Joint Hypermobility Syndrome

Most of us will probably know a few people in our lives who we could describe as being double-jointed – they can do ‘party tricks’ like contorting their bodies, are incredibly flexible, and can move their joints beyond a ‘normal’ range of motion. If that’s the case, the reality is that these people may have a mild form of hypermobility.

General joint hypermobility is not uncommon, often affecting the elbows, wrists, fingers and knees, and carrying no pain or medical complications. For 3% of the population, however, their hypermobility can be more extreme, and a sign of a more serious genetic condition called Joint Hypermobility Syndrome (JHS). JHS is a connective tissue disorder, which is often accompanied by joint pain, joint and ligament injuries, fatigue, and poor balance, alongside many other troubling symptoms.

Collagen And Joint Hypermobility

Collagen is the protein that adds flexibility and strength to your skin, joints, ligaments and tendons, and is otherwise known as the ‘glue’ that holds your entire body together. In people with JHS, their ligaments, which are the thick bands of tissue responsible for holding the joints together and preventing them from moving too much or too far out, are much stretchier and weaker, because there is a defect in the way that their collagen is formed, leaving them with faulty or weak collagen. If you have joints that are far more flexible than normal and it causes you pain, you may be suffering from JHS.

Being diagnosed with JHS can be daunting and confusing, and many people are unsure what the implications are for their overall health and wellbeing, their quality of life, and their ability to participate in work or exercise. Our podiatrists are experienced in working with many patients with JHS to support them in managing their joint hypermobility and any knee, hip or ankle problems that may arise, so they can continue to live and work as normally and safely as possible, and with as little pain as possible. As hypermobility can change over time, working with a trusted podiatrist who understands your unique situation and condition is important to ensure that you are future-proofing your body’s health and protecting your joints against any future injury.

Signs & Symptoms Of Joint Hypermobility Syndrome

The most common symptom of JHS is extreme flexibility and pain in your joints and muscles, but other symptoms can include:

Frequent joint and ligament injuries, including dislocations, subluxations and sprains
Joint and muscle stiffness
Easy bruising
Dizziness and fainting
Abnormal scarring
Thin, stretchy skin
Tiredness/fatigue
Clumsiness/poor balance
Bladder and bowel issues
Clicking joints

Risk Factors For Joint Hypermobility Syndrome

JHS is caused by your genetics – it tends to run in families and is an inherited condition. It is believed that if one parent has hypermobility, one in two of their children will also have it, and the genes that are responsible for creating collagen throughout the body are believed to play a role. Hypermobility can also be influenced by:

Age – the collagen fibres in your ligaments tend to bind more tightly together as you get older, which is why many of us become stiffer with age. Hypermobile people who are very flexible and pain-free when younger may find that they’re less flexible when they reach their 30s or 40s
Muscle tone – the weaker or more relaxed your muscles are, the more flexible your joints will be and the greater range of movement you will have
Gender – women are more likely to develop JHS than men
Ethnicity – people of different ethnic backgrounds have differences in the way their body is built, with people of Asian and West African descent being affected by JHS more often
Research also suggests that if you have autism, attention deficit hyperactivity disorder (ADHD) or Tourette’s syndrome you are more likely to have symptoms associated with JHS

What’s The Diagnostic Criteria For Joint Hypermobility Syndrome?

To be diagnosed with JHS, you will need to visit a podiatrist or other health provider to undergo a physical exam, to assess the range of motion in your joints and discuss your health history and other medical issues. They may also request blood tests to rule out any other possible genetic conditions.

Typically, a questionnaire called the Beighton Hypermobility Score will be used to measure the flexibility of your joints, by asking you to perform certain tasks. You will be asked to try to do exercises such as bend forward and place your hands flat on the floor without bending your knees, bend your thumbs backward to touch your forearms, and bend your little/pinky fingers backwards as far as you can.

As everybody (including people with JHS) experiences lessening flexibility as they get older, you may also be asked how hypermobile your joints were when you were younger. Questions may include, “Can you now (or could you ever) bend your thumb to touch your forearm?”, “As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?” and “As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?”. If you answer yes and are able to do a range of activities displaying extreme flexibility, you may be diagnosed with JHS.

Is There A Cure For Joint Hypermobility?

Unfortunately, Joint Hypermobility Syndrome cannot be prevented, or cured, because it is a genetic disorder that you inherit at birth. However, it’s encouraging to keep in mind that as people get older, their flexibility naturally decreases and their symptoms tend to improve. For some people, symptoms are mild, but for others, the pain can be severe, and everyone’s hypermobility affects their bodies in unique ways, so it’s important to work with a trusted podiatrist team to learn ways to protect your joints and manage your pain.

How Can I Manage The Symptoms?

