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What Is the Hypermobility?
The capacity to move joints beyond their usual range of motion is described as hypermobility in the medical community. Joint hypermobility is a widespread occurrence among the general public. It may be limited to a few joints, or it may be prevalent throughout the body. It tends to become less severe as one gets older. Although many people have no medical ramifications, joint hypermobility is widespread and seldom manifests itself in symptoms. Hypermobility can even be regarded as a benefit in some situations; for example, athletes, gymnasts, dancers, and singers may be expressly chosen for their ability to move more freely than the average person.
What Are the Hypermobility Syndrome?
Hypermobility may be related to joint and ligament injuries and discomfort, exhaustion, and other symptoms in a tiny percentage of the population, rather than being beneficial. A more underlying severe ailment, such as osteoarthritis, can manifest itself as hypermobility, and these conditions are frequently handed down down the generations. Heritable Disorders of Connective Tissue are the medical term for these disorders (HDCT).
We use the term “hypermobility syndromes” to refer to a subset of HDCT in which symptomatic hypermobility is now recognized as a common characteristic. There are several types of hypermobility syndromes. The most prevalent is Joint Hypermobility Syndrome, also known as Hypermobility Spectrum Disorder (HSD), which used to be considered by many specialists to be on the same spectrum as hypermobile Ehlers-Danlos syndrome (hEDS). Aside from the classical (cEDS) and vascular (vEDS) varieties of Ehlers-Danlos syndrome, HDCTs also include Osteogenesis Imperfecta and Stickler syndrome, both present in varying degrees in different ways people.
What Is the Source of Joint Hypermobility?
Some believe that persons with hypermobile joints have stretchier elastic tissues in their bodies, notably in their muscles and ligaments than people who do not have hypermobility joints. Persons differ significantly in their stretchiness,’ and hypermobility is most likely just the stretchiest subset of a large but typical group of people with this trait.
Nobody knows why certain children and adults with hypermobile joints experience unpleasant symptoms, while the majority do not, although these children and adults may have the most elastic tissues of all. A variety of other characteristics, such as more relaxed muscles at rest than the norm, may also have a role. In addition, there may be inherent variances in the way bone joints are structured, resulting in some people’s joints having wider ranges of motion than those of others.
What Is the Prevalence of Joint Hypermobility?
Joint hypermobility and hereditary susceptibility disorders (HSDs) are extremely frequent in children of school age. Everyone may recall students who could easily perform ‘the splits’ and others who could not do so despite their best efforts. Young adolescent girls are more likely than young teenage boys to have hyper-flexible joints, with up to 4 in 10 being female and 1 in 10 being male. The majority of these youngsters, on the other hand, do not experience any discomfort.
Approximately one in every ten children with hypermobile joints will suffer discomfort during physical activity, referred to as a hypermobility spectrum condition. Most people will recover with help and graded exercise, but a minority will find it more difficult to recover. Some children experience pain, although the majority do not, for reasons that are now unknown.
How Are Different Joints Affected by Hypermobility?
- A backward angle can be formed by extending the elbow joint.
- If the thumb contacts (or almost touches) the forearm, the wrist can be flexed to accommodate this.
- Hypermobile fingers may be retracted to a maximum of 900 degrees.
- The joints in the fingers and thumbs also bend in the opposite direction.
- Because of the increased flexibility in the fingers, the hands become less stable, requiring the muscles to work much harder while gripping, lifting, and manipulating items.
- Increased flexibility in the connective tissue has also affected the hips, spine, and ankles.
- When a kid is sitting flat on the floor, their legs fall out to the side, especially if the child is exceptionally young.
- The infant may have flat feet, mainly if the hip muscles are tight and the ankle muscles are weak.
Who Is Affected With Hypermobility?
Any person of any age can be affected by hypermobility. When compared to boys of the same age, girls’ joints tend to be more mobile (looser). Pain is reported more frequently by younger children. Teens may have fewer symptoms due to the tightening and strengthening of their muscles and joints as they get older.
When large groups of pupils are tested, up to 40% of them have the condition. In this group, around 10% of the youngsters develop hypermobility, which can cause discomfort after activities or at night. Some youngsters experience this discomfort while others with similarly lax joints do not experience pain, or swelling is a mystery.
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What Physical Symptoms Do the Hypermobility Syndromes Have in Common?
