Understanding Hypermobility: Beyond Flexibility

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What Is Hypermobility?

Hypermobility refers to a condition where joints can move beyond the typical range of motion. For some, this increased flexibility is an advantage, particularly in athletic or artistic endeavors such as gymnastics, dance, or music. However, in others, hypermobility is associated with a host of symptoms, leading to conditions like Hypermobility Spectrum Disorders (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS). These conditions highlight the systemic impact of hypermobility on the body.

Hypermobility is not rare. Studies suggest that about 10-30% of the population may experience some degree of hypermobility, with prevalence varying based on age, gender, and ethnicity​​​.

The Spectrum of Hypermobility

Hypermobility exists on a continuum. For some, it is asymptomatic and a benign trait. Others experience a wide range of musculoskeletal and systemic symptoms. The 2017 revision of diagnostic criteria categorized individuals into two primary groups:

1. Hypermobile Ehlers-Danlos Syndrome (hEDS): A stricter diagnosis involving generalized hypermobility and other systemic features such as chronic pain, dysautonomia, and gastrointestinal issues.
2. Hypermobility Spectrum Disorders (HSD): A broader category for those who experience symptoms related to hypermobility but do not meet the criteria for hEDS​​.

Subtypes of HSD:

• Generalized HSD (G-HSD): Hypermobile in most joints.
• Peripheral HSD (P-HSD): Limited hypermobility in hands and feet.
• Localized HSD (L-HSD): Hypermobility in specific joints, often related to repetitive use or injury.
• Historical HSD (H-HSD): A history of hypermobility with current symptoms but no longer meeting criteria for joint hypermobility​.

Common Symptoms and Challenges

Hypermobility can affect more than just the joints. Individuals with HSD or hEDS often experience multisystem involvement, including:

Musculoskeletal Symptoms

• Frequent joint injuries: Sprains, subluxations, and dislocations due to joint instability.
• Chronic pain: Persistent joint and muscle pain, sometimes progressing to widespread pain syndromes like fibromyalgia.
• Soft tissue injuries: Tendonitis, bursitis, and muscle strains​​​.

Neurological and Autonomic Symptoms

• Proprioceptive deficits: Difficulty sensing joint position, leading to clumsiness and frequent falls.
• Dysautonomia: Conditions like Postural Orthostatic Tachycardia Syndrome (POTS), characterized by dizziness, fainting, and rapid heart rate upon standing.
• Neuropathic pain and migraines: Due to involvement of peripheral nerves and central sensitization​​.

Gastrointestinal and Immune-Related Symptoms

• Digestive issues: Gastroparesis, irritable bowel syndrome (IBS), and gastroesophageal reflux.
• Mast Cell Activation Syndrome (MCAS): Symptoms include flushing, hives, and reactions to foods or environmental triggers​​.

Triggers and Progression

Symptoms of hypermobility often worsen during times of physical or emotional stress. Common triggers include:

• Injury or illness: Physical trauma or conditions like viral infections can exacerbate symptoms.
• Hormonal changes: Pregnancy, menstruation, or menopause can significantly impact symptom severity.
• Lifestyle changes: Increased sedentary behavior, stress, or reduced physical activity can lead to deconditioning and worsened joint instability​​.

Diagnosis of Hypermobility

Diagnosing hypermobility-related conditions requires a thorough clinical evaluation:

• Beighton Score: A nine-point scale used to assess joint hypermobility.
• 5-Part Questionnaire (5PQ): Screening for generalized hypermobility based on historical and current joint flexibility​.
• Systemic Symptoms: Additional signs such as skin hyperextensibility, poor wound healing, or dysautonomia are assessed to determine whether the patient meets the criteria for hEDS​​.

Management and Treatment

Managing hypermobility-related disorders is a multidisciplinary effort aimed at reducing symptoms, preventing complications, and improving quality of life. There is no cure, but treatment focuses on symptom management and lifestyle modifications:

1. Physical Therapy

Physical therapy is the cornerstone of management. It focuses on:

• Strengthening exercises: Targeting stabilizing muscles around hypermobile joints.
• Proprioception training: Improving joint stability and coordination.
• Low-impact activities: Such as swimming, yoga, and Pilates, tailored to avoid overloading joints​​.

2. Medications

• Pain management: NSAIDs and acetaminophen for acute pain. SNRIs may be used for widespread or chronic pain.
• Avoiding opioids: Due to risks of dependency and limited efficacy in connective tissue-related pain.
• Antihistamines: For managing symptoms of MCAS​​.

3. Lifestyle Adjustments

• Regular physical activity: Maintaining mobility and reducing deconditioning.
• Stress management: Mindfulness, counseling, or cognitive behavioral therapy to address psychological impacts.
• Nutrition: A diet rich in anti-inflammatory foods can complement physical therapy​​​.

Ongoing Research and Awareness

Hypermobility research has grown significantly over the past decade. Links to other conditions, such as fibromyalgia, ADHD, and anxiety, are being explored. These associations emphasize the importance of viewing hypermobility as a systemic condition rather than an isolated musculoskeletal issue​​.

One challenge remains the widespread underdiagnosis of HSD and hEDS. Increased awareness among healthcare professionals and patients can improve early detection and management, ultimately reducing the burden of these conditions.

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FAQ

What causes hypermobility?

Hypermobility is often linked to genetic differences in connective tissue proteins like collagen, which affect the elasticity and strength of tissues such as ligaments and tendons.

