Posted June 29, 2016
By Tim Koba, MS, ATC
If you’ve ever heard someone say they are double jointed, they may have generalized joint hypermobility. Generalized joint hypermobility is a connective tissue phenomenon characterized as having loose connective tissue including joints and skin. This is more common in adolescents and females. As we age, the collagen tends to stiffen up, but for some people, this extra joint motion can lead to various aches and pains.
The common screening tool for assessing general joint hypermobility is the Beighton score, which is a series of movements. The 4 movements are performed bilaterally. A scale of 4 or more out of 9 is indicative of having generalized hypermobility, but a score of 6 or higher is more indicative of having associated symptoms. The tests are pinky hyperextension done bilaterally, the ability to touch your thumb to your forearm bilaterally, hyperextension at the elbows and knees bilaterally and the ability to palm the floor from a standing position.
The reason we are concerned for joint hypermobility is the implication for injury and pain. Because the joints have some additional laxity or movement, symptomatic individuals have excessive joint motion. This additional motion can lead to a pain response as the joint moves beyond a normal range.
When I looked at the research to determine if the presence of general joint hypermobility can lead to injury risk, I was surprised the answer was generally no. For most injuries, the risk of sustaining an injury increases if there has been a previous injury. For those with joint dislocations, the presence of generalized hypermobility was not as important as local hypermobility of that joint. There is a connection between generalized joint hypermobility and ACL risk in soccer players. However, this is probably related to the knee joint being loose and the fact that the individuals are not able to adequately stabilize during intense activity.
While the ability to predict injury based on generalized joint hypermobility does not seem evident, there are some interesting correlations when looking at different injury subsets. For people who suffer from musculoskeletal pain, back pain during adolescence and fibromyalgia, there is a higher number of symptomatic individuals who have generalized joint hypermobility. Once again, the thought is joints have additional movement, which causes a pain response.
For many people who suffer from musculoskeletal pain, they have a hard time getting their pain receptors to calm down. The 2 main treatments for hypermobility-related pain are exercise and massage or soft tissue work. The goal of exercise is to improve body awareness, positioning, control and strength. When the muscles are working properly, they have the ability to aid in joint stiffness, and normal joint motion may decrease the pain response. Massage therapy and soft tissue work can help to ease pain through touch and by addressing specific problem areas. While the research is not definitive on the effectiveness of either exercise or massage, there are some observational studies that suggest it can help.
The key take-home point is generalized joint hypermobility is usually benign, although there are other symptomatic forms; however, it can be involved with excessive motion that causes musculoskeletal pain. The main treatment and preventative technique is to exercise in order to better stabilize joints, learn and reinforce proper movement and body control. In a flared up state, massage can help decrease the associated pain.
Folci, M and Capsoni, F. (2016). Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report. BMC Musculoskeletal Disorders; 17 (58).
Pacey, V. et. al. (2010). Generalized joint hypermobility and risk of lower limb joint injury during sport: A systematic review with meta-analysis. American Journal of Sports Medicine; 38.
Palmer, S. et. al. (2014). The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review. Physiotherapy; 9 (002).
Scheper, M. et. al. (2015). Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type); it is a challenge. Journal of Pain Research; 8.
Tobias, et. al. (2013). Joint hypermobility is a risk factor for musculoskeletal pain during adolescence. Arthritis and Rheumatism; 65 (4).
About the Author
Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.
You can connect with him on twitter @timkoba or check out his blog www.timkoba.blogspot.com.