Hypermobility in Children: Recommended Sports, Activities to Avoid, and Key Considerations

What sports are good for hypermobility children?

For children with hypermobility, the best sports and activities are those that prioritize joint stability, build strength and proprioception, and minimize high-impact or uncontrolled movements, such as swimming, cycling, and modified forms of dance or martial arts.

Understanding Hypermobility in Children

Hypermobility, often described as having "double joints," refers to joints that can move beyond the typical range of motion. While some degree of flexibility is normal and even advantageous, excessive hypermobility can be part of a broader condition like Benign Joint Hypermobility Syndrome (BJHS), Hypermobility Spectrum Disorder (HSD), or, in rarer cases, Ehlers-Danlos Syndrome (EDS). In children, hypermobility means their ligaments, which are designed to stabilize joints, are more elastic than average. This increased flexibility, while sometimes appearing impressive, can lead to:

• Joint Instability: Joints may be more prone to sprains, subluxations (partial dislocations), or full dislocations.
• Reduced Proprioception: A diminished sense of body position and movement, making coordinated actions more challenging and increasing the risk of falls.
• Fatigue: Muscles may work harder to stabilize joints, leading to quicker fatigue.
• Chronic Pain: Repetitive micro-trauma or compensatory muscle strain can lead to discomfort.

Therefore, selecting appropriate physical activities is crucial for managing symptoms, promoting healthy development, and preventing injury in hypermobile children.

General Principles for Sport Selection

When choosing sports for a child with hypermobility, the focus should shift from maximizing flexibility to enhancing stability, strength, and body awareness. Consider the following principles:

• Prioritize Joint Stability: Choose activities that strengthen the muscles surrounding joints, providing natural support.
• Low Impact: Minimize repetitive stress on joints, which can exacerbate pain or lead to injury.
• Controlled Movements: Opt for sports that emphasize precise, deliberate movements over ballistic, uncontrolled, or high-velocity actions.
• Enhance Proprioception: Activities that challenge balance and body awareness are highly beneficial.
• Individualized Approach: Every child's hypermobility is unique. What works for one may not work for another. Always consult with a healthcare professional (e.g., physiotherapist, pediatrician) for personalized advice.
• Focus on Enjoyment: Children are more likely to stick with activities they find fun and engaging.

Recommended Sports and Activities

Based on the principles above, several sports and physical activities are generally well-suited for hypermobile children:

• Swimming: Often considered the gold standard.
  • Benefits: Non-weight bearing, provides full-body resistance, builds muscle strength (especially core and back), improves cardiovascular fitness without joint impact, and enhances proprioception.
  • Considerations: Avoid hyperextending joints (e.g., locking elbows/knees during strokes). A qualified instructor can provide technique guidance.
• Cycling:
  • Benefits: Low-impact cardiovascular exercise, strengthens leg muscles (quadriceps, hamstrings, glutes) which support knee and hip joints.
  • Considerations: Ensure proper bike fit to maintain good posture and joint alignment. Stationary cycling can be a good alternative to avoid falls.
• Pilates and Modified Yoga:
  • Benefits: Excellent for building core stability, improving posture, body awareness, and controlled movement. Focuses on strengthening muscles that support the spine and major joints.
  • Considerations: Must be modified to avoid overstretching or extreme poses that push joints beyond their safe range. Emphasize strength and stability over flexibility. Seek instructors knowledgeable in hypermobility.
• Low-Impact Dance (e.g., Ballet, Contemporary - Modified):
  • Benefits: Improves coordination, balance, posture, and muscle strength. Can be excellent for body awareness.
  • Considerations: Avoid styles or movements that involve extreme turnout, high jumps, or ballistic actions. Focus on controlled movements and strength building.
• Martial Arts (e.g., Tai Chi, Aikido):
  • Benefits: Emphasize controlled movements, balance, discipline, and body awareness. Can build strength and stability without high impact.
  • Considerations: Choose styles that prioritize slow, deliberate movements and technique over high-impact striking or grappling.
• Strength Training (Supervised):
  • Benefits: Crucial for building the muscle strength needed to stabilize hypermobile joints. Focus on bodyweight exercises, resistance bands, or light weights.
  • Considerations: Must be supervised by a qualified professional (e.g., physiotherapist, certified personal trainer experienced with hypermobility) to ensure correct form and prevent injury. Focus on functional strength, not maximal lifts.
• Walking and Hiking (on even terrain):
  • Benefits: Excellent for cardiovascular health and building leg strength, particularly when wearing supportive footwear.
  • Considerations: Avoid uneven terrain that increases the risk of falls or ankle sprains. Supportive shoes are essential.

