Joint Hypermobility: Signs, Assessment, and Management

How Do You Tell If You're Hypermobile?

Identifying joint hypermobility involves assessing the extent of joint range of motion beyond typical limits, often through specific physical tests and an awareness of associated signs and symptoms.

Understanding Hypermobility

Joint hypermobility refers to the ability of a joint to move beyond its normal anatomical range of motion. It is primarily due to laxity in the ligaments and connective tissues that surround and stabilize the joints. While often confused with flexibility, which pertains to the extensibility of muscles and tendons, hypermobility is distinct, focusing on the inherent looseness of the joint structure itself.

Hypermobility can exist as an isolated trait, often termed benign joint hypermobility (BJH), which may cause no symptoms. However, when it leads to pain, frequent injuries, or other systemic symptoms, it may be classified as Hypermobility Spectrum Disorder (HSD) or, in more severe cases, be a symptom of an underlying heritable disorder of connective tissue (hEDS), such as Ehlers-Danlos Syndrome. Understanding whether you are hypermobile is crucial for guiding appropriate exercise, injury prevention, and general health management.

Common Signs and Symptoms

While a formal assessment is key, several subjective signs and symptoms can suggest hypermobility. These are often experienced due to the increased strain on joints and surrounding structures.

• Excessive Joint Range of Motion: You might notice your joints extend further than others, or you can perform "party tricks" like bending your thumb back to your forearm.
• Frequent Joint Pain: Pain, especially after physical activity or prolonged standing, is common. This often stems from the muscles working harder to stabilize lax joints.
• Recurrent Sprains and Strains: Due to less joint stability, ligaments and muscles are more prone to injury.
• Clicking, Clunking, or Grinding Joints: These sounds can indicate joint instability or the movement of tendons over bone.
• Easy Bruising and Thin, Stretchy Skin: While not directly a joint symptom, these can be indicators of underlying connective tissue fragility, particularly in systemic hypermobility disorders.
• Chronic Fatigue: The constant effort required by muscles to stabilize hypermobile joints can lead to persistent tiredness.
• Digestive Issues or Autonomic Dysfunction: In more complex hypermobility syndromes, issues like irritable bowel syndrome (IBS) or postural orthostatic tachycardia syndrome (POTS) can be present.
• Delayed Healing: Wounds may take longer to heal, or scars may be thin and wide.

The Beighton Score: A Clinical Assessment Tool

The Beighton Score is a widely used, simple 9-point system to screen for generalized joint hypermobility. It assesses hypermobility in five specific joints, with points awarded for bilateral (both sides) involvement in four of the tests.

To self-assess using the Beighton Score, follow these steps:

1. Passive dorsiflexion of the 5th metacarpophalangeal joint:

   • Place your arm on a flat surface, palm down.
   • Using your other hand, gently pull your little finger back towards the top of your hand.
   • Score 1 point if your little finger extends beyond 90 degrees (points upwards) on each hand (total 2 points possible).

2. Passive apposition of the thumb to the forearm:

   • Extend your arm straight out with your palm facing up.
   • Using your other hand, gently pull your thumb back towards your forearm.
   • Score 1 point if your thumb touches your forearm on each arm (total 2 points possible).

3. Elbow hyperextension:

   • Stand with your arms extended straight out in front of you, palms facing forward.
   • Look at your elbows from the side.
   • Score 1 point if your elbow extends more than 10 degrees beyond straight (forms a backward curve) on each arm (total 2 points possible).

4. Knee hyperextension:

   • Stand straight with your knees fully extended.
   • Look at your knees from the side.
   • Score 1 point if your knee extends more than 10 degrees beyond straight (forms a backward curve) on each leg (total 2 points possible).

5. Forward trunk flexion with palms on the floor:

   • Stand with your feet together and knees straight.
   • Bend forward at your waist, trying to touch the floor with your palms.
   • Score 1 point if you can place your palms flat on the floor (total 1 point possible).

Scoring and Interpretation: Add up your points from all 5 tests. The maximum possible score is 9. A Beighton Score of 4/9 or more is generally indicative of generalized joint hypermobility. However, it's important to note that the cut-off can vary slightly based on age, sex, and ethnicity. A higher score suggests greater joint laxity.

It is crucial to understand that while the Beighton Score is an excellent screening tool, it does not diagnose a hypermobility disorder like Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (hEDS). Such diagnoses require a comprehensive clinical evaluation by a healthcare professional, considering the presence of other symptoms and family history.

When to Seek Professional Assessment

While self-assessment with the Beighton Score can provide initial insight, professional evaluation is highly recommended if:

• You experience persistent or worsening joint pain despite self-care.
• You have frequent dislocations or subluxations (partial dislocations).
• You notice other systemic symptoms like chronic fatigue, easy bruising, skin fragility, or digestive issues, which could suggest a broader connective tissue disorder.
• Your hypermobility significantly impacts your daily activities or ability to exercise safely.
• You have a family history of hypermobility disorders or related conditions.

A general practitioner (GP) can provide an initial assessment and refer you to specialists such as a rheumatologist, physiotherapist, or geneticist, depending on your symptoms.

Living with Hypermobility: Considerations for Exercise

If you identify as hypermobile, your approach to fitness should prioritize joint stability and strength over extreme flexibility.

• Focus on Strength Training: Building strong muscles around your joints is paramount. Emphasize compound movements with controlled ranges of motion.
• Prioritize Stability: Incorporate exercises that challenge balance and proprioception (your body's awareness in space). Examples include single-leg stands, unstable surface training (if appropriate and safe), and core strengthening.
• Avoid End-Range Stretching: While flexibility may feel natural, pushing joints into their extreme ranges without muscular control can increase instability and injury risk. Focus on functional range of motion.
• Low-Impact Activities: Activities like swimming, cycling, and elliptical training are often well-tolerated as they reduce direct impact on joints.
• Listen to Your Body: Pay close attention to pain signals. "No pain, no gain" is a dangerous mantra for hypermobile individuals.
• Seek Professional Guidance: Working with a physiotherapist or an exercise physiologist knowledgeable about hypermobility can provide a tailored exercise plan, ensuring safety and effectiveness.

Conclusion

Understanding whether you are hypermobile is the first step toward effective self-management and, if necessary, professional intervention. While the Beighton Score offers a valuable self-assessment tool, it's crucial to consider the broader context of your symptoms and how they impact your quality of life. By recognizing the signs and symptoms of hypermobility and adopting a proactive approach to joint health, you can manage your unique physiology to promote stability, reduce pain, and enhance overall well-being.