Joint hypermobility syndrome

Hypermobility Syndrome – Joint Pain, Back Pain and Gut Issues

Some of us are born flexible and some of us are not. Collagen fibres, found throughout the body in the hair, skin and ligaments are the glue that holds us together and in a few of us, there are small changes in the chemical processes that can result in weakened collagen fibres and more elasticity in the ligaments that hold joints together. A hypermobile joint is one whose range of movement exceeds the norm for an individual. The maximal range of movement that a joint is capable of is determined by the tightness of the “holding” ligaments. Hypermobility is not just limited to joints. Increased mobility issues can cause joint pain, back pain and even gut issues due to this connective tissue becoming too stretchy.

There appears to be enough evidence to support that hypermobility can be an inherited condition and is quite common particularly in children and young people. There are some estimates that suggest one in every five people may have joint hypermobility.


Other Hypermobility Syndrome Symptoms

Is it always a problem? No, there are a few people with hypermobile joints that do not have any problems but when they do, symptoms can often include digestive problems. Stretchiness can also involve the colon so constipation or irritable bowel syndrome can be a finding. Pain and stiffness in joints and muscles, clicking joints, fatigue, recurrent injuries such as ankle sprains, thin and stretchy skin, easy joint dislocations, and dizziness and fainting can be other symptoms of hypermobility.


Hypermobility Syndrome Treatments

Joint Hypermobility Syndrome (JHS) is a term used when a few of these symptoms exist. People with JHS benefit greatly from a combination of controlled exercise, preferably Pilates based strengthening and Chiropractic and other therapies. Joints can become stiffer with age; however, joint hypermobility syndrome and associated symptoms can continue into adult life. It is even possible to have some joints that easily lock up in a hypermobile person surrounded by other joints that are moving excessively. Improving the joint movement and strengthening around the skeletal structure is always a priority for greater joint stability, helping in “holding together” the body. It is important to note that good joint movement is paramount in providing proprioception- a neural acknowledgement to where the joint is in space via feedback mechanisms to the brain. Good joint movement prevents the cycle of repeated injury from compensatory changes and is therefore fundamental in recovery. We have seen many ankle sprains with a locked talar joint (the ankle bone) that will continue to provide pain and foot gait dysfunction if it is not gently manipulated. Gait dysfunction can lead to knee and hip problems leading to other pain syndromes.

When we talk about hypermobility, many would not think of the gut connective tissue. It can be however a common symptom in hypermobility syndrome.  Supporting the gastrointestinal tract and the production of collagen/ connective tissue production within the body would be an important strategy to help. Glucosamine and Chondroitin is an evidence-based supplement for joint stiffness and pain that could be included in the treatment of JHS. The Cusack Protocol has been used by some which is a protocol of nutritional supplements to supposedly support the development of connective tissue, and can include polysaccharides such as aloe vera, certain mushrooms and a probiotic amongst others. Many people are taking collagen powder for rejuvenation purposes and faster joint healing following injury and could be included to help support hypermobile body types.


Hypermobility Scoring/Testing

A popular screening check for joint hypermobility syndrome is Beightons Score.  It does have some short comings as it only samples a small number of joints, potentially overlooking many joints that could be hypermobile. It also excludes other possible involved systems for example the gut and its connective tissue.


Joint hypermobility syndrome


Types of Hypermobility Syndrome

Age, sex and ethnicity can play a part with maximal joint elasticity at birth. Women and non- westerners have a higher percentage where fewer than five joints involved is also more common.

Common hypermobility as seen in dancers and gymnasts could be a form of non-pathological polymorphisms (small variations in extracellular genes of collagens, elastin, fibrils) or through acquired hypermobility (pure hard work!). By acquiring the desired mobility, their normal tissues protect them against injury.  Acquired diseases such as hyperparathyroidism, chronic alcoholism and rheumatic fever can cause increased mobility. Other forms of hypermobility can genetically involve the proteins and be more a pathological form of hypermobility called Ehlers Danlos Syndrome (EDS). Certain forms of EDS can affect the connective tissue of the blood vessel walls.


Protect Your Body

Most forms of hypermobility can often be managed quite effectively. Exercise should generally incorporate a lot of core strengthening involving muscles that surround the spine and hips. Joints can commonly get “locked up” within a hypermobile body and require gentle manipulation to allow for overall good loading, good joint mechanics and proprioception. Supplementation could be beneficial to support the production of collagen and to support joint integrity.

My story- many years ago, I was assessed by a podiatrist after noticing that my shoes wore unevenly at an alarming rate, and I was starting to experience knee pain. He said to me that there are three kinds of feet- Rigid, Normal and Hypermobile. He described me as beyond hypermobile but as “Ragdoll,”…I was walking on pancake feet. I have been in orthotics ever since and my children have been in them since they could walk having sadly inheriting my ragdoll feet.  I was sent home from school numerous times as a child with terrible stomach aches. I later discovered that it was simply the tight elastic around my tummy.  Anything tight now still causes me issues.

I am now in my 50’s and I can still get my foot in my mouth. In the Yoga lotus position, my knees collapse to the floor. Not all of me is flexible. My body does need holding together and can fall apart quite easily. I have responded really well to gentle Chiropractic manipulation and find it very relieving, and the Pilates based exercises have helped me be able to participate in other sports. It is like many things that need to be managed long term. I was delighted when low rise pants came into fashion 15 years ago and was not delighted when fashion then turned to the high waist.! So, I’ll be the 80-year-old trundling along with orthotics in my shoes and a muffin top – fashion keeps repeating though so I reckon I might be on trend by then 😊