Hypermobility Joint Syndrome

Familiar with the term “double-jointed”? People with hypermobility joint syndrome (HJS) no doubt hear these words often. Although everyone is born with a certain amount of joint dexterity, some people’s genetics gift them with a heavy dose of natural bendiness. This can occur even if they haven’t taken years of ballet and gymnastics.

HJS is a common health condition found in both children and adults. The incidence in school-aged children might be as high as 40% and as prevalent in 11.7% of the general population, per a review article of benign joint hypermobility syndrome.

According to the American College of Rheumatology, hypermobility occurs more often in females than males, and you will find this condition among all populations and ethnicities. However, hypermobility happens more often in Asian-American children than Caucasian and African-African children. The reasons for this are unknown.

Symptoms

Although you might not have any signs or symptoms, others with hypermobility could experience the following:

• Unstable in movement
• Feel as though your joints could come out of your sockets when you hold specific positions. For example, when weightlifting, you might feel as though your arms can come out of their sockets. (This is because those with hypermobility have joints that are typically looser than people without this condition.)
• Joint and muscle pain in the late afternoon or evening
• Pain after exercise
• Chronic pain in the calves, thighs, knees, and elbows
• Prone to strains, dislocations and exercise injuries
• Constant back pain
• Born with flat feet
• Loose skin
• Cramping in the legs, thighs, and calves
• Scarring
• Nerve disorders

These symptoms typically improve with rest and tend to lessen as people grow older and their flexibility minimizes. 

Tests and Diagnosis

To determine if you are hypermobile, a doctor often runs tests to see whether you have a higher range of motion in your joints than others. A doctor might also check for other features to determine if you have a more widespread syndrome, as hypermobility can mimic other conditions like arthritis. If needed, a medical professional might request further testing to ensure the hypermobility doesn’t indicate a different rheumatic disease.

Such specific mobility tests a doctor might conduct include the following:

• You can move your wrist and thumb down to where your thumb can touch your forearm.
• Your fingers can extend back further than 90 degrees.
• When you bend at the waist, you can place your palms down flat on the floor.
• You can clasp your fingers in front of you and move your arms all the way behind you without releasing your fingers.
• With your arms all the way extended, your arms bend beyond 90 degrees.
• When standing straight, your knees bow backward. Your doctor will need to look at you from the side to see this.
•  Your little fingers can move to where they lie perpendicular to the upper arm.

Causes

People inherit hypermobility, as this condition generally runs in families.

Other inherited disorders associated with hypermobility, such as Marfan and Ehlers-Danlos, also come from genetics passed on to children from parents.

Treatments

Doctors will individualize treatment based on your level of severity. Such activities to lessen pain include the following:

Perform strengthening exercises. You should look to strengthen the muscles surrounding the joints, as incorporating a joint strengthening routine into your workouts can help stabilize your body and prevent injuries. You need to take proper precautions when exercising, however. In a 2018 quantitative study on hypermobility and sports injury published in the British Medical Journal Open Sport & Exercise Medicine, researchers surveyed 114 individuals; 26% were hypermobile. They found joint dislocation exclusive to hypermobile individuals, as well as the duration of sports injury to be higher in those hypermobile than the non-hypermobile group.

Avoid common causes of joint injuries. These include running too fast, lifting too heavy weights, forgetting to warm up and cool down after a workout, and not stretching.

Keep proper posture. You should always work on having good posture when both standing and sitting, and keep your knees slightly bent when standing to avoid overextending them.

Sit against a wall when on the floor. Sitting on the floor cross-legged (also known as “Indian style” among children) can overstretch your hypermobile joints.

Take balance classes. Adding yoga and Pilates to your workout regimes can help you learn balance techniques that alleviate joint pain. Children might enjoy sports that include both balance and flexibility exercises such as gymnastics, ballet and cheerleading.

Wear well-fitted shoes. You might want to see an orthopedist to get fitted for proper orthotics, especially if you have been diagnosed with flat feet. For any shoes, always try them on to make sure they have good arch support and your feet don’t slide around when you wear them.

Use splints and braces. To protect your joints when exercising, you might to consider wearing splints or braces or even taping the joints to protect them from overextending and causing you pain later that day. 

Take medication when necessary. If you feel pain after exercise, you should speak with a medical professional. A doctor might either prescribe a pain relief medication or advise you to use an over-the-counter treatment like naproxen, ibuprofen or acetaminophen. You should ask your doctor if you take the medication before or after exercise, as recommendations vary.

Use pain management services. If you exercise often and/or maintain a physically active lifestyle, the pain might become cumbersome and inhibit your quality of life. If this happens, your doctor might advise you to receive further treatment at a pain management center.

Best Exercises for Hypermobility

With hypermobility, you want to work on strengthening and adding flexibility to your joints. You could begin incorporating the following simple joint-building exercises into your workout. You should be sure to warm up and cool down after each exercise session. As with these exercises, keep your arms and knees slightly bent. Those without hypermobility might extend them all the way, but you should try not to overstretch your joints.

Squats

How to do:
1. Stand with your feet shoulder-width apart. Keep your knees slightly bent to avoid overextending them.
2. Squat down and keep your hips back. Be sure to keep a slow and steady movement.
3. Keep bending until your hips go lower than your knees.
4. Bring yourself back up slowly by keeping your knees out and your chest up. Try to align your torso and head the entire time.
5. Stand back up with your knees slightly bent.
6. Repeat five times.
To make this movement harder, place a bar along your upper back. The extra weight will build muscle in your legs.

If you aren't comfortable using a bar, but still want to make squatting more difficult, try using a wall. You stand with your back against the wall and slowly squat down in the same fashion, pushing your weight against the wall.

Pushups

How to do:
1. Lie down on the ground with your face to the floor. Pull yourself up to plank position. This can be done by keeping your palms on the ground and the balls of your feet touching the ground.
2. Push yourself up so that your arms are slightly bent. Keep your body in a straight line and your arms next to your sides. Your elbows should point toward your toes.
3. Once you reach the top, lower yourself back down. Don't go all the way down to the floor. Keep your arms engaged the entire time.
4. Repeat 10 times.
To modify this exercise, keep your knees on the floor. This will alleviate some of the weight you need in your arms.

90 Lat Stretch

How to do:
1. Stand with your feet hip-width apart about two to three feet in front of a table. Keep your arms at your sides.
2. Bend the knee slightly and shift your weight to your heels. Bend forward and place your hands on the table. Keep your arms straight with a slight bend in the elbows.
3. Bend until you reach a straight line from the shoulders to your wrists.
4. Push your torso toward the floor for a deep stretch. Tuck your chin into the neck to avoid dropping your head to the floor.
5. Hold for 30 seconds.
6. Repeat three times.
To modify this exercise, turn your palms up toward the ceiling for a deeper stretch.

Sitting Hamstring Stretch

How to do:
1. Sit in a chair with good posture.
2. Extend your right leg. Bend the left leg so that the foot rests against your mid thigh.
3. Reach toward your right ankle.
4. Hold the stretch for 30 seconds.
5. Switch legs and repeat the stretch.
6. Repeat this exercise three times per leg.
Sitting for this stretch works for the hypermobile because you will not overextend your knees. But if you're comfortable, to modify this stretch, you can do it standing up.

Hamstring Curls

How to do:
1. Lie on your stomach.
2. Bring your heels as close to your glutes as possible.
3. Hold this position for 10 seconds. Feel the stretch in your quads.
4. Switch legs.
5. Perform three sets of 15 repetitions.
To modify this movement, you can stand up and hold on to the back of chair. To make curls more difficult, add ankle weights.