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.
Hypermobility is a syndrome that affects the connective tissues which is the stuff that holds our body together, it forms our ligaments, tendons, muscle, skin and most other soft squishy things. There are different subtypes of connective tissues and there are many different subtypes of hypermobility depending on what connective tissue it affects and by how much.
Why some people are hypermobile is not fully known but its to do with your genes and is most likely hereditary in nature. The connective tissue in those with hypermobility is very pliable or stretchy and so allows more mobility of the body’s joints, this can then lead to ‘arthralgia’ or joint pain believed to be from excessive shearing (side to side) forces that the joint experiences in day-to-day movements.
Now some people confuse hypermobility with just 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 shouldn’t be able to. But being double-jointed or flexible does not automatically mean you have Hypermobility Syndrome (HMS). Being double-jointed affects a lot of people, whereas HMS is thought to only affect between 4-15% of the population.
As mentioned there are many different subtypes of Hypermobility, some more severe than others. These go by names such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome, and Osteogenesis Imperfecta. However, for this blog I don’t want to get bogged down in these other much rarer causes of hypermobility, instead, I want to show you how you can assess if you have HMS, and what impact this may or may not have on your sport and exercise choices.
How do you know if you have Hypermobility Syndrome (HMS)?
There are two classification systems that you should use if you think you may have HMS. First there is the Beighton Score, and then there is the Brighton Criteria. This can be a bit confusing with the similar-sounding names but they are not to be confused as one and the same thing.
The Beighton Score
This is a series of tests that look at how some of your joints move. If you can do each test as described below give yourself 1 point…
1: Touch the floor with your palms flat without bending your knees
2: Can you bend your left elbow back past straight
3: The same for your right elbow
4: When lying flat on the 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
5: The same for your right leg
6: Can you bend your left thumb under so that it touches your forearm
7: The same for your right thumb
8: Can you bend your left little finger back past 90 degrees
9: The same for your left little finger
So one point for each, for a maximum total of 9. With this score you then move onto the Brighton Criteria
The Brighton Criteria
This uses the Beighton score you have and places it along side some other symptoms that often affect those with HMS and these are classed into Major and Minor categories, as shown below
1: A Beighton score of 4/9 or greater
2: Joint pain for longer than 3 months in 4 or more joints
1: A Beighton score of 1, 2 or 3 (or 0, 1, 2 or 3 if aged 50+)
2: Joint pain (> 3 months) in one to three joints or back pain (> 3 months).
3: Dislocation or subluxation (slipping of a joint) in more than one joint, or in one joint on more than one occasion.
4: Soft tissue problems, more than 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
5: 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)
6: Abnormal skin: striae (stretch marks), hyperextensibility, thin skin, papyraceous scarring (purple stretch marks).
7: Eye signs: drooping eyelids or myopia (short sighted) or antimongoloid slant (downward slant of eyes).
8: Varicose veins or hernia or uterine/rectal prolapse.
If you have two major, or one major and two minor, or four minor criteria, you are more than likely (93% certain) to have hypermobility syndrome (HMS).
Do you have HMS?
If you think you have HMS my first piece of advice is please don’t panic, I have seen and know many people with HMS, especially in my role as a shoulder specialist with this joint being affect a lot in HMS, and most lead a perfectly normal healthy and active lifestyle. Yes there are some issues and pain from time to time and occasionally some modifications are needed, but often these will be temporary and will go with time.
My second piece of advice if you think you have HMS is to go and see a specialist? Unfortunately, many clinicians are unaware of HMS, for example, many GP’s misdiagnose those with HMS in as much as 60-75% of cases putting their pains down to muscle strains, growing pains, or even worse attention-seeking. It’s only when referred to a specialist is a diagnosis usually made accurately.
Should You Play Sport and Exercise with HMS?
The short answer is YES!
Research has shown that although you can’t change the properties of connective tissues in those with HMS exercise can increase the control and stability of the joints and reduce joint pain. I wouldn’t say there is anyone best type of exercise to do with HMS but general consensus is exercises that are low impact, that work in multiple directions and includes bodyweight strengthening with control and balance work.
The best exercises/sports that cover all of these are swimming, cycling, rowing, pilates, and using things like cross trainers and elliptical trainers are ok too. Activities such as resistance training are also ok if taken slowly and steadily.
Unfortunately with HMS, it is not recommended to do certain sports, especially those with high risks of collision, contact and impact, such as rugby, hockey, skiing, trampolining.
As for non-contact sports like running, tennis, football and netball (although watching these non-contact sports I do see a lot of collisions) well this is a bit of a grey area with no general consensus. They are going to cause some increased forces into the joints and this may produce pain and discomfort but if taken slowly and steadily then you can get used and adapt to them.
Personally, I have had HMS patients run/jog regularly with no problems, until they increase the mileage or distances quick, too 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.
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 if you have HMS please enjoy your sport…
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