How Physiotherapy can help Bendy Bodies

HypermobilityFlexibility
Written By Jordan Craig

Do you consider yourself ‘double jointed?’

Always been able to suddenly fall into the splits as a popular party trick?

Have you had recurrent kneecap dislocations or subluxations?

If you answered yes to any of these, you may be interested in reading on to discover more about Hypermobility.

What is hypermobility?

Hypermobility refers to an individual with above-average movement or flexibility in a joint, affecting approximately 20% of the population. Often referred to as ‘double jointed,’ hypermobile individuals have an increased susceptibility to sprains, dislocations and joint subluxations. Their ligament collagen is more elastic, enabling their joints to have a greater range of motion than usual. When this increased flexibility causes pain in multiple areas, it may be classified as a Hypermobility Spectrum Disorder (HSD). Whilst extra flexibility can be advantageous for specific athletes and artists like dancers, gymnasts, circus performers, musicians, and swimmers, many hypermobile individuals can become fearful of exercise and playing sport.

The most prevalent hereditary connective tissue disorder is likely the hypermobile type of Ehlers–Danlos syndrome (hEDS). It is predominantly observed in individuals experiencing musculoskeletal issues such as joint hypermobility, joint subluxations/dislocations, and various skin and soft tissue symptoms.

It has been reported that 10-25% of children have hypermobility, with girls being more affected than boys. Usually symptoms are more evident between the ages of 13 and 19 years old with ¾ of adolescents presenting with symptoms at 15 years of age (Simmonds, Keer 2007).

It is important to note that hypermobility is NOT the same as flexibility. Flexibility involves muscles and the nervous system and does not relate to joint instability. It is possible to have either flexibility or hypermobility without the other.

What is EDS?

The Ehlers-Danlos syndromes (EDS) are a group of 13 heritable connective tissue disorders. The conditions are caused by genetic changes that affect connective tissue. Each type of EDS has its own set of features with distinct diagnostic criteria. Some features are seen across all types of EDS, including joint hypermobility, skin hyperextensibility, and tissue fragility. 

Symptoms of EDS

Symptoms of hypermobility spectrum involve weakness of the leg muscles, a sense of joint ‘stiffness,’ poor position sense/sense of clumsiness, clicking or clunking sensations, general pain and aching, tiredness, feeling unless, along with joint subluxations (Keer, 2003). However, hypermobility not only affects the physical body but also affects vascular structures, digestive system and can also.

Studies have found that people with hypermobility tend to have higher rates of dysautonomia- dysfunction of the nervous system. This can involve dizziness and fainting episodes. Chronic pain commonly co-occurs in hypermobility disorders and has the best outcome when addressed as early as possible. If you’re hypermobile with chronic pain, you may develop kinesiophobia—the fear of movement—if you begin to become injured easily.

What is collagen and connective tissue?

Connective tissue is distributed all over the body, offering support, protection, and structure to various body parts. Disorders related to connective tissue arise from problems hindering its proper function. Collagen stands out as the main element in connective tissue, with diverse types serving different roles. Conditions like the Ehlers-Danlos syndromes result from genetic alterations impacting the structure and function of collagen and related connective tissue proteins.

Where did the name come from?

The Ehlers-Danlos syndromes (EDS) are named after two doctors, Dr. Edvard Lauritz Ehlers and Dr. Henri-Alexandre Danlos, who described the condition in the early twentieth century. 

Screening for hypermobility

The Beighton score is basic screening tool which is commonly used to identify generalised joint hypermobility. The criteria of the Beighton score was first used to recognize generalised joint laxity in all populations and all age groups. It is a nine-point scale that evaluates five basic manoeuvres of a certain joints and ranges. The first four elements can be given a maximum score of 2, because these are performed on both limbs. The last element is scored with 0 or 1. The maximum score for ligament laxity is 9. There is no universal agreement on a threshold for beign joint hypermobility syndrome, some researchers use a Beighton scale score of 5/9, other researchers use a score of 6/9 and still others use a modified score of 3/9. However a score of 9 is representative of hyperlaxity whilst a score a score of zero represents no generalised laxity identified.

Hypermobility syndrome is diagnosed using the Beighton Score (see below)

  • Can bend left little finger past 90degrees towards the back of the hand

  • Can touch thumb onto the back of the forearm

  • Can bend elbow backwards into hyperextension

  • Can bend knee backwards into hyperextension

  • Can place hands flat on the floor without bending knees

To be classified as hypermobile you must score four out of nine. 

How can physio help me?

There is so much that a physiotherapist that understands hypermobility can do to help with current symptoms and long-term management. Although your ligaments might be less effective at supporting your joints, the muscles that surround the joints can be trained and strengthened to provide the extra support you need. Optimising how you hold your body (particularly in sustained positions) and how you move your body (particularly during repetitive tasks like walking) can also make a big difference, particularly in longer term management of hypermobility. A discussion about your symptoms, including common problems associated with hypermobility is important so your physiotherapist has a good understanding of how your symptoms

A personalized exercise and rehabilitation plan is developed progressively to target postural or movement patterns, enabling the entire body to move more freely. Pain neuroscience education and pain management strategies are also integral components of your treatment plan.

At Back to Bounce Sports Physiotherapy, our physiotherapists can evaluate your joint mobility and other factors related to hypermobility. We understand that hypermobility is not just about increased flexibility but also understand how it can affect an individual’s quality of life. Aching joints, painful muscles, fatigue and other symptoms need to be taken into account when approaching the management of hypermobility from a holistic perspective.

A one on one tailored assessment helps determine the severity of your condition and what strategies can be incorporated to improve function and reduce pain. Subsequently, they will assist you in creating a personalized plan to address any musculoskeletal pain you may currently be facing and collaborate with you on long-term strategies to care for your flexible body.

We coordinate with other members of your allied health team such as specialists and you GP to ensure you are gaining comprehensive care. Providing you with information and education on how to effectively care for your joints to ensure good stability and support of joints is important for long term management and to empower you and equip you with tools.

 How Physio Can Help

Our physios at Back to Bounce tailor a specific plan for your needs and goals

  • We utilise screening assessments to identify hypermobility, provide general advice, and suggest a specific exercise program. We focus on enhancing posture and strength to help manage or prevent musculoskeletal problems from developing.

  • Conduct posture and functional movement assessments to observe the body's overall movement and limb interactions with the trunk.

  • Create a rehabilitation plan to tackle any postural or movement challenges for improved full-body mobility emphasising motor control, stability, and strengthening exercises.

  • Enhance endurance and increase muscle strength to engage in activities that are significant to you.

  • Perform specific joint assessments for various body areas such as the neck, shoulders, back, hips, pelvis, knees, and feet.

  • Implement pacing and personalised exercise progression to help reduce instances of pain flare-ups.

  • Provide guidance on how to advance techniques for the gym and sports activities.

  • Give advice on lifting and executing exercises safely and correctly.

  • Coordinate with your GP, Specialists, and other members of your multidisciplinary team for comprehensive care.

Conclusion

Hypermobility syndrome is a complex, under recognised inherited connective tissue disorder often resulting in pain and withdrawal from sport and physical activity. Physiotherapists working alongside other members of the multidisciplinary team have an important role in both the identification and management of the condition. At Back to Bounce Sports Physiotherapy, we endeavour to keep people moving and feeling confident with movement. If you, or someone you know may have hypermobility spectrum disorder, seek guidance and a professional treatment plan.


If you would like to make an appointment to gain a plan for your physiotherapy management of hypermobility, you can book online or call our team on (07) 5378 1571.

Jordan Craig
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