Hypermobility: Understanding Its Permanence, Evolution, and Management

Does Hypermobility Go Away?

Joint hypermobility, often an inherent characteristic of an individual's connective tissue, typically does not "go away" in the sense of a complete resolution. While its manifestation and associated symptoms can change over a lifetime due to various factors, the underlying genetic predisposition and tissue properties usually persist.

Understanding Joint Hypermobility

Definition Joint hypermobility refers to the ability of a joint to move beyond its typical range of motion, often described as "double-jointedness." This increased laxity is primarily due to differences in the composition and structure of collagen, the main protein in connective tissues like ligaments, tendons, and joint capsules. It's important to distinguish between generalized joint hypermobility (affecting multiple joints) and localized hypermobility (affecting only one or a few joints).

Causes and Types The primary cause of joint hypermobility is genetic, involving inherited variations in genes that code for collagen and other connective tissue proteins. This leads to ligaments that are more elastic and extensible than average. Acquired hypermobility can also occur due to factors like repetitive stretching, certain neurological conditions, or injury, but this is less common than constitutional hypermobility. Hypermobility can exist on a spectrum, from benign joint hypermobility (where there are no associated symptoms or complications) to more complex conditions like Hypermobility Spectrum Disorder (HSD) or specific types of Ehlers-Danlos Syndromes (EDS).

Is Hypermobility Permanent?

The Lifespan Perspective For individuals with constitutional (genetic) joint hypermobility, the inherent elasticity of their connective tissues is a lifelong characteristic. The genetic blueprint that dictates the structure of collagen does not change. Therefore, the underlying physiological capacity for increased joint range of motion remains.

Factors Influencing Change While the capacity for hypermobility is permanent, its manifestation can vary throughout a person's life. Several factors can influence how hypermobility presents and whether it causes symptoms:

• Age: As people age, natural physiological changes occur, including a decrease in collagen elasticity and joint fluid, leading to a general stiffening of joints. This can make hypermobile joints feel less mobile or "tight," but it doesn't mean the underlying hypermobility has disappeared.
• Muscle Strength and Control: Strong, well-developed muscles surrounding a joint act as dynamic stabilizers. Individuals who build significant muscle strength and improve neuromuscular control around hypermobile joints can effectively reduce excessive movement and improve joint stability, thereby mitigating symptoms.
• Activity Levels and Lifestyle: Sedentary lifestyles can lead to muscle weakness and reduced proprioception, potentially exacerbating symptoms in hypermobile individuals. Conversely, appropriate physical activity can help manage it.
• Injury and Trauma: Joint injuries or repeated microtrauma can alter joint mechanics and potentially lead to pain and dysfunction in hypermobile joints.
• Hormonal Fluctuations: Hormones, particularly those related to the menstrual cycle and pregnancy, can influence ligamentous laxity.

How Hypermobility Can Evolve Over Time

Childhood and Adolescence Hypermobility is often most pronounced in childhood and adolescence. Children naturally have more flexible joints, and those with hypermobility may exhibit extreme ranges of motion. Many children with benign joint hypermobility experience no symptoms. However, some may develop growing pains, fatigue, or mild instability.

Adulthood As individuals enter adulthood, the natural stiffening process begins. Some hypermobile adults may find their joints feel less "loose" than they did in their youth. However, others may start to experience symptoms like chronic joint pain, fatigue, dislocations, subluxations, or soft tissue injuries due to repetitive strain on their connective tissues. This is often when individuals seek professional diagnosis and management.

Aging In older age, the general decrease in joint flexibility can make hypermobile joints feel more restricted. However, the underlying laxity can still predispose individuals to certain issues if not managed, such as osteoarthritis in frequently stressed joints, or continued issues with stability if muscle strength declines.

Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos Syndromes (EDS)

Beyond Benign Joint Hypermobility It's crucial to differentiate between benign joint hypermobility (where hypermobility is present without significant symptoms or systemic involvement) and conditions like Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). HSD and hEDS are connective tissue disorders characterized by joint hypermobility alongside a constellation of other symptoms, which can include chronic pain, fatigue, dysautonomia (e.g., POTS), gastrointestinal issues, and soft tissue fragility. These are lifelong conditions that require comprehensive, multidisciplinary management.

Clinical Implications For individuals diagnosed with HSD or hEDS, the hypermobility is a central feature of a broader systemic condition. While symptoms can be managed and improved, the underlying connective tissue differences do not resolve. Management focuses on improving quality of life, preventing complications, and addressing the wide range of symptoms.

Managing Hypermobility: A Proactive Approach

Since hypermobility itself doesn't "go away," management strategies focus on optimizing joint stability, reducing pain, and preventing injury. This is where exercise science plays a critical role.

Prioritizing Stability Over Flexibility A common misconception is that hypermobile individuals should stretch to maintain or increase their flexibility. This is often counterproductive and can exacerbate instability. The primary goal should be to enhance joint stability through strengthening the muscles that surround and support the joints.

Strength Training Targeted strength training is paramount. Focus on:

• Compound movements: Exercises like squats, deadlifts, and presses, performed with proper form, build global strength and stability.
• Isometric exercises: Holding a position without movement can build strength and improve joint control without excessive range of motion.
• Eccentric training: The lowering phase of a movement, which helps build strength and control.
• Core stability: A strong core is fundamental for overall body stability and efficient movement patterns.

Proprioception and Motor Control Proprioception is the body's ability to sense its position and movement in space. Hypermobile individuals often have diminished proprioception, which increases their risk of injury. Exercises that challenge balance and coordination are vital:

• Balance exercises: Single-leg stands, wobble boards, Bosu ball exercises.
• Unstable surface training: Gradually progressing to exercises on unstable surfaces can improve neuromuscular control.
• Mindful movement: Paying close attention to joint position during daily activities and exercise.

Pain Management and Lifestyle Adjustments

• Activity modification: Identifying and avoiding activities that consistently provoke pain or instability.
• Pacing: Managing energy levels and avoiding overexertion, especially for those with fatigue.
• Supportive devices: Braces or taping may be used temporarily for specific activities or during acute instability, but should not replace strength training.
• Ergonomics: Optimizing workspaces and daily routines to support joint health.

Avoiding Harmful Practices

• Excessive stretching: Avoid "end-range" stretching that pushes joints beyond their stable limits.
• High-impact activities: May need to be modified or limited if they cause pain or instability.
• Poor posture: Chronic poor posture can strain hypermobile joints.

When to Seek Professional Guidance

If you suspect you have hypermobility, or if you experience pain, instability, frequent dislocations/subluxations, or other systemic symptoms, it is essential to consult with healthcare professionals. This may include:

• Physician: For diagnosis and overall management.
• Physical Therapist: To develop a tailored exercise program focusing on stability, strength, and proprioception.
• Occupational Therapist: To assist with daily living activities and adaptive strategies.
• Rheumatologist or Geneticist: If a connective tissue disorder like HSD or EDS is suspected.

Conclusion

Joint hypermobility is largely a constitutional trait that does not "go away." While the sensation of joint laxity may lessen with age due to natural bodily changes, the underlying connective tissue properties remain. Effective management hinges on understanding the condition, prioritizing joint stability through targeted strength and proprioceptive training, and adopting a proactive approach to prevent pain and injury. With the right strategies and professional guidance, individuals with hypermobility can lead active, fulfilling lives, optimizing their joint health and overall well-being.