Hypermobility: Signs, Assessment, and Management

How Do You Know If You Are Hyperflexible?

Determining if you are hyperflexible, or hypermobile, typically involves assessing the range of motion in multiple joints, often using standardized clinical tests like the Beighton Score, alongside observing general physical signs and associated symptoms.

Understanding Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range. This increased range of motion (ROM) is due to a combination of factors, including laxity in the ligaments, joint capsule, and surrounding connective tissues, as well as the shape of the bones forming the joint. While some degree of flexibility is beneficial, hypermobility can range from a benign trait to a component of a more complex systemic condition. It's crucial to distinguish between general flexibility and clinical hypermobility, which often involves an unusually large range of motion across multiple joints.

The Beighton Score: A Clinical Assessment Tool

The Beighton Score is the most widely used clinical assessment tool for generalized joint hypermobility. It's a quick, nine-point system that evaluates the flexibility of specific joints, with each positive test counting as one point. A higher score indicates greater hypermobility.

To assess yourself or someone else using the Beighton Score, perform the following maneuvers:

1. Passive Dorsiflexion of the 5th Metacarpophalangeal Joint:

   • Action: With the palm flat on a table, gently pull the little finger back towards the forearm.
   • Positive Score: The little finger extends beyond 90 degrees (points back further than straight). (1 point for each hand, max 2 points)

2. Passive Apposition of the Thumb to the Forearm:

   • Action: Bend the thumb back towards the forearm, attempting to touch it.
   • Positive Score: The thumb touches the forearm. (1 point for each hand, max 2 points)

3. Elbow Hyperextension:

   • Action: Fully extend the arm at the elbow.
   • Positive Score: The elbow extends beyond 10 degrees (bends backward). (1 point for each arm, max 2 points)

4. Knee Hyperextension:

   • Action: Stand with knees fully extended.
   • Positive Score: The knee extends beyond 10 degrees (bends backward). (1 point for each leg, max 2 points)

5. Forward Trunk Flexion with Knees Extended:

   • Action: Bend forward from the waist, keeping the knees straight, and attempt to place the palms flat on the floor directly in front of the feet.
   • Positive Score: The palms rest flat on the floor. (1 point, max 1 point)

Interpreting Your Score: A score of 4 or more out of 9 points is generally considered indicative of generalized joint hypermobility in adults. In children and adolescents, a lower threshold (e.g., 5 or 6) may be used due to their naturally higher flexibility.

General Signs and Symptoms of Hypermobility

Beyond the Beighton Score, several other physical manifestations and associated symptoms can suggest hypermobility:

Common Physical Manifestations

• Unusual Joint Range: You can perform movements that most people cannot, such as touching your tongue to your nose, or bending fingers into seemingly unnatural positions.
• Easy Joint Popping/Clicking: Joints may frequently pop, click, or clunk without pain, due to increased joint play.
• Frequent Sprains or Subluxations: Joints may partially or fully dislocate easily, even with minor trauma.
• Soft, Velvety Skin: Some individuals with systemic hypermobility conditions may have unusually soft, stretchy, or fragile skin.
• Easy Bruising: Minor bumps can lead to significant bruising.
• Flat Feet (Pes Planus): The arches of the feet may be flattened due to lax ligaments.

Associated Conditions and Symptoms

Hypermobility can sometimes be benign (Benign Joint Hypermobility, BJH), meaning it causes no pain or problems. However, it can also be associated with a range of symptoms and conditions, collectively known as Hypermobility Spectrum Disorder (HSD) or, in more severe cases, Ehlers-Danlos Syndrome (hEDS). These include:

• Chronic Joint Pain: Pain, often described as aching or throbbing, in multiple joints or muscles, which can be disproportionate to activity level.
• Fatigue: Persistent tiredness not relieved by rest.
• Proprioception Issues: Difficulty sensing the position of your body in space, leading to clumsiness, poor balance, and increased risk of falls.
• Autonomic Dysfunction (Dysautonomia): Symptoms like dizziness upon standing (Postural Orthostatic Tachycardia Syndrome - POTS), fainting, or rapid heart rate.
• Gastrointestinal Issues: Bloating, constipation, or irritable bowel syndrome (IBS)-like symptoms.
• Anxiety and Depression: Higher rates of mental health conditions.
• Poor Wound Healing/Scarring: Scars may be thin and wide ("cigarette paper scars").

