Hypermobility: Understanding Joint Laxity, Types, Causes, and Management

What is hypermobility mean?

Hypermobility refers to joints that move beyond the typical, healthy range of motion, often due to increased laxity in ligaments and joint capsules, or variations in bone structure. While sometimes beneficial for activities requiring extreme flexibility, it can also lead to joint instability, pain, and an increased risk of injury.

Understanding Joint Hypermobility

Joint hypermobility, commonly known as being "double-jointed," describes a condition where one or more joints can move beyond the normal anatomical range of motion. It is crucial to distinguish hypermobility from general flexibility. Flexibility is the ability of a muscle to lengthen and allow a joint to move through its full range, often developed through stretching. Hypermobility, conversely, is an inherent characteristic of the joint itself, typically due to the structural properties of connective tissues (ligaments, tendons, joint capsules) or the shape of the bones forming the joint.

In hypermobile individuals, the connective tissues that normally provide stability to a joint are more elastic or "stretchy" than average. This increased laxity allows for greater movement at the joint, which can be asymptomatic (benign) or contribute to a range of symptoms and conditions.

Types of Hypermobility

Hypermobility can manifest in various forms, ranging from isolated instances to systemic conditions:

• Localized Joint Hypermobility: This refers to hypermobility affecting only one or a few specific joints (e.g., hyperextension of elbows or knees). It might be present without any associated symptoms or broader systemic involvement.
• Generalized Joint Hypermobility (GJH): This indicates hypermobility present in multiple joints throughout the body. It is often assessed using standardized clinical tools like the Beighton Score.
• Hypermobility Spectrum Disorder (HSD): This is a new diagnostic term for symptomatic generalized joint hypermobility, where the individual experiences symptoms like chronic joint pain, fatigue, or recurrent dislocations, but does not meet the full diagnostic criteria for a specific connective tissue disorder like Ehlers-Danlos Syndrome.
• Hypermobile Ehlers-Danlos Syndrome (hEDS): This is a specific type of Ehlers-Danlos Syndrome, a hereditary disorder of connective tissue. hEDS is characterized by generalized joint hypermobility along with a constellation of other systemic features, including fragile skin, tissue fragility, chronic pain, autonomic dysfunction, and gastrointestinal issues, due to genetic mutations affecting collagen synthesis or structure.

Causes of Hypermobility

The underlying causes of joint hypermobility are primarily genetic and anatomical:

• Genetic Predisposition: The most common cause is an inherited variation in the genes that control the production of collagen. Collagen is a primary structural protein found in connective tissues, including ligaments, tendons, and cartilage. If collagen is more elastic or less robust, it results in looser joints.
• Anatomical Variations:
  • Shallow Joint Sockets: Joints with shallower sockets (e.g., shoulder, hip) may allow for greater range of motion.
  • Ligamentous Laxity: Ligaments, which connect bones to bones and stabilize joints, may be naturally longer or more elastic.
  • Muscle Tone: Lower muscle tone can sometimes contribute to apparent hypermobility, as muscles provide dynamic stability to joints.
• Proprioception: In some cases, altered proprioception (the body's awareness of its position in space) can contribute to or exacerbate issues related to hypermobility, as the brain may not receive accurate feedback about joint position, leading to instability.

Common Signs and Symptoms

While many hypermobile individuals are asymptomatic, others may experience a range of issues:

• Joint Pain: Often chronic and widespread, varying in intensity. It can be due to increased stress on joint structures, muscle fatigue from compensating for instability, or microtrauma.
• Joint Instability: A feeling of joints "giving way" or feeling loose.
• Recurrent Dislocations or Subluxations: Partial (subluxation) or complete (dislocation) displacement of bones at a joint. This is particularly common in shoulders, patella (kneecap), and fingers.
• Clicking, Popping, or Grinding Sounds: Due to movement of joint structures.
• Fatigue: Often related to the increased muscular effort required to stabilize joints.
• Poor Proprioception: Difficulty sensing the position of limbs in space, leading to clumsiness or falls.
• Soft Tissue Injuries: Increased susceptibility to sprains, strains, and tendinitis.
• Skin Manifestations (in hEDS): Soft, velvety, stretchy skin; easy bruising; abnormal scarring.

