If you or someone in your family has naturally flexible joints, then it is possible that your child will too.  Extra flexible joints can be referred to as hypermobile joints, which means that they stretch further than normally expected.  Sometimes people might also refer to these joints as ‘double jointed’ (to be clear, there is only ever one joint, it is just extra flexible).  While hypermobile joints don’t always have a big impact on us as adults, for a child who is learning to move and coordinate their body, it can have a bigger impact.

In this blog post, we answer some of the key questions about joint hypermobility and how it might impact your child:

What is joint hypermobility? 

Joint hypermobility means that a person’s joints are extra flexible, or have an unusual range of movement.  People with joint hypermobility have joints are extra stretchy, or supple, and they might be able to move them into positions that other people find impossible.  These might be referred to as ‘party-tricks’ eg: bending their thumb backwards at an unusual angle.

For some people the joint hypermobility affects all their joints; for others it might only affect or only be noticed in some of their joints.

What causes joint hypermobility?

Joint hypermobility is thought to be caused by variations in structure of the collagen that make up our connective tissues.  Our connective tissues include our joint capsules, our ligaments, our tendons, our muscle fascia (the tissues that wraps around and runs through our muscles), and our skin.  When the collagen is less stiff than normal, then our connective tissues become more flexible, resulting in joint hypermobility.

Joint hypermobility often runs in families, so is genetically inherited from the parents to the children.  Joint hypermobility is also more common in females than males.

Less commonly joint hypermobility is caused by an underlying condition such as Ehlers-Danlos Syndrome, Marfan’s Syndrome or Osteogenesis Imperfecta.  In the vast majority of cases, a genetic cause for the joint hypermobility will not be identified, and your child will otherwise be typically developing.

How does it affect children?

The amount of joint hypermobility in children can vary widely.  As a result, there are some children who don’t have any problems as a result of their joint hypermobility, and some children who have significant difficulties.

Some signs and symptoms seen in children who have hypermobile joints include:

  • Extra flexible or ‘loose’ joints – elbows that bend backwards, knees that bend backwards, thumbs that can touch their forearms, and others.
  • Slower achievement of their gross motor milestones such as crawling and walking
  • Clumsier than their peers, falling over more often
  • Poor endurance or easily fatigued – this can be seen as wanting to be picked up when walking long distances, only being able to hold a pencil in a good grip for a short period of time before needing to change grips, or handwriting that starts off neat but deteriorates quickly

What is benign joint hypermobility syndrome?

When a person’s joint hypermobility causes a number of uncomfortable, painful or problematic symptoms, they are usually diagnosed with benign joint hypermobility syndrome.  Some of the signs and symptoms of benign joint hypermobility syndrome include:

  • Joint pain and stiffness – particularly in the legs (knees, hips, ankles), but the joint pain may occur in any joint
  • Muscle pain
  • Joints that ‘crack’ or click without much effort
  • Joints that subluxate or dislocate easily
  • Frequent joint injuries and sprains
  • Extreme fatigue and tiredness

A small number of children with benign joint hypermobility syndrome also experience gastrointestinal symptoms such as chronic constipation, gastro-oesophageal reflux, and abdominal pain.  This is because the gut is also contains a large amount of connective tissue, so when the tissue is hypermobile it impacts the movement of food through the gastrointestinal tract.

Joint hypermobility and low muscle tone often occur together…

If you have previously read our blog post on low muscle tone, you will recognise that some of the symptoms of joint hypermobility and low muscle tone are the same.  This is because the fascia that wraps around and through our muscles is connective tissue – so if the connective tissue is more flexible, then the muscle is more flexible and ‘loose’.  As a result, many children who have low muscle tone have joint hypermobility and visa versa.

My child has many of the symptoms above – how can I check if they have joint hypermobility and/or benign joint hypermobility syndrome?

There is a simple test called the Beighton Score, which you can do to check whether your child has hypermobile joints (please note: each of these movements must be done gently without forcing the movement):

  • Bending the wrist and thumb downwards to see if the thumb can touch the forearm
  • Bending the little finger back to see if it goes past 90 degrees
  • Sitting or standing with the knees as straight, and seeing if the knees can abnormally bow backwards
  • Holding the arms out straight, and seeing if the elbow can bend further than normal (beyond straight)
  • Checking whether your child can stand and bend forwards at the waist with their knees straight and touch their palms to the floor.

If you are concerned that your child has joint hypermobility – and particularly if they are experiencing pain, stiffness, or delayed developmental milestones – it is important to have them seen by a doctor or physiotherapist to check that they don’t have any serious underlying condition, and to also start treatment to help minimise their symptoms.

 How can I help my child?

Children with benign joint hypermobility syndrome will often benefit from treatment from a multidisciplinary team to help them to strengthen their muscles, support their joints, manage their pain and fatigue, and maintain their physical activity levels.

  • Strengthening muscles: When the connective tissues in the body are hypermobile, the muscles of the body have to work a little harder to keep our body parts stable.  As a result it is important that children with joint hypermobility syndrome are helped to strengthen their muscles.  Strengthening their muscles will help to support their joints, which in turn will help to decrease their symptoms.  Strengthening programs can consist of specific exercises recommended by a physiotherapist as well as general activities that encourage muscle conditioning.
  • Supporting joints: Supportive footwear and orthotics can be helpful to decrease the pain and stiffness in your child’s legs.  In addition, supportive footwear and orthotics can help to optimally align your child’s joints, which helps them to move with more ease, and can improve their motor performance.
  • Managing their pain and fatigue: Managing your child’s pain and fatigue often requires a multi-prong approach:
    • Ensuring regular, paced physical activity: It is important that children with joint hypermobility syndrome remain physically active as it helps to manage their pain.  By keeping their muscles and joints moving and strong, it helps to prevent pain and stiffness.  However, the key to doing this successfully is to ensure that the physical activity is paced.  This means that the physical activity is not excessively strenuous and fatiguing for your child, that it is done consistently and regularly, and that over time, very gradually, their level of physical activity is gradually increased.  In younger children, parents need to monitor and manage this by making sure their child has opportunity for rest breaks between periods of physical activity (because toddlers don’t know to stop!).
    • Avoiding high impact activities or sports that increase the risk of sprains and strains. Good activities or sports to try are walking, bike riding, and swimming.
    • You can try heat and cold packs to soothe sore joints and muscles
    • You may like to discuss with your child’s doctor if the use of simple pain relief medications may be helpful for your child.
    • Some children will also benefit from seeing a psychologist to give them cognitive strategies to help to manage their pain.

What is the outlook for my child?

The good news is that as we get older, our joints tend to become stiffer – so joint hypermobility and the symptoms of joint hypermobility syndrome often get better over time.  And for the vast majority of children, their symptoms of joint hypermobility get much better and are easily managed with some help and simple self-management.

How can I get help?

If you are concerned your child has joint hypermobility, and that is affecting their development or causing problematic symptoms, please call us to book in with one of our physiotherapists who can help your child to improve and manage their symptoms.