The majority of people who suffer from hypermobility syndromes are only mildly affected. The goal of health and social care professionals and voluntary organizations that work with people who suffer from these conditions is to encourage them to overcome obstacles through problem-solving and maintaining physical strength. People with hypermobility syndrome can lead relatively normal lives if their illness is effectively treated and they receive appropriate assistance.
On the other hand, some Heritable Disorders of Connective Tissue are associated with complicated and multi-systemic issues. Also becoming more well recognized is the fact that certain persons with milder versions of the hypermobility syndromes might have additional issues beyond hypermobility and discomfort, such as autonomic abnormalities.
HDCTs affect the connective tissue proteins in the body, responsible for the body’s intrinsic toughness. A person’s joints are lax because their connective tissues, particularly their ligaments and tendons, are looser and more elastic than those of a healthy person (soft tissues). Because their joints may twist and extend easily, hypermobile persons can easily harm the soft tissues around their joints, and their joints may partially dislocate (or’sublux’), or in rare circumstances, completely dislocate their joints. However, although most hypermobile persons heal from an injury (albeit at a slower rate than the general population), some partially recover or continue to regularly harm various portions of their bodies.
As an effect of structural flaws in the body’s connective tissue proteins, micro-traumas, typically not evident on tests such as magnetic resonance imaging (MRI), can occur again in the same region of connective tissue without entirely healing. It is possible that an injury linked with the hypermobility syndromes can cause acute pain that will subside quickly, but it is also possible that the injury could result in long-term chronic pain that will be severe and extensive.
Because connective tissue may be present in various body sections, the skin and internal organs may also be impacted. It is possible for certain people that this will result in additional difficulties with the gastrointestinal system, the autonomic nervous system, and problems with bladder function.
It is possible for persons suffering from hypermobility syndrome to have significant differences in the intensity of their symptoms, the impacted joints, and the amount of pain and exhaustion they are experiencing from one day to the next. These symptoms might make it challenging to go about one’s everyday life, school, or work. The resulting pain can become extensive and persistent, and it may first be misdiagnosed or mistaken with another disorder known as fibromyalgia, a kind of chronic fatigue syndrome.
One of the most prevalent symptoms is extreme exhaustion that remains after enough rest or a good night’s sleep. Aside from this, early muscular exhaustion may be induced because muscles must work hard to maintain joint stability. The fatigue associated with the hypermobility syndromes can be readily mistaken with the fatigue associated with a disorder known as Chronic Fatigue Syndrome, also known as Myalgic Encephalopathy (ME). It is critical to obtain the correct diagnosis since the treatment method, such as physiotherapy, occupational therapy, and pain management, may change depending on the diagnosis.
Infants with joint hypermobility are frequently delayed in their development of sitting, crawling, and walking skills.
Infants with joint hypermobility are frequently late to learn to crawl and, in some cases, may not crawl at all, preferring to move around on their bottoms instead. They take a long time to pull themselves up to standing and frequently do not walk until they are 18 months old.
Hip hypermobility is a condition in which infants frequently lay, sit, and stand with their hips wide apart. In turn, this leads to tension in the hip muscles, which has a long-term effect on the child’s motor function and is frequently the underlying cause of back and knee discomfort in children with GJH.
Diagnosis
Simple tests may determine whether or not a youngster has a larger range of motion in their joints than is usual for their age. Doctors utilize a variety of particular mobility tests, including the following:
- Using the wrist and thumb, the forearm may be brought into contact with the wrist and thumb.
- The tiny fingers may be stretched further back than 90 degrees in each direction.
- While viewed from the side, the knees appear to be unnaturally bent backward when the person is standing.
- When the arms are completely extended, they bend more than they usually would (beyond straight).
- A toddler or adult can place their palms flat on the floor by bending at the waist and keeping their knees straight.
Because the symptoms of hypermobility can often be mistaken for arthritis, you may need to get your kid-tested to ensure that they do not have a more severe condition (such as juvenile arthritis or other inflammatory conditions).
A sensory processing disorder (SPD) diagnosis is frequently given to children with joint hypermobility. Many of the concerns associated with having slack joints and a frightening disposition are attributed to sensory processing disorders. Specifically, suppose your child has been diagnosed with SPD and joint hypermobility. In that case, it is essential to ask the treating occupational therapist to explain how issues such as weakness, poor stamina, loss of flexibility in specific muscles, and anxiety and avoidant behavior will be addressed as part of the treatment plan.
Treatment
Simple things, such as the following, can aid with this condition:
- Exercise: The muscles surrounding loose joints should be strengthened whenever possible. Splints, braces, and tape are options that doctors offer to protect damaged joints while participating in physical activity.
