Can you bend your thumb far back enough to reach your forearm? Or put your arms flat on the floor while keeping your knees extended?
If you answered yes to those questions, you might have joint hypermobility.
Diagnostic issues and lack of awareness make it difficult to accurately determine hypermobility’s prevalence. However, research indicates that it is much more common among people of African and Asian descent, women, and the youth.
Many children outgrow hypermobility as they age and their joints become stiffer, while some carry it throughout adulthood with little to no ramifications.
Although hypermobility can seem benign and advantageous, it still adversely affects overall health, quality of life, and athletic performance.
So let’s explore joint hypermobility and find out how people with this condition can more safely navigate life.
Hypermobility pertains to the joints’ unusual capability to move beyond their normal range of motion. It can manifest in one or many joints in the body. It can also be either asymptomatic or present with other comorbidities.
In the case of the latter, doctors may give patients a diagnosis of hypermobility spectrum disorder (HSD). Formerly known as joint hypermobility syndrome (JHS), it is further categorized into the following types:
- Generalized (G-HSD) for hypermobility occurring in more than one joint or group of joints;
- Localized (L-HSD) for hypermobility limited to one joint or group of joints;
- Peripheral (P-HSD) for hypermobility restricted to the hands and feet; and
- Historical (H-HSD) for previously occurring hypermobility but with HSD symptoms still manifesting.
At the extreme end of the spectrum is hypermobility Ehlers-Danlos Syndrome (hEDS), a type of EDS among many others. hEDS is similar to JHS but presents with a broader range of symptoms.
It is important to note that joint hypermobility—differentiated from HSD and hEDS—is not a diagnosis. It is rather only a descriptor of joints’ abnormal range of motion. Even so, it can have negative consequences on a person’s life and thus warrants proper detection.
The Beighton Score is the most widely used tool for measuring joint hypermobility. It is a two-part scoring system, the first of which prompts patients to attempt five different maneuvers, namely:
- Bending forward and placing hands flat on the floor while keeping knees straight (1 point),
- Elbow hyperextension (1 point for each elbow),
- Knee hyperextension (1 point for each knee),
- Bending the little finger back > 90° (1 point for each little finger), and
- Bending the thumbs back to touch the lower arms (1 point for each thumb).
The second part of the test involves answering the following yes or no questions involving medical history:
- Can you now (or could you ever) put your hands flat on the floor while keeping your knees straight?
- Can you now (or could you ever) bend your thumb and touch your lower arm?
- When you were younger, did you entertain your friends by warping yourself into different positions?
- When you were a child or teenager, did you have a dislocated shoulder or kneecap more than once?
- Do you think of yourself as double-jointed?
A person is considered to have joint hypermobility if they score four or more on the maneuver test and answer yes to two or more medical history questions.
However, lower scores do not automatically discount the possibility of joint hypermobility in a patient. With over 300 joints in the body, the Beighton Score does not capture all possible manifestations of joint hypermobility.
Experts suggest that the Beighton Score be used only as an initial screening method and for clinicians to further examine other notable joints to rule out joint hypermobility.
Diagnosing Hypermobility Spectrum Disorder
Hypermobility Spectrum Disorder is primarily determined using the Brighton Criteria:
- Major Criteria
- A Beighton Score of four or more on the maneuver test
- Joint pain occurring for three months or more in four or more joints
- Minor Criteria
- A Beighton Score of one to three
- Joint pain in one to three joints
- History of joint dislocations
- More than three soft-tissue lesions
- Marfanoid habitus (characterized by tallness, slimness, and ratio of span to height greater than 1.03)
- Stretch marks, skin hyperextensibility, thin skin, and scarring
- Drooping eyelids, myopia
- Varicose veins, hernia, or uterine or rectal prolapse
A doctor can diagnose HSD if any of the following configurations are present:
- two major criteria
- one major criterion and two minor criteria
- four minor criteria
- two minor criteria and a close relative who has been diagnosed with HSD
The diagnosis of HSD is purely clinical at the moment, meaning there are no laboratory examinations or imaging tests that can confirm the disease. Instead, diagnosis is reliant on the presence of symptoms and ruling out other possible causes for these symptoms.
If you think you have joint hypermobility or HSD based on the abovementioned criteria, it is best to consult with a specialist for you to get an accurate diagnosis and necessary care.
Joint hypermobility is generally recognized as a condition arising from abnormalities in the genes responsible for producing collagen.
This protein’s primary function is to provide support, structure, and strength to the body’s connective tissues. Decreased collagen fiber density leads to the excessive flexibility of joints and hypermobility.
In addition to genetics, experts believe that environmental factors also play a role in the development of hypermobility. A person’s conditioning and the trauma, infection, and inflammation sustained throughout their lifetime can lead to joint hypermobility.
It is still unclear why some people’s hypermobility is asymptomatic while others’ are accompanied by painful and serious symptoms.
Asymptomatic hypermobility can even develop into HSD later on. Some experts believe that this ‘crossing over’ into a more severe form of the condition is simply the body becoming unable to cope with the strains of joint hypermobility over time.