Sports to Approach with Caution (or Modify)

Certain sports carry higher risks for hypermobile children due to their inherent demands for high impact, sudden changes in direction, or extreme joint ranges:

• Contact Sports (e.g., Rugby, American Football, Ice Hockey, Wrestling): High risk of uncontrolled collisions and joint trauma.
• High-Impact Sports (e.g., Trampolining, Competitive Gymnastics, Long-Distance Running on Hard Surfaces): Repetitive stress and high forces on joints can lead to pain, inflammation, and potential long-term damage.
• Sports with Sudden Direction Changes and Jumping (e.g., Basketball, Soccer, Netball, Tennis, Volleyball): These activities put significant stress on ankles, knees, and hips, increasing the risk of sprains and instability.
• Sports Requiring Extreme Ranges of Motion (e.g., Certain forms of Competitive Dance, Advanced Yoga/Acrobatics): While flexibility is present, pushing beyond safe limits can lead to injury.
• Bowling and Golf: Can involve repetitive rotational forces that may stress the spine and shoulders in hypermobile individuals.

If a child is passionate about one of these sports, discuss modifications with a physiotherapist or coach to minimize risks. For instance, in soccer, focusing on passing and strategy over aggressive tackling or rapid direction changes might be an option.

Important Considerations for Parents and Coaches

• Consult Healthcare Professionals: Always begin by consulting with a pediatrician, physiotherapist, or kinesiologist who understands hypermobility. They can provide a personalized assessment and recommendations.
• Qualified Coaching: Ensure coaches are aware of the child's hypermobility and are willing to make modifications. They should prioritize proper form and technique over intensity or performance.
• Warm-up and Cool-down: Emphasize thorough warm-ups to prepare muscles and joints, and cool-downs to aid recovery and maintain flexibility safely.
• Listen to Pain: Teach children to recognize and communicate pain. Pain is a warning sign, not something to push through.
• Gradual Progression: Introduce new activities slowly and increase intensity or duration gradually. Avoid rapid increases in training volume.
• Supportive Footwear and Bracing: Appropriate footwear with good arch support is crucial. In some cases, a physiotherapist may recommend braces or taping for added joint support during specific activities.
• Hydration and Nutrition: Ensure adequate hydration and a balanced diet to support overall joint health and energy levels.

The Role of Strength and Proprioception Training

Regardless of the chosen sport, a foundational program focused on strength and proprioception is paramount for hypermobile children. This includes:

• Core Stability: Exercises that strengthen the deep abdominal and back muscles to support the spine.
• Gluteal Strengthening: Strong glutes help stabilize the hips and knees.
• Rotator Cuff Strengthening: Exercises for the shoulder to improve stability.
• Balance Training: Activities like standing on one leg, using wobble boards, or performing tandem walks to improve joint position sense.
• Low-Load Resistance: Using body weight, resistance bands, or light weights to build muscle endurance and strength around vulnerable joints.

This foundational work can be incorporated into daily routines or serve as a specific component of their physical activity plan, ideally guided by a physiotherapist.

Monitoring and Progression

Regularly monitor the child for signs of discomfort, fatigue, or joint instability. Observe their technique during activities and encourage open communication about how their body feels. As their strength and proprioception improve, they may be able to gradually progress to more challenging activities, but this should always be done under professional guidance and with careful observation.

Conclusion

Choosing the right sports for hypermobility children is about empowering them to be active safely and joyfully. By prioritizing activities that build strength, enhance proprioception, and minimize joint stress, parents and educators can help these children develop strong, stable bodies, fostering a lifelong love for movement while protecting their unique joint structure. Always remember that a personalized approach, guided by healthcare professionals, is the most effective strategy.