatigue syndromes or is it because of Joint Hypermobility Syndrome?
Hypermobility predisposes people to developing Chronic fatigue syndrome (CFS), Fibromyalgia (FM), Chronic Regional Pain Syndromes (CRPS), Chronic Widespread Pain (CWP). In simple words, someone with hypermobility may have other pain and fatigue syndrome. However, people with pain and fatigue related syndromes may not be hypermobile. Thus, a careful diagnosis is necessary.
Hereditary Syndromes associated with JHS
- Marfan’s syndrome or Ehlers-Danlos syndrome, Osteogenesis Imperfecta: These are usually inherited disorders that are passed on to children by their parents. Often, children with Down syndrome will also be hypermobile.
Diagnosis of Joint Hypermobility Syndrome and Management
In some cases, people may have inflammation in their joints but no presence of abnormalities of their blood tests (so called seronegative inflammatory arthritis). Similarly, confusion is very common among clinicians to come to a particular diagnosis with the number of pain and fatigue syndromes associated with the joint hypermobility syndrome.
Most clinicians use the Beighton score which is a nine-point scoring system that looks for hypermobility. In the thumb, elbow and knee on both sides of the body and the ability to bend forward and place the palms of the hands flat on the floor without bending the knees. Hypermobility is often found at the jaw, neck, shoulders, other small joints of the hands and feet, hips, ankles and mid-foot, sticking to the Beighton scoring method is not enough in clinical examination. A high degree of applied musculoskeletal expertise and knowledge of the condition will be required to address all the problems.
If someone has been diagnosed with hypermobility and symptoms of pain, it is advisable that particular care should be taken with physical treatments. Avoiding activities that would strain the hypermobile joints.
Treatments should focus on improving the functional stability and mobility of the soft tissue structures. Awareness such as perception of correct posture with neuro-muscular proprioceptive training. Maintaining an active lifestyle with lifestyle modification. Even simple things like nutrition and balanced diet to maintain optimal body weight will be beneficial.