Hypermobility in Children
So you think your child is hypermobile?
Hypermobility refers to the ability of a joint to move through a greater than normal range of motion.
To understand how this happens let’s start with some simple anatomy…
Our joints are held together by connective tissue – namely the joint capsule and various ligaments. Connective tissue is made up of collagen which is flexible but strong. In some people the collagen is more stretchy and weaker allowing joints greater range of motion.
Think of gymnasts, ballet dancers, even swimmers – they all probably have some degree of hypermobility. Many children (and adults) will have one or more “double joints”. This is quite common and is considered a normal variant of development. For most children hypermobility affects just the joints. However, some children have a condition called Joint Hypermobility Syndrome or JHS. In addition to hypermobile joints a child with JHS may also have
- pain and stiffness in their joints and muscles - muscle weakness - delay in gross motor skills - increased incidence of sprains - fatigue more easily than their peers - digestive problems like gastro oesophageal reflux and constipation - problems with their bowel or bladder - anxiety
JHS can run in families and may be part of other disorders. A children's physiotherapist will refer a child suspected of having JHS onto a paediatrician who will make a diagnosis and assess the child for involvement of other body systems. You can see that having a few hypermobile joints on their own is very different to having Joint Hypermobility Syndrome.
What can you do if you think your child has hypermobile joints?
Children's physiotherapists often use the Beighton Scale to assess how hypermobile a child is. This is a 9-point scale that exams how hypermobile the fingers, wrist, elbows, knees and back are.
If your child is showing other signs of JHS your physio will refer you onto a paediatrician who specialises in this.
Your physiotherapist may also provide a program that includes the following -
Strengthening to support the joints that are hypermobile. Handwriting can be more challenging if the joints of the fingers and wrist are affected.
Stretching Seems funny right? Why would you want to stretch if the joint is already loose? If a joint is loose it will often ‘flop’ one way. The muscles on one side are stretched (and weak) and the muscles on the other side of the joint become tight (and weak). This often happens around the hip joint. So stretching the right muscles is important.
General exercise for fitness Your physio will work with you on what your child enjoys. Swimming and bike riding are good exercises that don’t impact too much on joints. It is of course good for the lungs and heart as well.
Pacing Because the muscles around a joint have to work harder than normal to keep the joint stable, some children will fatigue easily. Gradually building up to exercise is important, allowing your child to have rest periods during the day and not packing too much into the week are some suggestions.
Braces for the older child involved in sport soft braces to protect knees or ankles are sometimes recommended.
Advice on appropriate sports Depending on what joints are affected and how hypermobile they are some contact sports are not recommended.
Physiotherapy can assist in many ways to help a hypermobile child grow strong and healthy with good gross motor skills
Compiled by Cathy Molloy – Physiotherapist. March 2017