First of all what does Hypermobility mean, if we break the word down 'Hyper' means to 'too much' and 'Mobility' basically means 'movement' so Hypermobility = too much movement.
It's a syndrome that affects the connective tissue in our bodies, this is the stuff, the glue that holds our tissues and body together, it forms our ligaments, tendons, muscle, skin and most other things, there are different sub types and with hypermobility you have too much of a certain type and its disorganised in its structure, this is caused by a gene mutation and it is nothing that you can, or could have prevented.
Due to this gene the connective tissue is very pliable or stretchy and so allows excessive movements of the body's joints, this excessive movement and lack of control around a joint can then produce 'arthralgia' or joint pain believed to be from the shearing (side to side) forces that the joint experiences in day-to-day movements.
Now some people confuse hypermobility as being double jointed, you know those people with that party trick that turns your stomach, the ones that can bend a finger, elbow or shoulder into a position that they just shouldnt be able to (see above!!!), but my flexible friends, please don't panic…. double jointed or flexible people do not automatically have Hypermobility Syndrome (HMS), far from it, HMS is thought to only affect between 4-15% of the population depending on whose research you read.
But there are differing forms Hypermobility, some more severe than others, there is also blurring of the condition with some other medical conditions such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome and Osteogenesis Imperfecta, for instance HMS and EDS Type III are now classed as one and the same diagnosis, but for this article I don't want to get bogged down in these other causes of joint hypermobility, instead I want to show you how you can decide if you are just flexible or possibly have HMS, if you should seek further advice and guidance and what impact this may or may not have on your sport and exercise choices.
So how do you know if you have Hypermobility Syndrome (HMS)?
There are two classification systems that you can easily use if you think you may have HMS and want to seek further guidance, there is the Beighton Score (BSc) and the Brighton Criteria (BC), this can be confusing with the similar sounding names but they are not to be confused as one and the same thing.
This is a series of self tests that you can do looking at how some of your joints move. If you can do each test as described below give yourself 1 point…
- Touch the floor with your palms flat without bending your knees
- Can you bend your left elbow back past straight
- The same for your right elbow
- When lying flat on floor with your left leg straight out in front of you can you lift your left heel off the floor approx 1-2 inches without lifting your knee or upper leg
- The same for your right leg
- Can you bend your left thumb under so that it touches your forearm
- The same for your right thumb
- Can you bend your left little finger back past 90 degrees
- The same for your left little finger
So one point for each, a total of 9, so with this score you then move onto the Brighton Criteria
The Brighton Criteria
This now uses the score you have from the Beighton Scale and places it along side other symptoms that HMS suffers regularly incur these are classed into Major and Minor categories, as shown below
- A Beighton score of 4/9 or greater
- Joint pain for longer than 3 months in 4 or more joints
- A Beighton score of 1, 2 or 3 (or 0, 1, 2 or 3 if aged 50+)
- Joint pain (> 3 months) in one to three joints or back pain (> 3 months).
- Dislocation or subluxation (slipping of a joint) in more than one joint, or in one joint on more than one occasion.
- Soft tissue problems, more than 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
- Marfanoid habitus (being tall, slim with an arm span/height ratio >1.03, or an upper: lower segment ratio less than 0.89, arachnodactyly (very long fingers compared to span of the palm)
- Abnormal skin: striae (stretch marks), hyperextensibility, thin skin, papyraceous scarring (purple stretch marks).
- Eye signs: drooping eyelids or myopia (short sighted) or antimongoloid slant (downward slant of eyes).
- Varicose veins or hernia or uterine/rectal prolapse.
So if you have two major, or one major and two minor, or four minor criteria, you more than likely (93% certain) to have hypermobility syndrome (HMS).
Do you have HMS?
So do you think you have HMS?, well my first piece of advise is please don't panic, I personally have seen and treated a lot of people with HMS, especially in my role as a shoulder specialist with this joint being affect a lot in HMS, and nearly all lead healthy normal active lifestyles, including sports, yes there is some modification needed and an awareness from time to time that you will have some joint pain, but this will be temporary and will go with the correct advice and management.
That leads me to my second piece of advice if you think you have HMS, go and see a specialist physiotherapist, yes I said physiotherapist… why?, bias, probably, I am one after all, but mainly as a physio with experience in hypermobility is much more likely to spot and deal with the day-to-day management and issues of it rather than your GP. It was noted in one study that GP's missed Hypermobility Syndrome as a cause of joint pain in as much as 60-75% of cases putting the pain down to muscle strain etc, its only when referred to a physiotherapist that the diagnosis made.
This is absolutely no criticism of my medical colleagues far from it, but in their busy clinics they normally only have 5-10 mins to assess and diagnosepatenrs, physios on the other hand usually tend to have an hour with each new patient so are able get a more detailed, fuller history and it's only when digging deeper can the HMS pattern emerge and a diagnosis be made. A specialist physio can then also check for signs of those other medical conditions such as EDS, Marfan's or Osteogenesis Imperfecta and refer you on to a specialist HMS consultant for further testing if deemed necessary, although these are rare occurrences.
HMS,Sport and Exercise
Now the next question and main point of this article is if you have Hypermobility should/could you play sports and exercises.
The answer is Yes… and No… it's never straight forward is it…
Yes, you must exercise… research has shown that although you can't change the structure of the lax tissues holding your joints together, gentle non impact exercise can increase the control and stability of the muscles around the joints, so reducing the shearing forces, so reducing the joint pain.
The best type or style of exercises recommended is unclear, but general consensus is exercises that are best for HMS are non or low impact, that work in multiple directions and includes light body weight strengthening with control and balance work. The best exercise/sport that covers all of these points is swimming, but activities such as cycling, rowing and using things like cross trainers etc are ok, but these only tend to work in one direction so not utilising all planes or angle of movement. Activities such as gentle light weight resistance training are ok, if directed under guidance.
No, don't do some sports… unfortunately with hypermobility it is not recommended to do certain sports, especially those with high risks of collision and impacts, such as rugby, hockey, skiing, trampolining etc its common sense really, but what about those non contact sports like running and alleged non contact team sports like tennis, football and netball (although watching these non contact sports I do see a lot of collisions) well its a grey area with no general consensus, again, they are going to cause shear and impact forces into the joints and this may produce pain and discomfort. My advise is it really depends on the level of HMS you have and the frequency and intensity of the activity.
I have had HMS patients run/jog regularly with no problems, until they increase the mileage or distances quick, to fast, just like I have had HMS patients play netball with no problems until they try to make that catch which they had to over reach, but the pain is always temporary and not damaging, they have a bit of rest occasionally some physio treatment and then return back to doing the sport they love, with the knowledge that yes its a bit more risky but as sensible human beings it's about weighing up the risks v's benefits, when one out weighs the other, then a decision can be made.
So in summary as I tend to say to most of my patients, “Where the head and the heart want to go, the body tends to follow” if you're sensible, aware of the risks and know how to recognise the signs and symptoms when things are going to far, then I say enjoy your sport…
Once again thanks for reading
This article is intended as helpful advice, and should not be used in replacement of face to face medical advice, if you are in doubt on any of the above information please seek a medical consultation from your doctor
PS: A special thanks goes out to Tom Goom aka 'the running physio' for his help in sending me over some useful reasearch on HMS. Go have a look at his awesome site here www.therunningphysio.wordpress.com