• Alice Hill

Hypermobility in Children

Updated: Jul 27


What is Hypermobility?

It is normal for children to be more flexible than adults, but some children are a lot more flexible than others. A joint is considered to be ‘hypermobile’ when there is more flexibility than normal. When only one joint is affected, it is called ‘localized hypermobility’, but when several joints are affected it is referred to as ‘generalised hypermobility’. Up to 30% of children are thought to have generalized hypermobility.

Why are the joints more flexible in children with hypermobility?

Ligaments connect the bones in the body together and limit the amount the joints can move. Ligaments are made up of collagen. Children with hypermobility have more flexible ligaments because the structure of their collagen is slightly different to the collagen of children with normal flexibility.

What causes hypermobility?

Hypermobility is thought to be mostly due to genetics. It is more common in females than males, affecting approximately twice as many females. It is also more common in children with Asian and African descent.

Most of the time hypermobility occurs without an underlying condition and does not necessarily cause any problems. Occasionally hypermobility is the symptom of another condition, such as Joint Hypermobility Syndrome, Ehler’s Danlos Syndrome, Down Syndrome or Marfan Syndrome. Children with these conditions have a range of other symptoms in addition to joint hypermobility.

Does hypermobility cause problems?

Generalised hypermobility does not necessarily cause problems. In some activities, the extra flexibility is beneficial, for example, ballet, diving and gymnastics. Having extra movement in the joints can increase the risk of pain and injury, although joint dislocations are actually very rare. As we age, our flexibility naturally decreases, so hypermobility tends to become less obvious as children grow older.

Strengthening the muscles that support hypermobile joints will help to protect them from injury. The extra movement in hypermobile joints isn’t necessarily a problem unless the muscles aren’t strong enough to control the movement. A paediatric physiotherapist can design an exercise program to improve the strength and stability of hypermobile joints in children.

Should children with hypermobility play sport?

Yes! It is really important for children with hypermobility to remain active to keep their muscles strong. Strong muscles help to protect and control hypermobile joints. Sometimes children with hypermobility experience pain when they exercise. When this is the case, low impact exercise is a more gentle approach. Exercise in the pool and bike riding are examples of low impact exercise.

When should I seek help?

If your child has hypermobile joints and is avoiding physical activity or complaining of pain you should see your Paediatric Physiotherapist or GP. If your child has other symptoms in addition to hypermobile joints, you should consult your GP.

References

Bird, H.A. (2005). Joint hypermobility in children, Rheumatology, vol. 44. No. 6, pp. 703-704.

Hakim, A.J., (2013). Clinicians Guide to JHS. Retrieved from www.hypermobility.org/help-advice/hypermobility-syndromes/jhseds-hm-clinicians-guide/

Maillard, S. (2013). Flexible Kids. Retrieved from http://hypermobility.org/help-advice/physio-and-occupational-therapy/flexible-kids/

McCluskey, G., O’Kane, E., Hann, D., Weekes, J. & Rooney, M. (2012). Hypermobility and musculoskeletal pain in children: a systematic review. Scandinavian Journal of Rheumatology,vol. 41, no. 5, pp: 329-338.

Smith, T.O, Bacon, H., Jerman, E., Easton, V., Armon, K. Poland, F., Macgregor, A.J. (2014). Physiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials. Disability & Rehabilitation, vol. 36, no. 10, pp: 797-803.

Smits-Engelsman, B., Klerks, M., Kirby, A. (2011). Beighton score: a valid measure for generalized hypermobility in children. The Journal of Pediatrics, vol. 158, no. 1, pp. 130-134.

The Royal Childrens Hospital (2005) Orthopaedic Fact Sheet: Generalised Joint Hypermobility, retrieved from http://www.rch.org.au/uploadedFiles/Main/Content/rheumatology/Generalised_Joint_hypermobility.pdf


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