Double-Jointedness: Understanding Hypermobility, Self-Assessment, and Management

How do I know if I'm double-jointed?

Being "double-jointed" is a common term referring to individuals with joint hypermobility, meaning their joints can move beyond the normal range of motion. You can assess for generalized joint hypermobility through specific self-tests, most notably components of the Beighton Score, which evaluates the flexibility of several key joints.

Understanding "Double-Jointedness": Hypermobility Explained

The term "double-jointed" is a misnomer; no one actually has two joints where there should only be one. Instead, it describes joint hypermobility, a condition where the ligaments and connective tissues surrounding a joint are more elastic or lax than average, allowing for an increased range of motion. This increased flexibility is often due to variations in collagen, the primary protein component of connective tissues like ligaments, tendons, and cartilage. While sometimes an isolated trait, hypermobility can also be a generalized condition affecting multiple joints throughout the body.

The Beighton Score: A Clinical Assessment Tool

The Beighton Score is a widely used clinical assessment tool to quantify generalized joint hypermobility. It consists of five simple tests, evaluating nine specific points of flexibility. A higher score indicates greater hypermobility.

To perform the Beighton Score self-assessment, follow these steps:

1. Passive Dorsiflexion of the Fifth Metacarpophalangeal Joint (Both Hands):

   • Place your hand palm-down on a flat surface.
   • Using your other hand, gently pull your little finger backward (dorsiflexion) towards the back of your hand.
   • Score 1 point if your little finger extends beyond a 90-degree angle (i.e., it can bend backwards so that it is parallel or close to parallel with the back of your hand). (2 points total: 1 for each hand)

2. Passive Apposition of the Thumb to the Forearm (Both Hands):

   • Hold your arm straight out in front of you, palm facing inward.
   • Attempt to bend your thumb backward towards your forearm.
   • Score 1 point if your thumb can touch your forearm. (2 points total: 1 for each hand)

3. Elbow Hyperextension (Both Arms):

   • Stand with your arms straight out in front of you, palms facing forward.
   • Attempt to fully straighten your elbows, looking for an excessive bend or arc backward.
   • Score 1 point if your elbow hyperextends by 10 degrees or more (i.e., it forms a visible backward curve or angle). (2 points total: 1 for each arm)

4. Knee Hyperextension (Both Legs):

   • Stand straight with your legs fully extended, knees locked.
   • Observe your knees from the side.
   • Score 1 point if your knee hyperextends by 10 degrees or more (i.e., it forms a visible backward curve or angle, often described as "bowing out" or "recurvatum"). (2 points total: 1 for each leg)

5. Forward Trunk Flexion with Palms on the Floor (Single Point):

   • Stand with your feet together, knees fully extended (do not bend your knees).
   • Bend forward at your waist, attempting to touch the floor with your palms.
   • Score 1 point if you can place your palms flat on the floor without bending your knees. (1 point total)

Interpreting Your Beighton Score: The maximum possible score is 9. While there's no universally agreed-upon threshold, a score of 4 or more out of 9 is generally considered indicative of generalized joint hypermobility in adults. In children and adolescents, a lower threshold (e.g., 5 or 6) might be used due to their naturally higher flexibility.

Beyond the Beighton Score: Other Signs of Generalized Joint Hypermobility

While the Beighton Score is a primary tool, other signs and symptoms can suggest generalized joint hypermobility:

• Shoulder Flexibility: The ability to easily touch hands behind the back (one over the shoulder, one from below) or perform extreme internal/external rotation.
• Spinal Flexibility: Exceptional flexibility in the spine, allowing for deep backbends or forward folds.
• Unusual "Party Tricks": The ability to perform contortionist-like movements, such as putting a leg behind the head, dislocating a shoulder on command (though this should be avoided due to injury risk), or bending fingers into unusual positions not covered by the Beighton Score.
• Frequent Sprains or Strains: Paradoxically, while flexible, hypermobile joints can be less stable, leading to a higher propensity for sprains, subluxations (partial dislocations), or dislocations, particularly in ankles, knees, and shoulders.
• Clicking or Popping Joints: While common in many people, hypermobile individuals might experience more frequent or pronounced joint sounds due to increased laxity.
• Easy Bruising or Stretchy Skin: In some cases, especially with underlying connective tissue disorders, skin may be unusually soft, velvety, or stretchable, and bruising may occur easily.

When Hypermobility Becomes a Concern: Joint Hypermobility Syndrome (JHS)

Having joint hypermobility is not necessarily a problem and can even be an advantage in certain activities like dance, gymnastics, or yoga. However, when hypermobility is accompanied by chronic joint pain, fatigue, frequent injuries, or other systemic symptoms (such as digestive issues, dysautonomia, or skin fragility), it may indicate a more complex condition known as Joint Hypermobility Syndrome (JHS), which is now often referred to as Hypermobile Ehlers-Danlos Syndrome (hEDS) or part of the Hypermobility Spectrum Disorders (HSD). These are heritable disorders of connective tissue that require medical diagnosis and management.

Implications for Fitness and Training

For individuals with joint hypermobility, understanding their unique physiology is crucial for effective and safe exercise:

• Focus on Stability and Strength: Prioritize exercises that build strength around the joints to enhance stability. This includes compound movements, resistance training, and exercises that engage smaller stabilizing muscles (e.g., rotator cuff, glute medius, core).
• Proprioception and Balance Training: Hypermobile individuals may have reduced proprioception (the body's awareness of its position in space). Incorporate balance exercises (e.g., single-leg stands, unstable surfaces) to improve neuromuscular control.
• Avoid End-Range Passive Stretching: While tempting to exploit their flexibility, hypermobile individuals should generally avoid passive stretching to their absolute end range, as this can further destabilize joints and increase injury risk. Instead, focus on dynamic movements within a controlled range.
• Mindful Movement: Pay close attention to joint alignment and avoid "locking out" joints during exercises, which can place undue stress on ligaments. Maintain a slight bend in elbows and knees during exercises like presses or squats.
• Listen to Your Body: Be particularly attentive to joint pain or discomfort. What might be a normal stretch for someone else could be harmful for a hypermobile joint.

Seeking Professional Guidance

If you suspect you have generalized joint hypermobility, especially if you experience chronic pain, frequent injuries, or other systemic symptoms, it is highly recommended to consult a healthcare professional. A doctor, physical therapist, or kinesiologist can provide a comprehensive assessment, offer a diagnosis if appropriate, and guide you on safe and effective exercise strategies tailored to your specific needs. They can help differentiate benign hypermobility from a connective tissue disorder and ensure you train in a way that protects your joints and enhances your overall well-being.