Hypermobility

Hypermobility refers to an increased range of joint movement compared with age-matched peers and is a common feature of normal development in children. It is more evident in younger children, females, and some ethnic groups, and is frequently seen in dancers, gymnasts, swimmers and other athletes, where it may provide a functional advantage.

Although hypermobility can be associated with musculoskeletal pain, this relationship is debated. It is important not to attribute pain to hypermobility without considering other causes, particularly inflammatory or mechanical pathology.

When symptoms are related to hypermobility, they are usually symmetrical and may affect peripheral joints or be more widespread. Children may describe activity-related pain, such as finger discomfort after handwriting or joint pain following sport. Joints may feel 'clicky', and some children experience recurrent minor dislocations or sprains. Pain is often predictable, occurring during or after specific activities, and may be associated with stiffness the following morning. Children may reduce their activity because of pain, but symptoms can recur when activity is restarted. Anterior knee pain is common, particularly in association with flat feet, and some children may also develop hernias.

Hypermobility can also be a feature of inherited connective tissue disorders, which are rare but important to recognise. Clinical clues include tall stature, long limbs and fingers, a high-arched palate (suggestive of Marfan syndrome), skin hyperextensibility with easy bruising or thin scars (Ehlers–Danlos syndromes), or blue sclerae (osteogenesis imperfecta). These conditions carry additional risks, including cardiac, ocular and spinal complications, and should prompt specialist assessment.

Diagnosis of hypermobility is made on clinical examination (for example using a structured musculoskeletal assessment such as pGALS). Hypermobility may be generalised or localised, but where present it should be symmetrical.

Management is usually conservative. Most children benefit from reassurance, maintenance of normal physical activity, and optimisation of muscle strength and core stability. Where symptoms are limiting function, input from a paediatric physiotherapist can support return to normal activities and improve long-term outcomes.