Hypermobility: Understanding, Measuring, and Managing Joint Laxity

How to Measure Hypermobility?

Measuring hypermobility typically involves standardized clinical assessments, most notably the Beighton Score, which evaluates joint laxity across specific anatomical sites to determine generalized joint hypermobility.

Understanding Hypermobility

Joint hypermobility refers to the capacity of a joint to move beyond its normal anatomical range of motion. While often benign, it can sometimes be associated with symptoms like pain, instability, or soft tissue injuries, leading to conditions such as Hypermobility Spectrum Disorder (HSD) or, in more severe cases, hypermobile Ehlers-Danlos Syndrome (hEDS). It's crucial to differentiate between asymptomatic joint laxity and symptomatic hypermobility that requires clinical attention.

Why Measure Hypermobility?

Assessing hypermobility is important for several reasons:

• Injury Risk Assessment: Individuals with hypermobility may be at increased risk for certain injuries, including sprains, dislocations, and chronic pain syndromes.
• Exercise Prescription: Understanding a client's joint laxity allows fitness professionals to tailor exercise programs, emphasizing stability, proprioception, and strength within a safe range of motion, rather than pushing into extreme end-ranges.
• Clinical Diagnosis: For healthcare professionals, measuring hypermobility is a key component in the diagnostic criteria for HSD and hEDS, guiding appropriate management and referral.
• Baseline Assessment: Establishing a baseline helps monitor changes over time and evaluate the effectiveness of interventions.

Clinical Assessment Tools: The Beighton Score

The Beighton Score is the most widely used and validated clinical tool for assessing generalized joint hypermobility. It is a 9-point scale that evaluates joint laxity in five specific areas of the body. Each positive finding contributes one point to the total score.

Here's how to perform the Beighton Score assessment:

1. Passive Dorsiflexion of the 5th Metacarpophalangeal Joint (Left and Right):

   • Procedure: With the palm flat on a table, the examiner passively extends the little finger (5th digit) backward.
   • Positive Score (1 point per hand): If the little finger can be bent backward beyond 90 degrees.

2. Passive Thumb Apposition to the Forearm (Left and Right):

   • Procedure: The examiner passively flexes the thumb towards the forearm.
   • Positive Score (1 point per thumb): If the thumb can touch the forearm.

3. Elbow Hyperextension (Left and Right):

   • Procedure: With the arm fully extended, the examiner visually assesses the elbow joint.
   • Positive Score (1 point per elbow): If the elbow hyperextends by more than 10 degrees (i.e., forms an angle greater than 180 degrees).

4. Knee Hyperextension (Left and Right):

   • Procedure: With the leg fully extended (e.g., standing or lying supine), the examiner visually assesses the knee joint.
   • Positive Score (1 point per knee): If the knee hyperextends by more than 10 degrees (i.e., forms an angle greater than 180 degrees).

5. Trunk Flexion with Palms on Floor:

   • Procedure: While standing with knees fully extended, the individual bends forward at the waist, attempting to place their palms flat on the floor.
   • Positive Score (1 point): If the palms can be placed flat on the floor with knees fully extended.

Scoring Interpretation: A total score of 4 out of 9 or higher (in adults) is typically indicative of generalized joint hypermobility. In children and adolescents, a higher cutoff (e.g., 5 or 6) may be used due to greater natural laxity. However, the Beighton Score is a screening tool, not a definitive diagnosis for symptomatic hypermobility conditions.

Limitations of the Beighton Score:

• It does not assess all joints (e.g., shoulders, hips, spine).
• It does not account for pain or other symptoms associated with hypermobility.
• Scores can decrease with age due to natural stiffening of connective tissues.
• It is a snapshot and can be influenced by factors like warm-up or time of day.

Other Assessment Considerations

While the Beighton Score is primary, a comprehensive assessment of hypermobility involves more than just joint range of motion:

• History and Symptoms: A thorough history is paramount. Inquire about:
  • Joint pain, especially chronic or widespread pain.
  • History of dislocations, subluxations, or sprains.
  • Clicking, popping, or grinding sensations in joints.
  • Fatigue, bruising, or skin elasticity issues.
  • Family history of hypermobility, Ehlers-Danlos syndromes, or related conditions.
  • Impact of hypermobility on daily activities and exercise.
• Functional Movement Assessment: Observe how individuals move during various tasks (e.g., squatting, reaching, lifting). Hypermobility can lead to compensatory movement patterns or instability during functional tasks.
• Goniometry: For precise measurement of specific joint ranges of motion, a goniometer can be used. This is particularly useful for tracking changes over time or for research purposes.
• Clinical Diagnostic Criteria: For suspected Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS), a healthcare professional will use broader diagnostic criteria that incorporate the Beighton Score alongside systemic manifestations, family history, and other musculoskeletal features.

When to Seek Professional Guidance

If an individual consistently scores high on the Beighton Score, experiences chronic joint pain, recurrent dislocations, excessive fatigue, or has a family history of hypermobility disorders, it is strongly recommended to consult a healthcare professional. A rheumatologist, geneticist, or a physiotherapist with expertise in hypermobility can provide a definitive diagnosis and guide appropriate management strategies, including specialized physical therapy and pain management.

Implications for Exercise and Training

For individuals with hypermobility, exercise programming requires a nuanced approach:

• Prioritize Stability and Strength: Focus on strengthening the muscles surrounding the joints to provide active stability.
• Proprioception Training: Enhance body awareness and joint position sense through balance exercises and unstable surface training.
• Avoid End-Range Loading: Instruct individuals to work within their stable, pain-free range of motion, avoiding excessive stretching or movements that push joints to their anatomical limits.
• Controlled Movements: Emphasize slow, controlled movements rather than ballistic or high-impact activities, especially initially.
• Warm-up and Cool-down: Thorough warm-ups prepare joints and muscles, while cool-downs aid recovery and flexibility without overstretching.
• Individualized Approach: Every hypermobile individual is unique. Programs must be tailored to their specific symptoms, limitations, and goals.

Understanding and appropriately measuring hypermobility is a critical step towards optimizing physical well-being, preventing injury, and guiding effective exercise interventions for this unique population.