Joint Hypermobility: Understanding, Assessment, and Management

Do I Have Hypermobility?

Assessing whether you have joint hypermobility involves understanding its characteristics and often includes a simple self-assessment like the Beighton Score, which evaluates the range of motion in key joints.

Understanding Joint Hypermobility

Joint hypermobility, often referred to as "double-jointedness," describes joints that can move beyond their normal, expected range of motion. Unlike general flexibility, which is often a result of muscle and connective tissue extensibility, hypermobility primarily stems from the inherent laxity of the ligaments and joint capsules themselves.

• Distinction from Flexibility: While flexibility is a desirable physical attribute that can be improved through stretching and training, hypermobility is a structural characteristic. A highly flexible person might have excellent hamstring flexibility, allowing them to touch their toes, but their joints may not necessarily extend beyond their physiological limits. A hypermobile individual, however, might exhibit an unusual range of motion in joints like the elbows or knees, bending them backward.
• Causes of Hypermobility: The primary cause of joint hypermobility is often genetic, involving variations in the connective tissues that make up ligaments, tendons, and cartilage. Collagen, a fundamental protein providing strength and elasticity to these tissues, may be structured differently, leading to greater laxity. This genetic predisposition can result in inherently "looser" joints.

The Beighton Score: A Common Assessment Tool

The Beighton Score is a widely used, simple clinical tool for assessing generalized joint hypermobility. It evaluates the range of motion in five specific areas of the body, with each positive finding contributing one point to the total score (maximum of 9 points). While not a diagnostic tool for conditions like Ehlers-Danlos Syndrome, it serves as an excellent initial screen.

To perform the Beighton Score assessment on yourself or another:

1. Passive Dorsiflexion of the 5th Metacarpophalangeal Joint:

   • Test: With your arm resting on a flat surface, grasp your little finger just below the knuckle (metacarpophalangeal joint). Gently pull the finger backward towards the back of your hand.
   • Positive: If your little finger can bend backward beyond 90 degrees. (1 point for each hand, max 2 points)

2. Passive Apposition of the Thumb to the Forearm:

   • Test: Extend your arm with your palm facing down. Try to touch your thumb to the underside of your forearm.
   • Positive: If your thumb can make contact with the forearm. (1 point for each arm, max 2 points)

3. Hyperextension of the Elbows:

   • Test: Fully extend your arm straight out.
   • Positive: If your elbow joint bends backward (hyperextends) more than 10 degrees. (1 point for each arm, max 2 points)

4. Hyperextension of the Knees:

   • Test: Stand with your knees fully straightened.
   • Positive: If your knee joint bends backward (hyperextends) more than 10 degrees, often appearing as a "bowing" backward of the knee. (1 point for each leg, max 2 points)

5. Forward Flexion of the Trunk with Palms to the Floor:

   • Test: Stand with your knees straight. Bend forward at the waist, trying to place your palms flat on the floor directly in front of your feet.
   • Positive: If you can place your palms flat on the floor with your knees fully extended. (1 point, max 1 point)

Interpreting Your Results and Next Steps

Once you've completed the Beighton Score, sum up your points. A score of 4 or more out of 9 is generally considered indicative of generalized joint hypermobility in adults. For children and adolescents, a lower threshold (e.g., 5 or 6) may be used due to higher natural laxity.

• Benign Joint Hypermobility (BJH): Many individuals with a high Beighton Score experience no pain or significant problems. This is often referred to as Benign Joint Hypermobility (BJH). For these individuals, hypermobility might even be an asset in certain activities like dance, gymnastics, or certain sports.
• Hypermobility Spectrum Disorder (HSD) / Ehlers-Danlos Syndrome (hEDS): If hypermobility is accompanied by chronic pain, joint instability (e.g., frequent subluxations or dislocations), fatigue, or other systemic symptoms (e.g., skin elasticity, digestive issues, cardiovascular problems), it may fall under the umbrella of Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). These are complex connective tissue disorders that require a formal medical diagnosis.
• When to Seek Professional Advice: If you score high on the Beighton Score and experience any of the following, it is advisable to consult a healthcare professional (e.g., a general practitioner, rheumatologist, or physical therapist):
  • Persistent or recurrent joint pain
  • Frequent joint instability, sprains, or dislocations
  • Clicking, popping, or grinding sounds with joint movement, especially if painful
  • Unexplained fatigue, bruising, or skin issues
  • Concerns about your overall health related to hypermobility

Managing Hypermobility: Exercise and Lifestyle Considerations

For individuals with hypermobility, the focus of exercise and physical activity shifts from maximizing flexibility to enhancing stability and strength.

• Focus on Stability and Strength: Instead of stretching, prioritize exercises that build muscular strength around the joints. This helps to create a "muscular brace" that compensates for lax ligaments. Examples include resistance training (weights, bands), bodyweight exercises, and compound movements that engage multiple muscle groups.
• Proprioception and Balance Training: Hypermobile individuals may have reduced proprioception (the body's sense of its position in space) due to lax joint capsules. Incorporate exercises that challenge balance and coordination, such as standing on one leg, using wobble boards, or practicing yoga/Pilates with an emphasis on controlled movements.
• Avoid Overstretching and Passive Flexibility: While it might feel natural to stretch into extreme ranges, excessive passive stretching can further destabilize already lax joints. Focus on active range of motion within a safe, controlled limit.
• Low-Impact Activities: Activities like swimming, cycling, and elliptical training are often excellent choices as they provide cardiovascular benefits with less impact on the joints.
• Mindful Movement: Pay close attention to your body's signals. Avoid movements that cause pain or a feeling of "giving way" in a joint. Learn to stop before reaching your end-range of motion in exercises.
• Professional Guidance: Working with a physical therapist or an exercise professional knowledgeable in hypermobility is highly recommended. They can design a safe and effective exercise program tailored to your specific needs, focusing on stabilization and proper movement patterns.

Key Takeaways

Hypermobility is a common characteristic, and for many, it's benign. However, for others, it can be associated with pain, instability, or broader connective tissue disorders. Using tools like the Beighton Score can provide an initial indication of generalized hypermobility. Regardless of your score, prioritizing joint stability, strength, and proprioception through targeted exercise is key to maintaining joint health and function. Always consult with a healthcare professional for a proper diagnosis and personalized management plan if you have concerns.