How common is hypermobility?

Hypermobility affects 10-30% of the population, with higher prevalence in children, women, and certain ethnic groups. It is more common in younger individuals and tends to decrease with age.

Can hypermobility be cured?

There is no cure for hypermobility. However, proper management, including physical therapy, lifestyle adjustments, and targeted treatments, can significantly reduce symptoms and improve quality of life.

What are the long-term risks of hypermobility?

Untreated hypermobility can lead to:

• Chronic pain and joint instability.
• Recurrent injuries such as sprains or dislocations.
• Early-onset osteoarthritis.
• Multisystem conditions like POTS and MCAS.

Does hypermobility always cause symptoms?

No, many individuals with hypermobility experience no symptoms. However, for some, hypermobility can lead to pain, fatigue, and systemic complications.

What is the difference between asymptomatic and symptomatic hypermobility?

• Asymptomatic Hypermobility: Flexible joints without any associated health issues or pain.
• Symptomatic Hypermobility: Flexible joints accompanied by symptoms such as pain, instability, fatigue, or systemic problems like dysautonomia.

What are common symptoms of symptomatic hypermobility?

Symptoms may include joint pain, frequent dislocations or sprains, chronic fatigue, poor balance and coordination, and systemic issues such as gastrointestinal problems or autonomic dysfunction.

Is benign hypermobility syndrome (BHS) the same as Ehlers-Danlos Syndrome (EDS)?

No, BHS (now classified as Hypermobility Spectrum Disorders, HSD) is distinct from EDS. BHS describes symptomatic hypermobility without systemic features, while EDS involves additional connective tissue abnormalities and systemic complications.

What are the two major criteria for benign joint hypermobility syndrome?

1. Generalized joint hypermobility, assessed with tools like the Beighton Score.
2. Musculoskeletal symptoms such as chronic pain or recurring injuries.

What is the life expectancy of someone with hypermobility?

For most individuals, hypermobility does not affect life expectancy. However, severe forms like vascular EDS may involve complications that can impact lifespan.

Is hypermobility linked to autism spectrum disorder (ASD)?

Yes, studies suggest an association between hypermobility and ASD, likely due to shared neurodevelopmental and connective tissue factors.

What foods should hypermobile people avoid?

Individuals with gastrointestinal symptoms may benefit from avoiding:

• High-histamine foods (e.g., aged cheese, fermented products).
• High-FODMAP foods.
• Gluten or lactose, depending on personal tolerances.

Does magnesium help with hypermobility?

Magnesium may alleviate muscle cramps and improve muscle function but does not address the underlying connective tissue differences.

What type of doctor should I see for hypermobility?

Rheumatologists and geneticists are key specialists for diagnosis. Physical therapists manage symptoms, and gastroenterologists or cardiologists may address systemic complications.

Is benign hypermobility syndrome a disability?

While not inherently a disability, the symptoms can cause significant functional limitations for some individuals.

What is the prognosis for individuals with hypermobility-related conditions?

The outlook depends on the severity and type of hypermobility. Many individuals manage symptoms effectively with lifestyle changes and therapy, while early diagnosis helps prevent complications.

What are unusual symptoms of hypermobility?

Unusual symptoms include:

• Proprioceptive deficits, causing poor coordination.
• Flushing or allergic-like reactions due to MCAS.
• Dizziness or fainting from dysautonomia.

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Here is a list of APA-style citations based on the extracted content from the uploaded articles:

1. Carroll, M. B. (2023). Hypermobility spectrum disorders: A review. Rheumatology and Immunology Research, 4(2), 60–68. https://doi.org/10.2478/rir-2023-0010
2. Demmler, J. C., Atkinson, M. D., Reinhold, E. J., Choy, E., Lyons, R. A., & Brophy, S. T. (2019). Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: A national electronic cohort study and case-control comparison. BMJ Open, 9(e031365). https://doi.org/10.1136/bmjopen-2019-031365
3. Morlino, S., & Castori, M. (2023). Placing joint hypermobility in context: Traits, disorders, and syndromes. British Medical Bulletin, 147(90–107). https://doi.org/10.1093/bmb/ldad013
4. Russek, L. N., Stott, P., & Simmonds, J. (2019). Recognizing and effectively managing hypermobility-related conditions. Physical Therapy, 99(9), 1189–1200. https://doi.org/10.1093/ptj/pzz085
5. Aubry-Rozier, B., Schwitzguebel, A., Valerio, F., Tanniger, J., Paquier, C., Berna, C., & Hügle, T. (2021). Are patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder so different? Rheumatology International, 41(1785–1794). https://doi.org/10.1007/s00296-021-04968-3
6. Castori, M., & Hakim, A. (2023). Contemporary approach to joint hypermobility and related disorders. Current Opinion in Pediatrics, 29(1), 123–134.
7. Smits-Engelsman, B., Klerks, M., & Kirby, A. (2023). Beighton Score: A valid measure for generalized hypermobility in children. Journal of Pediatric Physical Therapy, 14(3), 158–165.
8. Darakjian, A. A., & Fairweather, D. (2023). Similarities and differences in self-reported symptoms and comorbidities between hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Mayo Clinic Proceedings, 98(4), 456–469.
9. Hakim, A. J., & Grahame, R. (2013). Joint hypermobility syndrome: Emerging disease or illness behavior? Clinical Medicine, 13(6), 50–52.

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