Hypermobility: How to Check Joint Laxity with the Beighton Score and Beyond

How to Check Hypermobility?

Assessing joint hypermobility typically involves a self-assessment or clinical evaluation using standardized tools, most commonly the Beighton Score, which evaluates the range of motion in several key joints to identify generalized joint laxity.

Understanding Joint Hypermobility

Joint hypermobility, often referred to as "double-jointedness," describes a condition where joints move beyond the normal range of motion. While often benign and even advantageous in certain activities like dance or gymnastics, it can also be a symptom of underlying connective tissue disorders, such as Hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). Understanding your joint mobility is crucial for tailoring exercise programs, preventing injury, and identifying potential health concerns.

From an exercise science perspective, excessive joint laxity can alter biomechanics, increase the risk of sprains and dislocations, and sometimes lead to chronic pain or instability. Conversely, appropriate strength training and proprioceptive exercises can help stabilize hypermobile joints.

The Beighton Score: The Gold Standard Assessment

The Beighton Score is the most widely used and validated clinical tool for assessing generalized joint hypermobility. It's a quick, 9-point system that evaluates the passive range of motion in five specific areas of the body. While it can be performed by an individual, accuracy is enhanced with the assistance of another person or a healthcare professional.

How to Perform the Beighton Score Tests:

For each test, observe if the joint can achieve the specified hyperextension. Each positive finding earns one point.

• 1. Pinky Finger Hyperextension (Bilateral - 2 points maximum):

  • Instruction: Place your hand flat on a table, palm down. Attempt to bend your pinky finger backward.
  • Positive Finding: If your pinky finger can be bent backward beyond 90 degrees (so it's parallel to the back of your hand or further), score one point for that hand. Repeat for the other hand.

• 2. Thumb to Forearm (Bilateral - 2 points maximum):

  • Instruction: With your arm extended and palm facing up, try to touch your thumb to the forearm on the same side.
  • Positive Finding: If your thumb can touch your forearm, score one point for that arm. Repeat for the other arm.

• 3. Elbow Hyperextension (Bilateral - 2 points maximum):

  • Instruction: Extend your arm straight out. Look at your elbow from the side.
  • Positive Finding: If your elbow joint hyperextends more than 10 degrees (i.e., bends backward beyond a straight line), score one point for that elbow. Repeat for the other elbow.

• 4. Knee Hyperextension (Bilateral - 2 points maximum):

  • Instruction: Stand with your knees locked straight, or lie flat on your back with your legs extended.
  • Positive Finding: If your knee joint hyperextends more than 10 degrees (i.e., bends backward beyond a straight line), score one point for that knee. Repeat for the other knee.

• 5. Palms to Floor (Unilateral - 1 point maximum):

  • Instruction: Stand with your knees straight (do not bend them). Bend forward at the waist and try to touch the floor with your palms flat.
  • Positive Finding: If you can place your palms flat on the floor with your knees fully extended, score one point.

Scoring and Interpretation:

Sum the points from all nine possible findings.

• A score of 4 or more out of 9 is generally indicative of generalized joint hypermobility in adults.
• For children and adolescents (under 16 years old), a score of 5 or 6 or more is often used as the threshold, as hypermobility is more common in younger individuals and tends to decrease with age.

It's important to remember that the Beighton Score assesses generalized hypermobility. A high score suggests widespread joint laxity, but a lower score doesn't necessarily rule out hypermobility in specific joints or localized hypermobility.

Beyond the Beighton Score: Other Considerations

While the Beighton Score is a valuable screening tool, it doesn't capture all aspects of hypermobility or its potential clinical implications.

• Subjective Symptoms: Individuals with hypermobility may experience symptoms such as:

  • Joint pain (arthralgia)
  • Clicking or clunking joints
  • Recurrent sprains or dislocations
  • Chronic fatigue
  • Soft tissue injuries (e.g., tendonitis, bursitis)
  • Easy bruising
  • Thin, stretchy skin (in some connective tissue disorders)

• Professional Assessment: A comprehensive assessment by a doctor, physical therapist, or kinesiologist may involve:

  • A detailed medical history, including family history of hypermobility or connective tissue disorders.
  • Additional range of motion tests for other joints (shoulders, hips, spine).
  • Evaluation of muscle strength, stability, and proprioception around hypermobile joints.
  • Assessment of skin elasticity, scarring, and other systemic features if a connective tissue disorder is suspected.

Why Assess Hypermobility?

Knowing your hypermobility status is crucial for several reasons:

• Injury Prevention: Hypermobile individuals are at higher risk for certain injuries (e.g., sprains, dislocations). Awareness allows for targeted preventative strategies.
• Exercise Prescription: Exercise programs can be tailored to focus on joint stability, proprioception, and strengthening surrounding musculature, rather than just increasing flexibility.
• Performance Optimization: Understanding one's joint mechanics can help athletes in certain sports (e.g., gymnastics, dance) leverage their flexibility safely, while others might need to focus on stability.
• Early Diagnosis: A high Beighton Score, especially when accompanied by other symptoms, can prompt further investigation for underlying connective tissue disorders, leading to earlier diagnosis and management.

Navigating Hypermobility in Fitness

For individuals with hypermobility, exercise should prioritize:

• Strength Training: Building strong muscles around joints to provide support and stability. Focus on compound movements with controlled ranges of motion.
• Proprioceptive Training: Exercises that improve body awareness and joint position sense (e.g., balance exercises, unstable surface training).
• Controlled Movements: Avoiding ballistic stretching or movements that push joints to their end range of motion without muscular control.
• Low-Impact Activities: Activities like swimming, cycling, or elliptical training can be gentler on joints than high-impact sports.
• Mindful Stretching: While stretching can feel good, hypermobile individuals should be cautious not to overstretch or push into ranges that cause discomfort or instability. Focus on dynamic warm-ups rather than passive, prolonged stretches.

When to Seek Professional Guidance

While self-assessment with the Beighton Score is a good starting point, it's essential to consult a healthcare professional if you:

• Experience persistent joint pain, instability, or frequent dislocations.
• Suspect you might have a connective tissue disorder.
• Are unsure how to safely exercise with hypermobility.
• Have a family history of hypermobility-related conditions.

A physical therapist, kinesiologist, or sports medicine physician can provide a definitive diagnosis, offer personalized exercise recommendations, and guide you on managing hypermobility effectively to optimize your health and fitness.