Hypermobility

This is a very informative article by Jen Guest from Smart Health Training and Services. It is detailed, could be a bit confronting, but also offers ways to help children who have hypermobility. Jen is a physio and pilates teacher at Smart Health so she certainly knows her stuff!

Hypermobility is where the joint range of movement that exists is beyond that of normal. This may occur in one or more joints and is commonly, though not exclusive to, the elbows and knees. 5% of the population have at least one hypermobile joint. It is a little more prevelant in females, younger people and the Asian backgrounds.

Hypermobility is caused by;

Shallow bone ends leading to poor joint congruency

Poor joint proprioception

Hypotonia (low tone in muscles)

Protein deficiency and Hormonal changes causing structural changes in the collagen that builds the ligaments. Proteins such as Elastin and Relaxin

Connective tissue disorders such as Marfan’s Syndrome, Ehlers Danlo’s Syndrome, Osteogenisis Imperfecta)

The concerns with the more extreme cases of hypermobility are recurrent strains, dislocation and subluxation and possibly damage to joint capsules, labrum or cartilage. There may even be increased anxiety with the fear of recurrent dislocations leading to abnormal movement patterns. A study in 2003 indicates that there is an association between hypermobility and orthostatic intolerance, leading to chronic adrenalin release and increased anxiety levels. (Gazit etal. American Journal of Medicine 2003)

Due to the increased neutral zone at the hypermobile joint, the intrinsic muscles are relatively inefficient in maintaining a level of joint control. As a result, the extrinsic muscles tend to be overactive and global guarding may occur. This can lead to muscle fatigue and possibly connects to Chronic Fatigue Syndrome.

Benign Hypermobility Joint Syndrome is a common condition in children where they report pain and discomfort. It is where they experience daytime soreness, night time awakening and discomfort after exercise. It is commonly described as growing pains. The discomfort often reduces as the child ages and their soft tissues shorten, becoming relatively tighter and thus helping to stabilize. The condition is described as benign to differentiate from hypermobility conditions that involve organs such as ears and heart.

The tests for hypermobility include;

Fingers flex back beyond 90 degrees

The thumb can be pulled back to the forearm

The elbows and knees extend beyond 10 degrees extension

The hands touch flat to the floor in forward bend

The lumbar spine hyperextends

Treatment options for the hypermobile client include stabilizing the joints, thus Pilates is ideal. We can also offer taping, bracing and splinting. Medication such as anti inflammatories are useful for symptom relief.

In extreme cases, Prolotherapy may be prescribed. Proliferation therapy where saline, glucose or protein rich plasma is injected into the joint space, ligaments of tendons to create an irritant and set of a sticky inflammatory process thus stabilizing the joint.