- Protection for the joints: Using the following suggestions, your kid will be less likely to overstretch their hypermobile joints:
- Do not sit cross-legged with your knees bent on the floor (“Indian style”).
- When standing, slightly flex the knees to increase stability.
- Put on shoes that provide strong arch support.
- Discontinue any odd joint motions that hypermobile youngsters are known to perform to amuse their peers.
- Medications: These do not fix loose joints. If you have discomfort after exercising, talk to your doctor about using over-the-counter anti-inflammatory medications such as naproxen or ibuprofen.
What Role Does Physiotherapy Play in the Treatment of Hypermobility Syndrome?
The supporting ligaments in the joints of some children with hypermobility syndrome will gradually become stronger over time, allowing them to grow out of the issues they are experiencing. Other children may experience chronic issues, and the team of professional Paediatric Physiotherapists and Occupational Therapists can assist in reducing the consequences of hypermobility syndrome by doing the following:
- in individual intervention sessions, delivering an exercise regimen to develop muscular strength and endurance, therefore supporting the joints;
- implementing particular arm and hand workouts to enhance muscle strength and endurance will ultimately result in greater joint stability.
- aid in maintaining core stability and good posture
- suggestions for gross motor development
- help with developing stronger gross motor skills if you are having difficulty
- Advice and assistance in improving the quality and performance of fine motor skills, particularly handwriting, are provided.
- give recommendations on how to stretch out tight muscles
- Administration of the combined use of technology and writing duties in the classroom.
- shoe-wearing recommendations or referral to a Podiatrist if deemed essential
- splinting
- give guidance on the forms of exercise and sports that are suited for each individual.
- Advice on suitable pain management strategies, such as the use of heat or ice, is provided.
- Retaining muscular strength and good posture into maturity, as determined by frequent posture examinations, reduces the chance of injury and chronic discomfort throughout adulthood.
- In addition, offering guidance on minimizing variables that may exacerbate symptoms, such as excess weight.
- The implementation of a home program
- referral to a medical professional if there is any doubt about the severity of the hypermobility; and
- using assistive technology like pencil grips and built-in cutlery handles to aid with proper joint posture and to lessen tiredness and pain while doing activities of daily life.
JHS Prognosis
The majority of the time, joint hypermobility syndrome does not have any long-term repercussions. Hypermobile joints, on the other hand, can cause joint discomfort. Joint hypermobility can eventually develop into degenerative cartilage and arthritis due to repeated stress on the joint. Certain hypermobile joints, such as damaged ligaments, might be more vulnerable to harm.
Which Type of Specialists Treat Hypermobility Syndrome?
Doctors specializing in treating hypermobility syndrome include general practitioners, family practitioners, internists, rheumatologists, orthopedists, physical therapists, and occupational therapists.
Are There Any Differences Between Joint Hypermobility and Ehlers-Danlos Syndrome?
We now refer to hypermobility spectrum disorders (HSDs) rather than joint hypermobility syndrome because everyone has a unique experience with the condition. Some people are incredibly adaptable – they experience no discomfort and expertise, no other challenges in their lives. In contrast, Ehlers-Danlos syndrome, hypermobility type, is a condition that affects the joints (EDS-HT). Additionally, joint hypermobility with persistent pain is caused by this, in addition to the many other more generalized symptoms that it usually produces.
The HSDs are located in the middle of these two extremes. Many people suffer from serious difficulties such as pain, joint dislocations, or repeated common injuries. The symptoms of the two illnesses are quite similar, and their symptoms are incredibly similar. On the other hand, EDS is often at the more severe end of the spectrum and manifests itself in a wider variety of symptoms.
- If a kid has stretchy or flexible joints but does not experience exercise-related discomfort, they are said to have joint hypermobility without pain. This is a distinct advantage for certain youngsters, and it is frequently correlated with athletic prowess in general.
- HSDs is a diagnosis made when the primary or sole symptoms are exercise-related discomfort and joint hypermobility.
- EDS is typically considered the correct diagnosis when a family history of comparable symptoms or problems such as hernias and dislocations.
Is It Possible to Avoid Joint Hypermobility Syndrome?
Because joint hypermobility syndrome is hereditary, there is no way to prevent it from occurring. However, when joint hypermobility syndrome manifests in symptoms, it is feasible to avoid harm and suffering by avoiding trauma and receiving proper therapy.