Differentiating Benign Joint Hypermobility from Hypermobility Spectrum Disorder (HSD) / Ehlers-Danlos Syndrome (hEDS)

It's crucial to understand that having hypermobile joints does not automatically mean you have a disorder. Many people are simply "double-jointed" without any associated problems.

• Benign Joint Hypermobility (BJH): Refers to hypermobility without pain or other systemic symptoms. It's often an advantage in activities requiring extreme flexibility (e.g., dance, gymnastics).
• Hypermobility Spectrum Disorder (HSD): Diagnosed when a person has generalized joint hypermobility (often confirmed by a Beighton Score of 4+) and experiences chronic pain or other systemic symptoms (like those listed above) that significantly impact their quality of life, but do not meet the full diagnostic criteria for a specific connective tissue disorder like hEDS.
• Hypermobile Ehlers-Danlos Syndrome (hEDS): This is a specific genetic connective tissue disorder, representing the most common type of EDS. Diagnosis requires meeting strict criteria, including generalized joint hypermobility, as well as specific systemic manifestations of connective tissue laxity.

Self-assessment using the Beighton Score and observing general signs can give you an indication of hypermobility. However, only a healthcare professional can diagnose HSD or hEDS.

Implications of Hypermobility for Fitness and Health

Advantages

• Enhanced Performance: In sports or activities requiring extreme flexibility (e.g., gymnastics, ballet, martial arts), hypermobility can be a significant asset.
• Greater Range of Motion: Allows for deeper stretches and potentially more effective muscle activation through a full ROM during strength training.

Potential Challenges and Risks

• Joint Instability and Injury: The primary concern is that increased ROM without adequate muscular strength and stability can lead to joint instability, increasing the risk of sprains, dislocations, and subluxations.
• Chronic Pain: Ligaments and muscles may work harder to stabilize joints, leading to overuse injuries and chronic pain.
• Proprioceptive Deficits: Reduced joint position sense can impair coordination and balance, increasing fall risk.
• Delayed Healing: In cases of underlying connective tissue disorders, healing from injuries can be slower.
• Osteoarthritis Risk: While not universally true, some research suggests that chronic joint instability and microtrauma could contribute to earlier onset of osteoarthritis.

When to Seek Professional Advice

While being flexible is generally good, if you suspect you are hypermobile and experience any of the following, it's advisable to consult a healthcare professional, such as a general practitioner, rheumatologist, or physical therapist:

• Persistent or worsening joint pain that impacts daily life.
• Frequent joint dislocations or subluxations.
• Unexplained fatigue.
• Dizziness, fainting, or rapid heart rate upon standing.
• Easy bruising or unusual skin fragility.
• Concerns about your balance or coordination.
• A family history of hypermobility syndromes like Ehlers-Danlos Syndrome.

A medical professional can conduct a thorough examination, including the Beighton Score, and assess for any underlying conditions, providing an accurate diagnosis and appropriate management plan.

Managing Hypermobility: A Proactive Approach

If you are hypermobile, whether benign or part of a spectrum disorder, a proactive approach to fitness is key. The focus shifts from increasing flexibility (which you already have) to enhancing strength, stability, and proprioception.

• Strength Training: Build strong muscles around hypermobile joints to provide essential support and stability. Focus on controlled movements and proper form.
• Proprioceptive Training: Exercises that challenge balance and joint position sense (e.g., single-leg stands, wobble boards) can improve joint awareness and reduce injury risk.
• Low-Impact Activities: Activities like swimming, cycling, or elliptical training can provide cardiovascular benefits without excessive joint stress.
• Core Stability: A strong core provides a stable base for all movements, reducing strain on peripheral joints.
• Avoid Overstretching: While tempting, pushing into extreme ranges of motion can exacerbate instability. Focus on maintaining current flexibility rather than increasing it.

Understanding your body's unique capabilities and limitations is the first step toward optimizing your health and fitness. For individuals with hypermobility, this means prioritizing stability and strength to support their joints and prevent potential complications.