Introduction to joint hypermobility and connective tissue disorders
December 03, 2020
Blog series: Ehlers danlos syndrome and related connective tissue disorders: The Pilates Approach to Therapeutic Exercise
What is joint hypermobility?
Joint hypermobility, in simple terms, is when there is “too much” movement within a joint. This occurs when the connective tissue, or ligaments, are overstretched and not stabilizing the joint the way it is supposed to. Joint hypermobility may be something you were born with, often referred to as “double jointed,” or something that developed following trauma to a joint, such as after repeated ankle sprains.
Take a look at the pictures below. On the left, you can see a woman with a hypermobile elbow, where the joint is hyperextended. This is most likely something this woman was born with and not from an acute injury. On the right, is a depiction of the overstretching of ligaments around the ankle following a sprain.
How do I know if I am hypermobile?
Joint mobility is something that occurs on a spectrum, and is often something we may assess during a physical therapy evaluation. Joint mobility is measured on a 6 point scale, and is something that varies within the general population. Take a look at the chart below to get a better sense of how we grade the mobility of a joint:
Having slight increased movement within a single joint does not necessarily lead to pain or dysfunction, but may increase the risk of injury to that joint. More often, joint hypermobility becomes problematic when it is generalized and widespread.
What is generalized joint hypermobility?
Generalized joint hypermobility is an umbrella term to describe the presence of excess movement in several joints of the body. To assess for generalized joint hypermobility the Beighton Score is often used. The Beighton Score is a quick clinical assessment that uses a 9 point scale considering multiple joints of the body. Take a look at the picture below to see what joints are assessed:
Generalized joint hypermobility without the presence of symptoms is not necessarily problematic. That being said, one may argue that participation in certain forms of exercise may be beneficial to prevent future problems down the road.
In more severe cases of hypermobility, the presence of multiple loose joints will increase the risk of injury and negatively impact one’s quality of life. Here are some of the more common signs and symptoms associated with generalized joint hypermobility:
- Recurring pain in multiple joints
- Frequent injuries including muscle strains and joint sprains
- Chronic Fatigue
- History of dislocations or joints “popping in or out”
- Poor balance or coordination
- Presence of thin, stretchy skin
- Bowel or bladder problems
When a patient presents with symptomatic generalized joint hypermobility, he or she may be referred to a geneticist for genetic testing to rule out certain diagnoses. The genetic conditions that often present with moderate to severe joint hypermobility are known as connective tissue disorders(CTDs). The more commonly known of these conditions include Ehlers Danlos Syndromes (EDS), Marfan’s Syndrome, and Loeys-Dietz Syndrome. In many cases, these CTDs are often associated with several other diagnoses and conditions. For this reason, if you have a suspected connective tissue disorder and are symptomatic, it is important to be seen by a specialist and receive specialized care.
Why physical therapy?
Physical therapy is the conservative treatment of choice for symptom management of patients with diagnosed or suspected connective tissue disorders. Physical therapy can help improve one’s quality of life by reducing fear associated with movement and improving strength and stability. Stay tuned for our next post to learn more about CTDs and how physical therapy and pilates can help!