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Joint Hypermobility is a condition in which joints can be moved beyond the normal or expected range of movement – sometimes referred to as being double jointed. When Joint Hypermobility affects multiple joints in the body, it may be due to a systemic condition causing excessive mobility of the connective tissues which bind the body together, including ligaments, tendons, muscles, skin, blood vessels and the gastrointestinal tract.
The condition does not necessarily cause pain in and of itself, in fact it may be an advantage to have extra flexibility, for example, many dancers and gymnasts are hypermobile. However the disadvantage is that extra flexibility may result in poorer stability, a difficulty in sensing the position of joints (reduced proprioception) and a susceptibility to injuries such as joint sprains or dislocations along with slower recovery.
Joint Hypermobility Syndrome, sometimes called Benign Joint Hypermobility Syndrome (BJHS), refers to a group of conditions in which Hypermobility occurs along with chronic pain (pain lasting more than 3 months) and affects multiple joints. It has been recognised condition since 1967.
Joint Hypermobility Syndrome has been under recognised and under treated by health professionals and the medical establishment, though awareness of the condition is growing. Because people with JHS may exhibit a good range of movement even when they are in severe pain, their pain may have been ignored or trivialized at times. It may even have been implied that they are exaggerating or imagining the pain or that they are just suffering from anxiety.
Joint Hypermobility is often hereditary, so if you have very flexible joints, it’s likely that one or both of your parents do also. It’s more common in women and in children and adolescents.
Problems with proprioception and sometimes coordination can lead to frequent injury. Recovery from injury is often prolonged, due to recurrent re-injury of the healing tissues. Re-injury may occur without the person realising that it’s happening at the time, such as during periods of prolonged poor posture. A person with hypermobility usually has greater than average spinal movement for example, so can slouch even more fully than someone who is relatively stiff, putting the spinal discs under great pressure.
More serious causes of Joint Hypermobility include several genetic conditions such as Ehrlers Danlos Syndrome (which may cause fragile skin, easy bruising, heart, vascular and lung disorders) and Marfan Syndrome (which may cause skeletal abnormalities, eye, vascular, heart and lung problems). For this reason, people with Joint Hypermobility who have other symptoms are advised to consult a knowledgeable physician for a thorough medical assessment.
Lack of joint stability may result in having to work harder in the muscles to hold yourself up against gravity, so people with Joint Hypermobility may find prolonged sitting and standing extremely difficult. This can lead to slouching along with painful overuse of the superficial muscles, along with limited activation of the deeper ‘core’ muscles that would normally assist with balance and stability. The result can be feeling tight and stiff all over, however stretching (for example yoga classes) may exacerbate the problem by increasing joint mobility.
Varicose veins, hernias, pelvic organ prolapse, irritable bowel syndrome, stretch marks and scarring, snapping or clicking joints, scoliosis, fibromyalgia, osteoarthritis, pronated feet, fatigue, anxiety and depression are conditions which may be related to and co-exist with Joint Hypermobility. Conditions which affect the autonomic nervous system, including palpitations, dizziness, fainting and excessive sweating are also more common in people with JHS.
Regular physical activity, especially during the teenage years when the body is growing quickly, assists the development of a strong and healthy musculo-skeletal system that is resistant to injury. However with JHS pain can cause avoidance of exercise and physical de-conditioning. In the long term this can result in more pain. Although rest may be required at times to assist with tissue healing following injury, staying active and improving cardio-vascular fitness, strength, core stability, balance and posture and keystones in the management of JHS.
Recommended exercises include Clinical Pilates, the Feldenkrais Method, swimming, hydrotherapy and Tai Chi. Contact sports and any forms of exercise with a high risk of injury are not advisable for most people with hypermobile joints. The important thing is to find a balance and exercise that is right for the individual. Advice from a Physiotherapist with an understanding of JHS can be very valuable.
There is a is a great new blog site where you can get information and support. Visit Hypermobility Connect.
The Feldenkrais Method is very useful when someone has moderate or severe pain. People with JHS frequently report that they don’t feel pain during physical activity, they only feel it afterwards, when it is too late to change the way in which they move.
Feldenkrais helps you become more aware of small discomforts, before they develop into pain, so that you can stop and change the way you are doing something. Because it is so gentle even people with severe pain can participate in one-to-one Feldenkrais sessions, with view to progressing to classes, where they can gain greater independence and freedom from pain. Through gentle movement lessons, participants clarify their ‘self image’ – the detailed map of the body, which everyone has in their brain. Improved body awareness and proprioception reduces the frequency and severity of re-injury, allowing the body to repair the damaged tissues.
Clinical Pilates can assist teenagers and adults with JHS and mild to moderate pain to safely improve their body awareness, posture and strength, promoting a return to more vigorous forms of physical exercise. Individual assessment is essential prior to commencing our programmes.