Diagnosis and Assessment

Diagnosis of hypermobility typically involves a clinical assessment by a healthcare professional, such as a physician, physical therapist, or rheumatologist.

• Medical History: The practitioner will inquire about joint pain, dislocations, family history of hypermobility, and other systemic symptoms.
• Physical Examination: This is crucial for assessing joint range of motion. The Beighton Score is a widely used, nine-point screening tool that assesses hypermobility in specific joints:
  • Passive dorsiflexion of the 5th metacarpophalangeal joint > 90 degrees (bilateral, 2 points)
  • Passive apposition of the thumb to the forearm (bilateral, 2 points)
  • Elbow hyperextension > 10 degrees (bilateral, 2 points)
  • Knee hyperextension > 10 degrees (bilateral, 2 points)
  • Palms flat on the floor with knees straight (1 point) A score of 4 or higher generally indicates generalized joint hypermobility.
• Differential Diagnosis: It's important to differentiate benign hypermobility from other conditions that might cause similar symptoms, particularly other connective tissue disorders.

Implications for Exercise and Daily Life

Hypermobility has dual implications, offering both advantages and potential challenges:

• Advantages: Individuals with hypermobility may excel in activities requiring extreme flexibility, such as gymnastics, dance, ballet, and certain martial arts. Their extended range of motion can be a performance asset.
• Risks and Challenges:
  • Increased Injury Risk: The primary concern is joint instability, which predisposes individuals to sprains, dislocations, and chronic pain.
  • Chronic Pain: Persistent joint and muscle pain is common, often due to the increased muscular effort required to stabilize joints or from repetitive microtrauma.
  • Proprioceptive Deficits: Reduced joint position sense can lead to awkward movements, clumsiness, and an increased risk of falls.
  • Muscle Imbalances: Muscles may become overactive in an attempt to compensate for ligamentous laxity, leading to tightness and pain.

Management and Exercise Strategies

For individuals with symptomatic hypermobility, the focus of management is on improving stability, strength, and proprioception, rather than increasing flexibility.

• Prioritize Stability and Strength: The goal is to build strong muscles around the joints to provide dynamic stability.
  • Resistance Training: Emphasize controlled movements through a safe, stable range of motion, avoiding end-range hyperextension. Focus on compound movements with proper form.
  • Core Strength: A strong core is fundamental for overall stability, reducing stress on peripheral joints. Include exercises like planks, bird-dog, and dead bugs.
  • Gluteal and Scapular Stability: Strengthening these areas is crucial for hip, knee, and shoulder stability respectively.
• Enhance Proprioception and Balance:
  • Balance Training: Incorporate exercises on unstable surfaces (e.g., balance boards, foam pads) or single-leg stances to retrain joint position sense.
  • Mind-Body Connection: Focus on conscious control and awareness of joint position during all movements.
• Avoid End-Range Passive Stretching: While it might feel good temporarily, excessive passive stretching can further destabilize already loose joints. Instead, focus on active range of motion within a controlled, stable limit.
• Low-Impact Activities: Activities like swimming, cycling, and elliptical training are often well-tolerated as they minimize joint impact.
• Pain Management: If pain is present, strategies may include activity modification, heat/cold therapy, over-the-counter pain relievers, and in some cases, referral to a pain specialist.
• Physical Therapy: A skilled physical therapist is invaluable. They can assess specific instabilities, design a tailored exercise program, teach proper movement mechanics, and provide manual therapy techniques to address muscle imbalances.

When to Seek Professional Help

If you suspect you have hypermobility, especially if you experience persistent joint pain, recurrent dislocations, excessive fatigue, or other concerning symptoms, it is advisable to consult with a healthcare professional. A proper diagnosis can lead to effective management strategies, mitigate potential complications, and help you safely navigate your fitness journey.