Top Tips for Hypermobility

Hypermobility is very common – 1 in 10 adults are hypermobile in some of their joints and it often runs in families. 100% of professional ballerinas and Olympic gymnasts are hypermobile – it can help for children to know about people who use their hypermobility as an advantage. It is normal for very young children to have a far greater range of joint movement than adults and this becomes less common as children get older.

Where there are symptoms, such as activity related musculoskeletal pain, recurrent ankle sprains, occasional short lived joint swelling and handwriting difficulties, and no other cause for these symptoms can be identified, the diagnosis of hypermobility syndrome can be made. There is often associated anterior knee pain, TMJ dysfunction, iliotibial band syndrome and mechanical back pain.

Hypermobility alone should not stop children from doing physical education, sports or attending school. Exercise is therapeutic and should be encouraged but may need to be built up gradually. Exercise which improves core strength such as pilates and yoga are particularly helpful. Non weight-bearing exercises such as swimming and cycling should be encouraged.

Check for peripheral hypermobility – at finger, wrists and toes – as well as more centrally at elbows and knees. The Beighton score is a tool for assessing hypermobility in adults but has not been validated in children.

Consider Marfans as a cause of hypermobility if family history or other suggestive symptoms such as tall stature, high arch palate, high myopia, recurrent hernias, varicose veins, history of spontaneous pneumothorax or family history of early death from aortic dissection.

Consider Ehler's Danlos if there is very elastic skin, excessive bruising or unusual scarring.

Pains associated with hypermobility tend to respond poorly to analgesia and escalating analgesia should be avoided.

Usually reassurance that there is no other cause for the pain and no long term sequelae, along with patient information on hypermobility, are all that is required. For more severely affected children targeted physiotherapy to improve core strength and stabilise joints and / or occupational therapy review to aid handwriting can be helpful.

Refer if you suspect a secondary cause, or symptoms are severe or causing persistent disruption to school, sports or daily activities.

There is no good evidence what so ever that hypermobility leads to arthritis of any description.

Please note: a pdf document of these Top Tips is also available here.