If you have JHS, it’s important to maintain a healthy lifestyle and protect your joints. You can improve your joint and muscle strength by:

Maintaining good muscle strength. This will help to stabilise your joints and stop muscles from tiring out as quickly, as hypermobility may cause them to work harder than normal.
Learning about the ideal forms of exercise to support your joints safely (over-extending your joints in dance or yoga may cause more damage).
Using techniques such as muscular taping or braces to help to improve gait and prevent injury.
Participating in a tailored exercise programme to target physical needs.
Exercising regularly with frequent breaks.
Easing joint pain and stiffness with heat packs or warm baths.
Eating a healthy diet high in Vitamin C.
Using custom-designed orthotics to help stabilise the feet at the ankles, providing additional support for the surrounding muscles
Wearing ergonomic, supportive footwear that supports the feet in place as opposed to letting them easily roll at the ankle

Hypermobility Can Affect People Very Differently

There is a wide variation in the shape of the foot in people who are hypermobile. Most tend to have flat feet but a few have a high-arched foot, which can cause pain and problems when walking. In addition to this, patients with JHS experience higher rates of osteoporosis in their joints. Hypermobility in your feet, knees and hips can also increase the likelihood of strains, sprains and dislocations in these areas.

How A Podiatrist Can Support You (And Your Joints)

While there’s no cure, all of these preceding issues can be managed, and many people with JHS can live a full and active life when working alongside the support of an experienced podiatrist who understands your condition, and is able to prevent and treat further pain and injuries with a wide range of proven techniques, assessments and strategies, to reduce your symptoms and and improve your quality of life:

A podiatrist can assess your joints and your gait, prescribing a custom pair of orthotics that can help support your feet and legs by reducing harmful movements and preventing injury and deterioration
Using braces, guards and strapping to help stabilise the joints during physical activity
Wearing good, supportive footwear that help prevent excess motion – which our podiatrists can help with recommending the best shoe for your foot type
Having a good strengthening program to help muscles support and stabilise the joints
Maintaining good posture and trying to avoid overextending your joints where possible

If you’re concerned about hypermobile joints or joint pain, our experienced podiatry team here in Masterton are here to help.

FAQs

Are there different degrees or types of hypermobility?

Yes, hypermobility can vary in degrees and types. The Beighton scale is commonly used to assess hypermobility, which involves evaluating joint flexibility and assigning a score based on specific movements. There are also different types of hypermobility syndromes, such as Ehlers-Danlos syndrome (EDS), which is a group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility, and other associated symptoms.

What are the potential complications or associated conditions with hypermobility?

Hypermobility can be associated with various complications and conditions, including:

Joint instability and recurrent dislocations or subluxations
Chronic joint pain
Soft tissue injuries (sprains, strains)
Ligament and tendon issues (tendonitis, tenosynovitis)
Development of arthritis in affected joints
Fatigue and muscle weakness
Poor posture and spinal abnormalities
Gastrointestinal issues (such as functional bowel disorders)
Autonomic dysfunction
Increased risk of injuries during physical activities

Are there any long-term effects of hypermobility if it is unmanaged?

For some yes, and for others no. If left untreated, for some hypermobility can lead to long-term effects including chronic pain, joint instability, and an increased risk of joint damage and arthritis. Untreated hypermobility can also impact daily activities, quality of life, and overall function.

What lifestyle modifications can help with hypermobility?

Adopting certain lifestyle modifications can help manage hypermobility symptoms. These may include:

Engaging in regular low-impact exercises to strengthen muscles and stabilise joints (under the guidance of a healthcare professional)
Avoiding high-impact activities that may strain or excessively stress the joints
Maintaining a healthy weight to minimise joint stress
Using joint supports, such as braces or taping, during physical activities
Practicing good posture and body mechanics to reduce strain on joints
Ensuring proper rest and recovery after physical activity
Managing stress levels, as stress can worsen symptoms in some individuals
Implementing a balanced diet with adequate nutrients to support joint and connective tissue health

What footwear recommendations are suitable for individuals with hypermobility?

When it comes to footwear recommendations for individuals with hypermobility, it’s generally beneficial to prioritise stability and support. Consider the following:

Look for shoes with firm midsoles and good arch support.
Opt for shoes with a secure and snug fit to minimise excessive foot movement within the shoe.
Choose shoes with a wider toe box to accommodate any foot splay and reduce pressure on the toes.
Consider shoes with features like lace-up or adjustable closures for a customised fit.
Avoid shoes with excessive cushioning or lack of stability, as they may contribute to instability or pronation.

Is there a risk of developing arthritis or joint degeneration with hypermobility?

Yes, individuals with hypermobility, particularly those with certain connective tissue disorders like Ehlers-Danlos syndrome, may be at a higher risk of developing arthritis or joint degeneration. The excessive joint movement and instability associated with hypermobility can contribute to increased wear and tear on the joints over time. It’s essential to manage hypermobility and seek appropriate medical care to minimise the risk of joint damage and related complications.