Hypermobility simply means a joint that goes beyond the average range of motion - for example, someone who stands with hyperextended knees or “double jointed” elbows. Recent increased awareness around this topic has shown that hypermobility is more common than previously thought. Some estimate 1 in 10 people present as hypermobile. Although everyone with increased mobility does not experience pain, a percentage of this group do suffer from chronic or recurring pain - aptly labeled: Symptomatic hypermobility.
Symptomatic hypermobility is a widely under recognized condition, but seen prevalently in the physical therapy setting due to its close link to chronic pain and injury. Significant connective tissue disorders such as hypermobile Ehlers-Danlos Syndrome and Marfan’s Syndrome are included under this umbrella; however, it also encompasses people with milder forms of connective tissue variances. Hypermobility can lead to multi-system complaints which make diagnosis difficult, and as a result, many people with symptomatic hypermobility make it well into adulthood without knowing their increased mobility is to blame for their myriad of seemingly unconnected issues.
Diagnosing Symptomatic Hypermobility
Currently, there are very few validated scales for testing joint laxity or hypermobility. One of the most widely used outcome measures is called the Beighton Scoring System. The test is limited as it only assesses the flexibility of 5 different joints in the body (thumbs, elbows, knees, pinky fingers, and spine). Furthermore, the final score indicates simply the number of joints affected – not the extent of laxity. The good news is hypermobility is getting more attention in the recent years. As a result, Doctors of Physical Therapy Aiko Callahan, Stephanie Greenspan, and Annie Squires recently developed the Hypermobility Screening Tool - a comprehensive self-reporting screening tool designed to efficiently gather information across multiple body systems to better guide treatment.
What causes hypermobility?
The consensus is that hypermobility is a genetic disorder of the connective tissue. Specifically, the genes that are involved in creating collagen are believed to play a role. Because it is mostly familial, if your mother or father has hypermobility, there is a 50% that you do as well. There is also a possibility of de novo mutation – where hypermobility does not run in your family, but you could have a new mutation.
Signs and Symptoms of Hypermobile Individuals
The following list demonstrates the systemic effect of hypermobility spectrum disorders. Please note this list is not by any means exhaustive and you do not need to have all of the symptoms listed to have symptomatic hypermobility.
Musculoskeletal:
Increased flexibility
Temporomandibular joint disorders
Increased back and sacroiliac joint pain
Neurological:
Headaches
Dysautonomia/POTS
Carpal tunnel syndrome or thoracic outlet syndrome
Gastrointestinal:
Abdominal pain
Acid reflux
Irritable bowel syndrome
Nausea
Constipation
Psychiatric:
Anxiety
Depression
Insomnia
Other:
Pelvic pain
Incontinence
Chronic fatigue syndrome
Exercise intolerance
Why does Hypermobility cause Chronic Pain?
Multiple factors play into why there is a higher prevalence of chronic pain in this population. A commonly accepted theory is that less stability at the joints leads to more stress on the structures that support that joint creating microtraumas over time. Not only may you experience more trauma, but being lax has been linked to decreased muscle strength, decreased awareness of where you are in space, and overall increased prevalence of injuries.
Another purposed mechanism of action for chronic pain is called central sensitization. Central sensitization occurs when the brain becomes overreactive and sends signals of pain at a lower threshold. Sometimes people even continue to experience pain after the mechanism that caused the pain is gone. If you have a history of multiple injuries due to laxity, your nervous system may have become upregulated in this heightened state.
Getting Relief and Preventing Problems Down the Line:
Hypermobility spans many body systems. Because every individual with symptomatic hypermobility presents with different issues, your team will need to be specific to your needs. The following lists some providers who may be helpful in managing your health and symptoms:
Pain management specialist
Nutritionist/Dietitian
Dentistry/sleep specialist/TMJ specialist
Cardiology
Neurology
Psychology
Gastroenterology
Allergy/immunology
Urogynecology
Health/Wellness/Life coach
Social work
Orthopedics
Functional medicine/integrative medicine
Physical and occupation therapy
How does a Physical Therapist Help People with Increased Mobility?
While we cannot change genetics, physical therapists are a great resource for people with joint laxity or hypermobility.
A physical therapist who works with people with hypermobility can:
Decrease pain through techniques such as massage, dry needling*, soft tissue work
Optimize posture and movement patterns to rely less on passive structures like ligaments, and more on the muscles and good structural alignment
Enhance muscle activation and body awareness through biofeedback, taping techniques, and bracing
Help improve central sensitization and decrease anxiety around movement through visualization and graded exercise
Improve exercise tolerance through graded exercise, optimizing movement, and utilizing appropriate rest
Decrease gastrointestinal distress and constipation through visceral manipulation* and education
Improve pelvic pain and health with pelvic floor physical therapy*
*Denotes that the physical therapist requires a certification or additional training to specialize in this area of expertise.
It is important to find the right physical therapist for you. If you cannot find a physical therapist who specializes in hypermobility in your area, find someone who is compassionate and willing to learn and collaborate with you on your healing journey.
If you are struggling with symptoms of hypermobility, connect with us for free to find out if House of Balance Integrative Health and PT can help you.
References:
To learn more about the Beighton Scoring System, click on the link below:
To learn more about the Hypermobility Screening Tool, click on the link below: