Joint Hypermobility Syndrome: Diagnosis, Causes and Pain Management.

Joint Hypermobility Syndrome Definition

Joint hypermobility syndrome ( JHS ) is a condition of the articulations that have a range of motion wider than the physiological one.
Patients affected by joint hypermobility syndrome have very flexible joints and generally, it causes pain and stiffness in the joints and muscles.
However, being hypermobile does not necessarily mean you will have any pain or difficulty. If you have symptoms, you likely have joint hypermobility syndrome (JHS).

Diagnosis of Joint Hypermobility Syndrome

During my career as a Physiotherapist and Sports Therapist, I met many athletes and people referring to being affected by joint hypermobility but only a few of them had a really JHS.

To be diagnosed with JHS an individual have to be thoroughly assessed.

The Beighton Score is often used as a quick test to assess the range of movement in some of your joints.

The Beighton score consists of a series of five tests, the results of which can add up to a total of nine points.

The score is worked out as follows:

  1. one point if you can place your palms on the ground while standing with your legs straight.
  2. one point for each elbow that bends backward.
  3. one point for each knee that bends backward.
  4. one point for each thumb that touches the forearm when bent backward.
  5. one point for each little finger that bends backward beyond 90 degrees.

If your Beighton score is four or more, it is likely that you have joint hypermobility.

 

However, this cannot be used to confirm a diagnosis, because it is important to look at all the joints.

Your GP may also carry out a blood test and X-rays to rule out other conditions associated with joint pains, such as rheumatoid arthritis.

If you have other symptoms in addition to hypermobile joints, your GP may carry out a further assessment of your condition using the Brighton Criteria, which can help determine if you have joint hypermobility syndrome (JHS).

The Brighton criteria take into account your Beighton score, but also consider other symptoms, such as joint pain and dislocated joints, and how long you have had them. 

Causes of Joint Hypermobility Syndrome.

Joint hypermobility syndrome is due mainly to weak ligaments that make your joints lose and stretchy.

The weakness is that collagen, which strengthens the ligaments, is different from other people’s. 

If the structure of your collagen is altered, it may not be as strong, and the tissues that contain collagen will be fragile. This can lead to weakened or easily stretched ligaments.

Other Causes of Joint Hypermobility Syndrome:

1. The shape of the ends of your bones.

A joint is a junction between two bones. The shape of the bones determines how far you can move your limbs.

For example, your limbs will be more flexible if the socket that the bone moves around in, such as the shoulder or hip socket, is shallow.

2. Muscle tone.

Children with joint hypermobility may have a degree of hypotonia (low muscle tone), which makes the muscles “floppy” and could mean the child can bend their joints more than usual

3. Sense of your joint movements (proprioception).

You should be able to sense the position and movement of your joints. For example, even with your eyes shut, you should know whether your arm is bent or straight. The medical term for this sense is “proprioception”.

However, some people with joint hypermobility have an abnormal sense of joint movement and can sense when a joint is overstretched, giving them a wider range of movement.

Who has Joint Hypermobility Syndrome?

Joint hypermobility is thought to be very common, particularly in children and young people. 

In many cases, the joints become stiffer with age, although joint hypermobility and its associated symptoms can continue into adult life.

It’s thought to be more common in females than males, and less common in white people than those of other ethnic backgrounds.

Some estimates suggest that around one in every five people in the UK may have hypermobile joints.

Joint hypermobility syndrome can run in families and it cannot be prevented (inherited condition ).

Most experts agree that joint hypermobility syndrome is part of a spectrum of hypermobility disorders which include Ehlers-Danlos syndrome. 

Joint hypermobility syndrome symptoms

The most common symptoms of Joint hypermobility syndrome are:

  • Tiredness, even after rest.
  • Pain and stiffness in the joints or muscles.
  • Recurrent soft tissue injuries – such as sprains and sports injuries.
  • Joints that dislocate (come out of the correct position) easily.
  • Have poor balance or coordination.
  • back and neck pain.
  • Clicking Joints.
  • Dizziness and fainting.
  • Have thin, stretchy skin.
  • Have digestive system problems such as constipation, gastro-oesophageal reflux disease (GORD), and irritable bowel syndrome (IBS).

JHS can cause symptoms that affect your digestive system because the muscles that squeeze food through your digestive system can weaken.

Joint hypermobility syndrome and risk of injury

The nature of JHS means that you are at increased risk of injuries, such as:

  1. Joints Dislocations.
  2. Muscles Sprains.
  3. Sports Injury. 
  4. Increased risk of developing Osteoarthritis earlier in life than usual (Although a link is not entirely certain ).

Managing the condition may therefore also involve treating short-term injuries as they arise while following a long-term treatment plan to manage daily symptoms.

The joints more exposed to this condition are mainly the knee, ankle, and shoulder joints. 

Less exposed to joint hypermobility is the hip joint as it has 2 levels of joint protection:

  1. Ligaments.
  2. Stabilizer Muscles.

Stabilizer muscles, which mainly are missed in the knee and ankle joints, give further protection to the joint in case there is a deficit of the ligament’s function such as in the case of joint hypermobility syndrome.

The photo gallery below shows the hip muscles compartments.

The photo gallery below shows the knee joint’s muscles that misses stibilizer muscles.

Self Care of Joint Hypermobility Syndrome

Please follow these simple tips to manage your Joint hypermobility syndrome:

  1. Ensure you have a generally healthy lifestyle – including having a healthy diet and maintaining a healthy weight; this will help improve the strength of your joints and reduce the strain on them.
  2. Stay as active as you can, but stick to “low-impact” exercises, such as swimming or cycling to reduce strain on your joints.
  3. Apply heat therapy to soothe sore joints.
  4. Painkillers and NSAIDs are also available as gels or sprays that can be applied directly onto painful joints.

If you are not able to manage your symptoms with these tips please seek the help of your GP, Physiotherapist, or Sports Therapist.

Sports Specialists and Physiotherapists could give you a specific exercise program that includes strength and balance training, special stretching techniques, and advice about pacing and body posture.

Is Joint Hypermobility always a bad thing?

Many people with hypermobile joints don’t have any problems, and some people – such as ballet dancers, gymnasts, and musicians – may benefit from the increased flexibility. 

All individuals that think they may have Joint hypermobility syndrome should get a precise diagnosis of it because very often they don’t have the syndrome but only joint hypermobility.

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