Hypermobility aka being "bendy"
- Apr 11
- 4 min read
Earlier this year I posted about hypermobility on my socials. I collaborated with Chiropractor, Dr Huw from our favourite clinic in East Fremantle and presented him with a number of questions about hypermobility, his thoughts on early intervention and how this work may be linked to emotional regulation. Dr Huw has been practising since 2021 and worked also in various regional areas in the North West providing free care to those in need. Dr Huw is inspired by contributing to the larger community and receives satisfaction from seeing the joy and relief clients experience after long periods of pain and discomfort.
Dr Huw defines hypermobility as joints that move beyond the normal range of motion for a person’s age, sex, and population group. He adds that hypermobility is considered a normal variation in joint flexibility, but in some people, it can cause symptoms such as injuries or pain or be part of a medical condition like Ehlers-Danlos Syndrome (EDS). Some studies suggest around 10% of children may show generalised joint hypermobility when assessed, using standard clinical measures. Many of these children do not experience symptoms related to their mobility, and their joint flexibility will naturally decrease with age as the connective tissues stiffen.
As for the role genetics play in hypermobility I was suprised to learn that women are three times more likely to have generalised hypermobility than men. Another factor includes the differences in collagen being coded into DNA. Collagen is one of the proteins that gives strength to tendons and ligaments, and the elasticity of that protein is based on how it is created following that DNA code. Some conditions like Ehlers-Danlos syndrome can be linked to a specific gene mutation which causes hypermobility, and sometimes other symptoms as well.
Dr Huw states that while there is some evidence of an association between neurodiversity and hypermobility, this is very much an emerging area and there were no solid conclusions drawn. Hypermobility in the general population is approximately 20%, while one systematic review found that people with Autism were hypermobile at a rate of 22 - 31%, suggesting a possible relationship. One theory is connective tissue variations that may affect both the musculoskeletal and nervous systems. Personally, I have a serious interest (fixation) about the role that inflammation plays in hypermobility and neurodiversity. Dr Huw explained that inflammation
can cause an exacerbation of hypermobility related symptoms, as inflamed joints, ligaments and tendons often swell and further reduce the stability of the already hypermobile joint. It can also lead to muscle guarding around an inflamed joint, trying to protect it from further injury, but results in fatigue and stiffness. This was a real event in my life and proceeded into years of fear avoidance where I lost all confidence in the ability of the knee. In the clinical world rehabilitation and recovery are seen as a 50/50 split between physical healing and psychological adaptation. While phases of discomfort are normal, any time you suffer from intense or sustained pain and discomfort you should seek medical attention. As for treatment exercise is the best thing for anyone who is hypermobile, under the personalised instruction of a professional, increasing the strength of the muscles around the joints to improve stability and reduce the risk of injury. Being immobile or avoiding movement can weaken these muscles and increase the chance of injury.
Hypermobility can be diagnosed in the clinic via one of the validated scales, such as the Beighton Scale. This assesses the range of motion at multiple joints on both sides of the body, and if excess movement is detected at a certain number of these joints, hypermobility is likely. The thresholds are different for different ages, children tend to be more flexible and therefore 6/9 score is required before puberty, 5/9 in adults and 4/9 in people over 50. The more specific causes of hypermobility / the syndromes with resulting hypermobility are not diagnosed in the clinic usually, with this being reserved for a specialist. Through a detailed history of the patient as well as the hypermobility testing, we may be able to make a good case when referring the patient, ultimately helping lead to a diagnosis. Treatment of someone who is hypermobile depends on the degree of hypermobility, the presence of visceral symptoms and the practitioner's confidence in meeting the individual's needs. As with all patients the first step in care is a thorough medical history and physical examination, which often reveals that the condition is more than just hypermobility. If it is suspected to be something like Ehlers-Danlos (presence of visceral symptoms), the next step is to refer the patient to their GP who will then refer out to appropriate specialists (geneticist, rheumatologist, etc).
This doesn't mean that the patient can't be co-managed with the specialists, as chiropractic can be beneficial for managing the pain/discomfort that comes along with hypermobile joints.
The main goals for the management of hypermobility in children are to minimise levels of discomfort while encouraging maximum uptake of physical activities and strengthening programs. Education is also critical, helping the individual and parents understand what hypermobility actually means and what role it will play in overall function moving forward. Having an understanding of why their body is responding in the way it is can do a lot in motivating people to properly manage the condition while also helping reduce any negative habits that may form, such as catastrophising or fear avoidance behaviour.
As for hypermobility and its links to emotional regulation the relationship between the mental state and physical body is well established however evidence is still emerging. Disruption to the physical body affects the ability of the nervous system to work as optimally as possible, while the opposite is also true, having a dysregulated neurological system can lead to a range of physical manifestations in the body.
References :
1. https://www.healthywa.health.wa.gov.au/sitecore/content/Hospitals/PCH/Home/ For-health-professionals/Referrals-to-PCH/Prereferral
guidelines/Hypermobility?utm_source=chatgpt.com
Comments