Joint Hypermobility: Understanding Being "Double-Jointed," Risks, and Management

Is it healthy to be double-jointed?

Being "double-jointed" is a common term for joint hypermobility, a condition where joints move beyond their typical range of motion. While often benign and sometimes advantageous, it can also predispose individuals to certain health issues, necessitating a balanced understanding and appropriate management.

What Does "Double-Jointed" Actually Mean?

The term "double-jointed" is a misnomer; no one actually has extra joints. Instead, it refers to a condition called joint hypermobility, where the connective tissues (ligaments, tendons, and joint capsules) that support a joint are more lax or elastic than average. This allows the joint to extend or flex beyond what is considered the normal physiological range for that joint. It's a spectrum, ranging from hypermobility in a single joint to a generalized condition affecting multiple joints throughout the body.

The Science of Hypermobility: Joint Laxity Explained

At the core of joint hypermobility is the composition and structure of collagen, the most abundant protein in the body, which provides strength and elasticity to connective tissues. In individuals with hypermobility, there can be variations in the genetic makeup of collagen, leading to tissues that are more pliable and less rigid. This increased laxity allows for greater range of motion, but also means less inherent stability, making the joint more reliant on surrounding muscles for support.

Generalised Joint Hypermobility (GJH) and Its Spectrum

When hypermobility affects multiple joints, it's referred to as Generalised Joint Hypermobility (GJH). GJH exists on a spectrum, with varying degrees of severity and associated symptoms:

• Benign Joint Hypermobility Syndrome (BJHS): This is the most common form, characterized by hypermobile joints without significant pain or other systemic symptoms. Many individuals with BJHS lead normal, active lives.
• Hypermobility Spectrum Disorder (HSD): This newer classification encompasses symptomatic hypermobility that doesn't fully meet the criteria for more specific genetic conditions like Ehlers-Danlos Syndromes. Symptoms can include chronic pain, fatigue, and other systemic issues.
• Ehlers-Danlos Syndromes (EDS): These are a group of inherited connective tissue disorders, some of which feature severe joint hypermobility as a primary symptom. EDS can involve widespread systemic issues affecting skin, blood vessels, and internal organs, and require specialized medical management. Hypermobile EDS (hEDS) is the most common type.

Potential Advantages of Joint Hypermobility

For many, being hypermobile is not only healthy but can offer distinct advantages:

• Athletic Performance: Athletes in sports requiring extreme flexibility, such as gymnastics, dance, figure skating, martial arts, and even some forms of yoga, often benefit from hypermobile joints. Their extended range of motion can contribute to greater artistic expression and performance.
• Flexibility and Range of Motion: Generally, hypermobile individuals possess a greater capacity for flexibility, which can make certain movements easier and potentially reduce the risk of muscle strains if properly managed.

Potential Risks and Health Concerns

While some enjoy the benefits of hypermobility, it's crucial to acknowledge the potential downsides:

• Increased Risk of Injury: The primary concern is the reduced passive stability of the joints. This can lead to:
  • Sprains: Overstretching or tearing of ligaments.
  • Dislocations and Subluxations: Where a joint either completely separates or partially separates from its normal alignment.
  • Muscle Strains: Muscles may have to work harder to stabilize the joint, leading to overuse and strain.
• Chronic Pain: Many individuals with hypermobility experience chronic musculoskeletal pain, often due to the increased stress on surrounding muscles and connective tissues trying to compensate for joint laxity.
• Osteoarthritis (Premature): While not universally true, some research suggests that repetitive micro-trauma and altered joint mechanics in hypermobile joints could contribute to earlier onset of osteoarthritis.
• Proprioception and Balance Issues: The increased joint laxity can sometimes affect proprioception (the body's sense of its position in space), leading to clumsiness, poor balance, and an increased risk of falls.
• Systemic Manifestations: In more severe cases like EDS or HSD, individuals may experience a range of non-musculoskeletal symptoms, including fatigue, digestive issues, autonomic dysfunction (e.g., Postural Orthostatic Tachycardia Syndrome - POTS), and skin fragility.

When to Seek Professional Advice

If you suspect you or a client might be hypermobile, especially if experiencing symptoms, it's advisable to consult a healthcare professional. This includes:

• Persistent joint pain or muscle aches.
• Frequent joint dislocations or subluxations.
• Unexplained fatigue or systemic symptoms.
• Concerns about balance or coordination.
• A family history of hypermobility syndromes.

A doctor, physical therapist, or kinesiologist can assess joint laxity using tools like the Beighton Score and provide appropriate guidance or referrals.

Managing Hypermobility: Strategies for Health and Performance

For those with hypermobility, the focus should be on enhancing joint stability and overall body awareness.

• Strength Training and Stability: This is paramount. Instead of extreme stretching, prioritize exercises that build strength in the muscles surrounding hypermobile joints. Focus on controlled movements, proper form, and progressive overload. Examples include:
  • Closed-chain exercises: Squats, lunges, push-ups, which engage multiple muscles and provide proprioceptive feedback.
  • Isometric holds: To build static strength around a joint.
  • Core stability exercises: A strong core is fundamental for overall joint support.
• Proprioceptive Training: Exercises that challenge balance and body awareness can help improve the nervous system's ability to sense joint position and prevent injury. Examples include:
  • Standing on unstable surfaces (e.g., balance boards, foam pads).
  • Single-leg stances.
  • Yoga or Pilates (with modifications to avoid overstretching).
• Mindful Movement: Avoid "hanging out" in end-range positions or performing excessive, uncontrolled stretching. Focus on functional range of motion and consciously engaging muscles to stabilize joints during movement.
• Pain Management: If pain is present, consult a healthcare provider for appropriate strategies, which may include physical therapy, anti-inflammatory medications, or other interventions.
• Regular Medical Check-ups: Especially for those with symptomatic hypermobility or a diagnosis of HSD/EDS, regular monitoring by a medical team is essential to manage systemic symptoms and prevent complications.

Conclusion: A Balanced Perspective

Being "double-jointed" is not inherently healthy or unhealthy; it's a genetic predisposition that can manifest in various ways. For some, it's a benign trait that offers athletic advantages. For others, it's a component of a more complex condition requiring careful management to prevent pain and injury. Understanding the spectrum of hypermobility, listening to your body, and implementing a targeted exercise strategy focused on strength and stability are key to living a healthy, active life with hypermobile joints. Always seek professional guidance if you have concerns about your joint health.