What makes HSD, hEDS, and other hypermobility-related disorders fascinating are the myriad comorbidities that come along with them.
It appears that collagen deficiency not only results in musculoskeletal and skin complications, but also autonomic, gynecological, gastrointestinal, and neurodevelopmental issues.
Autonomic dysfunction is one of the key complications associated with hypermobility syndromes. Dysautonomia happens when the autonomic nervous system is unable to regulate automatic bodily functions, leading to chronic pain, orthostatic intolerance, and fatigue.
Among women with a hypermobility disorder, gynecological issues such as pelvic floor weakness, menorrhagia (menstrual bleeding lasting more than seven days), and dysmenorrhea are common.
Gastrointestinal problems are also prevalent among people with hypermobility disorders. A review of studies on hEDS found that individuals with the syndrome usually experience abdominal pain, constipation, diarrhea, and even gut-brain interaction disorders.
Furthermore, new research is discovering that hypermobility is also highly associated with neurodivergence. A nationwide cohort study has found that individuals with EDS are 7.4 times more likely to have autism spectrum disorder (ASD) than a comparison group.
Although asymptomatic joint hypermobility does not come with the abovementioned complications, it still presents dangers to those living with the condition.
Even just one joint with hypermobility can cause awkward movement patterns affecting other joints. When not corrected early, these minor biomechanical alterations can ultimately lead to more serious musculoskeletal issues.
For instance, the hypermobility of the subtalar joint in the feet causes flexible flatfoot. This condition can lead to a weird gait and, later on, knee and back pain.
Joint pain and dysfunction can also lead to kinesiophobia, the fear of movement due to feeling vulnerable to pain and injury. Avoiding physical activity leads to deconditioning, further leading to fatigue and increased pain.
With hypermobility also comes decreased proprioception, which is our ability to sense our body’s position in space. This impairment increases the risk of injury, as good proprioception is required to react quickly to changes in our joints’ and limbs’ positions.
For those unaware of the abovementioned risks of asymptomatic joint hypermobility, the increased bendiness from the condition may be considered an asset and not a liability.
True enough, hypermobility can be advantageous to sports that favor (and even require) exceptional flexibility. These activities include dance, gymnastics, swimming, and diving. Record-breaking Olympians Michael Phelps and Simone Biles are testaments to these gains.
Some research also backs this assumption. According to a study, the looseness of hypermobile individuals’ joints affords protection against ligament and joint sprains.
Various studies also found no increased risk for injury amongst hypermobile individuals engaging in sports.
However, it’s important to take these findings with a grain of salt. With the shortcomings of the current tools for measuring hypermobility, it can be difficult to say with certainty how the condition affects athletes. Self-reported data also muddle study findings.
Furthermore, research on the correlation between hypermobility and sports injury is a mixed bag. For every article stating that hypermobility has no impact on injury rates, there is another claiming that it does.
One insight we can glean from the heterogeneity of these studies’ results is the need for individualized care for each hypermobile athlete. With 360 joints in the body, there is almost no end to the number of configurations of hypermobility a person can have.
Thus, consultation with an expert is crucial in determining the safety of a specific sport for a hypermobile person. Because for sure, improper training techniques can exacerbate the symptoms of hypermobility and worsen the condition.
While there is no cure for hypermobility, proper management can alleviate symptoms and support the normal functioning of hypermobile individuals.
A cornerstone in the management of hypermobility is physical activity and therapy. Most practitioners recommend strengthening the muscles around joints for support.
While this suggestion isn’t bad, it fails to get into the crux of hypermobility, which is a deficiency in collagen fiber density.
Instead, I highlight the role of the fascia—the largest connective organ in the body—in hypermobility.
The fascia is a three-dimensional continuum of connective tissue that encases, separates, and supports all of our cells and muscles.
Impairment in collagen leading to a more compliant fascia is the likeliest cause of decreased proprioception and chronic pain amongst hypermobile individuals.
Why? Because our fascia contains the most amount of proprioceptors than any other sensory organ. Our fascia also covers other organ systems—which may be why hypermobile persons feel pain beyond the musculoskeletal system.
Because we are only beginning to understand the depth of the fascia’s role in our bodies, there are limited studies to confirm these hypotheses. However, a few promising studies note the link between fascia mobility and hypermobility disorders.
In sum, hypermobility is a prevalent condition that affects one’s health, athletic performance, and quality of life. Many people go through life without realizing they have hypermobility, causing their condition to deteriorate over time.
If you suspect that you have hypermobility, your best course of action would be to consult with an expert to test for the condition and get the appropriate care.
Decades of working with people with hypermobility has taught me that restoring fascia to a healthy state is a great way to manage the condition and its symptoms. Rev6 exercises, in particular, are revolutionary in reorganizing your fascia to help you live a healthier, pain-free life.
Get started by scheduling an appointment with me through this link: https://rev6.fit/dr-edythe-heus/.
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