Joint Hypermobility (adult)

What is Joint Hypermobility?

Joint hypermobility (“double jointed”) is the term used when someone’s joints bend further than most people’s joints. It may exist by itself or be part of a more complex diagnosis such as “Hypermobility Spectrum Disorder” or “Ehlers-Danlos Syndrome”.

Your doctor might test how far your joints can move.

How common is Joint Hypermobility?

Up to 10% (1 in 10) of the population have some joint hypermobility; women are affected three times more often than men.

Hypermobile or “double jointed” people sometimes find they perform some activities better than others, e.g. dance, gymnastics or swimming.

Are there symptoms with Joint Hypermobility?

Joint hypermobility usually causes no symptoms and requires no treatment. “Clicky” joints are common and do not mean anything is wrong.

Less commonly, it can be associated with:

• joint instability, ie joint dislocation
• chronic pain and fatigue
• abnormalities of the autonomic nervous system (see below) and
• skin symptoms.

Joint hypermobility can be associated with complete or partial joint dislocations (subluxations). These can sometimes produce injury of surrounding ligaments, tendons and muscles. Some hypermobile people take longer to recover from such injuries.

Ligaments in the back may be more “stretchy” and can be associated with chronic head and lower back pain. The jaw (temporomandibular) joint can also be painful.

Hypermobility may be associated with an increased risk of a chronic pain. Muscle stiffness and poor sleep may occur. In some cases, this may be due to fibromyalgia, a chronic pain disorder.

The part of the body responsible for the body’s “fight or flight” response is called the autonomic (“automatic”) nervous system. Joint hypermobility can be associated with this part of the nervous system affecting the heart and blood vessels (cardiovascular) and the stomach/gut (gastrointestinal) systems not working as well. This may cause palpitations, dizziness, fainting, reflux, nausea and/or vomiting and constipation.

Soft stretchy skin, easy bruising and skin scarring can be seen. Sometimes, the abdominal organs and pelvic floor may also be affected.

How is Joint Hypermobility diagnosed?

There is no blood test to diagnose generalised joint hypermobility or hypermobility spectrum disorder. The diagnosis is usually made by history and clinical examination by a doctor with special experience in hypermobility.

The Ehlers-Danlos Syndromes (EDS) are a group of inherited disorders associated with hypermobility and soft tissue fragility. When there are signs of other organs being involved, a Geneticist may review you to consider whether genetic testing would be helpful.

The most common form of EDS is the hypermobile type. There is no genetic marker for this syndrome. Diagnosis is based on a set of criteria including joint hypermobility/instability, soft tissue fragility, pain and family history.

The treatment of EDS (hypermobility-type) and joint hypermobility spectrum disorder are the same.

How is Joint Hypermobility treated?

The treatment of joint hypermobility involves treating the symptoms, including pain and joint instability.

Joint instability can be improved with intensive physiotherapy (exercises) aimed at strengthening the muscles surrounding the affected joint. Graded exercise and muscle strengthening is important to improve joint pain and fatigue.

If there is associated depression or anxiety these should be addressed.

If present, cardiovascular and gastrointestinal symptoms should be investigated and managed by a specialist.

Many people with hypermobility don’t have any symptoms, but if present, they can range from mild to severe.

While there is no cure for joint hypermobility, with the help of a multidisciplinary healthcare team symptoms can be managed.

Further information is available from the Hypermobility Syndromes Association: https://www.hypermobility.org/