Have you ever heard someone say they are double-jointed; perhaps you are even double-jointed? This can bring up images of circus performers and gymnasts contorting their bodies in inhuman ways. This can cause questions regarding normality? Could it be harmful? Or is it normal?
What is Hypermobility?
The best way to think about joint hypermobility is to visualize where joints move beyond the normal limits. Singular joints can be affected by trauma, but having multiple joints affected can be caused by an internal reason. A common colloquial term for hypermobility is “double-jointed” or “loose-joints.” Hypermobility can be caused by a genetic mutation of a protein in collagen. Collagen is found throughout the body; it helps hold the joints together, holds the organs in place, and is located in the walls of the blood vessels. For the most part, people do not have any issues and live long and healthy lives and in fact can be a benefit to ballet dancers, contortionists, and gymnasts. However, it can cause problems for others with symptoms of:
- The clicking of the joints
- Joints too easily dislocate
- Extreme fatigue
Due to the required extra effort to focus on keeping the joints from going beyond the normal range of motion and musculature involvement.
- Recurrent injuries
- Digestive issues
It can fluctuate between constipation and diarrhea.
A rare complication can be median arcuate ligament syndrome (MALS), which can cause delayed gastric emptying, which leads to symptoms of nausea and vomiting.
- Dizziness and fainting
This can be due to the poor integrity of vessels leading to changes in blood pressure when moving from a sit to stand, or when out in high temperatures called postural orthostatic tachycardia syndrome (POTS).
- Skin abnormalities
Skin can have challenges healing with increases in scaring.
The skin can also hang loosely from the muscle tissue.
When this occurs, it is known as joint hypermobility syndrome (JHS). The weaker the collagen, the more symptoms of hypermobility will be present, and this is called Ehlers-Danlos Syndrome (EDS). EDS has 13 different individual subtypes, all with a unique clustering of symptoms that requires a geneticist to diagnose.
In the research, hypermobility has been reported to be found in about 3% of the population. This sounds small, but there are significant issues with under-reporting because each person with hypermobility presents with different clusters of symptoms. It is more common in females than males with no apparent reason.
How to recognize it
Hypermobility is diagnosed using symptoms reported combined with a physical exam. The most common system used is Beighton scoring system. This assesses five areas of the body:
Knuckles of pinky fingers
Base of both thumbs
Elbows
Knees
Spine
There is a total of nine points possible, depending on the age of the patient. Children are generally more flexible, so a score of 6 is required for hypermobility, verses an adult up to 50 years old require a score of 5. For adults over 50, the score is a 4. If you are in doubt, follow up with a medical provider.
Who needs to be on the Healthcare team
Since there may be more going on then just joint hypermobility, it may be beneficial to assemble a team of providers to support your overall well-being. There is not one medical provider that can care for the symptoms. It is essential that all members of the team to be trained, or at least be familiar with hypermobility disorders and Ehlers-Danlos syndromes. Trying to decide who is on the team can be a challenge as there are over 65 types of healthcare providers.
Here is a basic list to start with:
- General Practitioner
This can be the most important one as it can be the key to communication between the other providers. They could be a family provider or an internal medicine specialist.
- Cardiologist
Management and diagnosis of the symptoms of fainting or heart palpations.
- Gastroenterologist
Management of any digestive concerns.
- Medical Geneticist
They can help determine the cause of the hypermobility.
- Physiatrist
To assist with physical medicine and rehabilitation and possible orthotic bracing.
- Chiropractor
or pain management
- Physical Therapy
Stability Exercise
This is not an all-encompassing list but an essential list to start, and it's based on the listed symptoms presenting. This isn’t to overwhelm anyone that has no symptoms and is going through life normally. If you are having issues, this could be how you get to the bottom of it.
Hypermobility & Pain
We learned that hypermobility can cause pain back in the 1960s. There is curiosity as to why it causes pain in some people and no pain in others as there are ballet dancers and gymnasts who clearly have complete control of the body and yet can bend beyond the standard motion. This comes down to the strength of the muscles around the joint. Dancers and gymnasts are some of the strongest people in terms of complete body awareness.
Repetitive joint dislocations can cause pain and the muscle spasms when trying to find stability. An individual with generalized joint hypermobility with pain in 4 or more joints for three months or more could be diagnosed with chronic pain. Within care concerning pain due to hypermobility, it is vital to set expectations and keep those expectations reasonable. It may not be feasible to be pain-free, but to get to the point of functionality, and able to complete both mandatory tasks and fun activates, is reasonable.
Best Care Options
With hypermobility disorders, it is all about developing stability. Hypermobile patients need to focus on exercises to strengthen the muscles around the joint. Without strength, the muscles will spasm to achieve stability, which will cause pain. People will need to learn what normal range of motion is for each joint to avoid hyperextension. Utilize protective equipment for the joints during physical activity by using padding or braces. And see a Physical Therapist or trained Chiropractor in order to have a detailed joint strengthening program developed for you. It is essential to understand frequent adjusting can make the pain and instability worse if not paired with exercises.
Despite this high prevalence, due to lack of awareness, consistent clinical presentation, and our current reliance on physical examination for diagnosis, it is mostly overlooked by primary care physicians as well as by specialists. This is why this has become a personal mission of mine to ensure that if someone comes to me in pain that I have appropriately screened every patient that comes into the clinic.
Ultimately, hypermobility is a normal variant of human physiology. It is important to avoid excessive joint motions and hyperextensions. As time goes on there can be damage to the joints in the long run. Please follow up with a provider before there are issues to learn how to control your body safely.