Hypermobility: Understanding Its Problems and Management

What problems can hypermobility cause?

Hypermobility, while often perceived as beneficial flexibility, can predispose individuals to a range of musculoskeletal and systemic issues, from chronic pain and joint instability to fatigue and broader connective tissue concerns, particularly when it manifests as Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS).

Understanding Hypermobility

Hypermobility refers to the ability of a joint or joints to move beyond the typical, healthy range of motion. This excessive laxity is often due to more elastic ligaments and joint capsules. While some individuals experience "benign joint hypermobility" with no associated problems, for others, this increased range of motion can lead to significant physical challenges and systemic complications. It's crucial to distinguish between simple hypermobility (a trait) and symptomatic conditions like Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS), where hypermobility causes pain and other issues.

Common Problems Associated with Hypermobility

The inherent laxity in connective tissues, particularly ligaments and joint capsules, can lead to a cascade of problems for individuals with hypermobility.

• Joint Instability and Dislocations:

  • Subluxations and Dislocations: The most immediate and common problem. Ligaments, which are meant to provide passive stability to joints, are overly stretchy in hypermobile individuals. This means joints can easily move out of alignment (subluxation) or completely displace (dislocation) with minimal force, leading to acute pain and tissue damage.
  • Increased Risk of Injury: Repetitive microtrauma from joints constantly moving to their end-range, or beyond, can cause chronic inflammation, sprains, and strains in surrounding muscles and soft tissues.

• Chronic Pain:

  • Musculoskeletal Pain: This is a hallmark symptom. Muscles around hypermobile joints must work harder to compensate for lax ligaments, leading to chronic tension, spasms, and fatigue. This compensatory effort can result in widespread pain, often described as aching, burning, or sharp.
  • Referred Pain: Due to muscle imbalances and nerve irritation, pain can be felt in areas distant from the hypermobile joint.
  • Osteoarthritis: While hypermobility might seem to protect joints, the repetitive microtrauma and abnormal joint loading can actually accelerate degenerative changes, leading to early-onset osteoarthritis.

• Fatigue and Muscle Weakness:

  • Compensatory Muscle Overload: The constant effort required by muscles to stabilize loose joints is energy-intensive, leading to chronic fatigue that is not relieved by rest.
  • Generalized Weakness: This can be a primary symptom, or secondary to pain and disuse, further exacerbating joint instability.

• Proprioception Deficits:

  • Poor Joint Position Sense: Proprioception is the body's ability to sense its position and movement. In hypermobile individuals, the stretch receptors in overly lax ligaments may not provide accurate feedback to the brain, leading to a reduced awareness of limb position. This can manifest as clumsiness, poor coordination, and an increased risk of falls.
  • Delayed Reflexes: Slower protective reflexes mean the body reacts less effectively to sudden movements or loss of balance, increasing injury risk.

• Connective Tissue Issues Beyond Joints:

  • Skin Fragility: Easily bruised skin, slow wound healing, and velvety or stretchy skin are common in more severe forms of hypermobility (e.g., hEDS).
  • Vascular Issues: Tendency for varicose veins, easy bruising, and in rare, severe forms (like vascular EDS), fragile blood vessels that can rupture.
  • Gastrointestinal Dysmotility: Issues like reflux, gastroparesis (slow stomach emptying), irritable bowel syndrome (IBS)-like symptoms (constipation, diarrhea, bloating) are frequently reported.
  • Pelvic Organ Prolapse: Weakened connective tissue can lead to prolapse of organs like the bladder, uterus, or rectum.

• Autonomic Dysfunction:

  • Postural Orthostatic Tachycardia Syndrome (POTS): A common comorbidity, characterized by an abnormal increase in heart rate upon standing, leading to symptoms like dizziness, lightheadedness, fainting, brain fog, and fatigue.
  • Orthostatic Hypotension: A drop in blood pressure upon standing.
  • Mast Cell Activation Syndrome (MCAS): An immune condition where mast cells release too many inflammatory mediators, leading to symptoms like hives, flushing, itching, gastrointestinal upset, and fatigue.

• Psychological Impact:

  • Anxiety and Depression: Chronic pain, unpredictable symptoms, and the limitations imposed by hypermobility can significantly impact mental health.
  • Kinesiophobia (Fear of Movement): Due to repeated injuries or pain, individuals may develop a fear of movement, leading to inactivity and further deconditioning.

Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS)

It's vital to understand that while hypermobility is a trait, HSD and hEDS are diagnosable conditions where hypermobility causes significant symptoms and systemic involvement. HSD encompasses symptomatic hypermobility that doesn't meet the strict criteria for hEDS or other connective tissue disorders. hEDS is the most common type of Ehlers-Danlos Syndrome, characterized by generalized joint hypermobility, skin hyperextensibility, and tissue fragility, along with a range of systemic manifestations. Recognizing these conditions is key to appropriate management.

Management and Mitigation Strategies

While hypermobility cannot be "cured," its associated problems can be effectively managed through a multidisciplinary approach focused on stability, strength, and symptom management.

• Strengthening and Stability Training:

  • Focus on Local Stabilizers: Emphasize strengthening the muscles that directly support and stabilize joints, such as the rotator cuff for the shoulder, deep core muscles for the spine, and gluteal muscles for the hips.
  • Low-Impact Exercise: Activities like swimming, cycling, Pilates, and specific strength training are preferred to minimize joint stress.
  • Avoid Hyperextension: Consciously avoid positions that push joints to their end range of motion or into hyperextension.

• Proprioceptive Training:

  • Balance Exercises: Single-leg stands, wobble boards, and uneven surfaces help retrain joint position sense.
  • Mindful Movement: Focusing on controlled, deliberate movements to improve body awareness.

• Pain Management:

  • Physical Therapy: Tailored exercise programs, manual therapy, and modalities to reduce pain and improve function.
  • Pharmacological Interventions: Over-the-counter pain relievers, or prescription medications for more severe pain, neuropathic pain, or inflammation.
  • Lifestyle Adjustments: Pacing activities, using assistive devices (braces, orthotics) when appropriate, and stress management techniques.

• Education and Self-Management: Understanding the condition, identifying triggers, and learning strategies to prevent injury and manage symptoms are paramount.

When to Seek Professional Help

If you experience persistent joint pain, recurrent dislocations, excessive fatigue, unexplained systemic symptoms (like digestive issues, heart rate irregularities), or suspect you may have HSD or hEDS, it is crucial to seek evaluation from healthcare professionals. A diagnosis and a comprehensive management plan from a multidisciplinary team (e.g., rheumatologist, physical therapist, geneticist, pain specialist) can significantly improve quality of life and prevent further complications.