The Hypermobile Client

Hypermobility

Many clients will often present to the clinic reporting that they are “double jointed” and/or “hypermobile”.

So what does this actually mean?

I often explain to them that hypermobility is where there is more movement or mobility at a joint to that of what is normal.  This can often present itself in one region of the body or perhaps across multiple joints in the body.  When it comes to explaining to the client what normal is, I often find this difficult and will often compare them to the many 1000’s of clients that I have seen over the years, saying that they are quite bendy and mobile compared to many of my clients who aren’t.

When it comes to having to categorize someones mobility, I would often explain to clients that there is a mobility spectrum where some people are particularly stiff and generally lack flexibility/mobility in their joints compared to the other end of the spectrum where there are those people who are particularly mobile, bendy and flexible.

Recognizing Hypermobility

The Beighton Score is one way to determine if an individual is hypermobile.  This is a 9 point scale that looks at the assessment of various joints within the body.  Please see the YouTube video link below for an explanation of the Beighton Score.

Like any test, there are pro’s and con’s.  The limitations to this test is that it is only samples a small number of joints and gives no indications of the degree of hypermobility due to the widespread nature of its distribution.

Some individuals are born with a different connective tissue make up and are therefore more hypermobile, ranging from benign joint hypermobility syndrome to those individuals who suffer from connective tissue disorders such as Ehlers Danos and Marfans disease.  Hypermobility is only one part of the clinical picture for these individuals suffering from connective tissue disorders.   Hypermobility can also be caused by repetitive trauma and is common in sports where repetitive movement is performed.

When it comes to looking at the types of injuries that hypermobile clients suffer from, often they are the same as any other individual.  Often it is the treatment and management of these injuries that needs to be adjusted for the hypermobile client.  Hypermobility is something that an individual may genetically inherit or can cause due to repetitive stress.

A Quick Look At Benign Joint Hypermobility Syndrome

For more detailed information on Benign Joint Hypermobility Sydnrome, please refer to the web links and books below.

Benign Joint Hypermobility Website – http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/joint-hypermobility-syndrome/

Hypermobility Association – http://hypermobility.org/

Hypermobility Book – http://www.amazon.com/Hypermobility-Syndrome-Diagnosis-Management-Physiotherapists/dp/0750653906/ref=pd_sim_b_5

Benign Hypermobility Facts

• It occurs in the absence of other defined rheumatological diseases.
• General consensus  is that it declines during childhood and adult life
• Females > Males
• Varies amongst ethnic groups, most commonly in those of Asian origin -> African descent and least of all Europeans.

Clinical Features Of Joint Hypermobility Syndrome

• Clinical features of JHS are variable in terms of their nature, severity and occurrence.
• Pain is the overriding symptom
• Predisposed to effects of trauma due to fragile connective tissue
• Healing times maybe slower and rehabilitation is prolonged
• Risk factor for the development of premature OA
• Fibromyalgia Syndrome is frequently diagnosed in hypermobile subjects
• Impairment of joint proprioceptive acuity
• Lack of efficacy of local anaesthetics topically applied or given by injection
• Pain enhancement, leading to the development of full chronic pain syndrome
• Association between hypermobility and anxiety states with panic attacks and phobic states
• Autonomic dysfunctions including symptoms such as palpitations, light-headiness, dizziness or fainting

Diagnosing Benign Joint Hypermobility

Major Criteria
1.  Beighton score 4/9 or greater (currently or historically)
2.  Arthralgia for longer than 3 months in four or more joints

Minor Criteria
1.  Beighton score of 1,2 or 3/9 (or 0, 1, 2, 3 if aged 50+)
2.  Arthralgia (> 3 months in one to three joints or back pain > 3 months)
3.  Dislocation/subluxation in more than one joint
4.  Soft tissue rheumatism e.g. epicondylitis, tenosynovitis, bursitis
5.  Marfanoid habitus (tall, slim, span height ration >1.03
6.  Abnormal skin: striae, hyperextensibility of the skin, thin skin, papyraceous scarring
7.  Eye signs: drooping, eyelids or myopia
8.  Varicose veins or hernia or uterine/rectal prolapse

Benign Joint Hypermobility Syndrome is diagnosed in the presence of:

• 2 major criteria
• or 1 major criteria and 2 minor criteria
• or 4 minor criteria

Treatment & Management

The book by Rosemary Keer called “Hypermobility Syndrome” references the Panjabi model with regards to the treatment and management of hypermobility.  The Panjabi model classifies the body into 3 subsystems that are functionally independent.
1.  Passive musculoskeletal subsystem includes bones, ligaments, joint capsules, passive mechanical properties of the muscle
2.  Active musculoskeletal subsystem includes muscles and tendons
3.  Control of neural and feedback subsystem

Based on this model, those with Benign Joint Hypermobility Syndrome may have their subsystems affected in the following way:

• Less passive subsystem support
• Decreased muscle tone and tensile strength in the active subsystem
• Deficient proprioception which compromises the individuals motor control.

When it comes to the Osteopath, Physiotherapy or Exercise Physiologist working with a hypermobile client, it is important that these areas are addressed.  A focus on balance, proprioception, joint control, stability and strength through range of motion is imperative.  For more information about the ideas and concepts discussed above, please check out this book.  The amazon link is http://books.google.com.au/books/about/Hypermobility_Syndrome.html?id=Z3tLOlyeuI4C&redir_esc=y