Hypermobility

The term hypermobility is not a diagnosis, just an observation about an individual’s flexibility and tells us something about their ‘connective tissue’ make up. Connective tissues, include fascia, tendons and ligaments, are largely made from varying amounts of the proteins collagen and elastin. The relative amounts of these proteins affects how loose or stiff this fibrous ‘scaffolding’ material is. These tissues all play a critical role in supporting the body’s structures including our joints and muscles for effective movement but also for holding all out internal structures in place such as our vital organs; this includes the brain and other really crucial bits of anatomy. Tendons, for example, are not just involved in creating body movement; they are also critical in allowing the heart to pump blood normally by supporting valves that stop blood from flowing the wrong way.

Hypermobile individuals may be aware that they have above average flexibility. This is usually quite normal in the same way that being above average height is normal; it just means these individuals have greater than average movement abilities. Whilst this is usually obvious, being aware of hypermobility internally is not so obvious. For patients struggling with general aches and pains and perhaps general health problems, we clearly want to know if they just have a harmless condition where they simply have above average musculoskeletal flexibility or more of a pathological problem associated with potentially serious health problems. In screening for this it is important to be assessed by doctors with a specialist interest in this area or a consultant rheumatologist. Blood tests and other medical tests are undertaken along side clinical observations to be sure of a clear diagnosis where possible.

Benign Hypermobility

Benign hypermobility does not involve any underlying disease process and as such is not a serious condition. However, it is still associated with significant problems due to the fact that patients with less ligament stiffness will inevitably rely more on muscle control and body awareness to maintain joint stability and this may have implications in injury prevention as well as general musculoskeletal health. For example, we know that hypermobile individuals are more likely to struggle with various aches and pains including chronic back pain and neck pain and headache, including migraine. These patients are a challenging group to treat and must eventually rely on on-going physical conditioning to maintain optimal musculoskeletal health.

Pathological Hypermobility

The more serious conditions associated with hypermobility include Ehlers-Danlos Syndrome, Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Marfan Syndrome where there is an underlying pathology usually with a genetic basis. These conditions require a team approach to treatment where medical help, functional rehabilitation and support for various levels of mental wellbeing problems are a key ongoing part of support, guidance and reassurance.

Beighton Score

A commonly used clinical test to assess hypermobility is called the Beighton Score. This can be a useful screening tool but does have some limitations in that there is no consideration given to the neck and shoulders or feet and ankles and the test of spinal mobility - touching the floor - is largely a measure of hip flexion more than spinal flexion).

The test gives a score out of a possible 9 for each of the following:

Bend your little finger away from the palm of the hand beyond 90 degrees - 1 point for each hand

Hold your hand out with the palm facing upwards. Move the palm of the hand and your fingers towards you and then pull the thumb towards the front of the forearm - 1 point for each thumb that touches the forearm

Straighten your elbows as far as they go - 1 point for each side that hyper-extends more than 10 degrees past a straight position

Straighten your knees as far as you can - 1 point for each side that hyper-extends more than 10 degrees past a straight position

Standing barefoot and keeping your knees straight, reach towards the floor - 1 point for placing the palms of your hands flat on the ground

A score of 6 or greater is considered to be an indication of ‘generalised ligamentous laxity’.