Joint Hypermobility
Syndrome

If you have ever entertained your friends with body contortions, excelled at ballet, yoga or gymnastics, or been called “double-jointed,” you may have hypermobile joints that are able to extend beyond what is considered normal range of motion. The condition affects up to 15 percent of the population, and women are three times more likely to be hypermobile than men.
Many people with hypermobile joints experience few problems, but for some, hypermobility can cause pain and instability during physical activity, a condition called joint hypermobility syndrome, or JHS.
While hypermobiliy can be advantageous in certain sports and activities, hypermobile joints can be highly unstable, making you vulnerable to injury. As you age, joint hypermobility can contribute to balance issues that increase your risk of falling. In older adults, hypermobile joints are more prone to osteoarthritis from wear and tear.

Joint Hypermobility Causes

Loose or elongated ligaments within the joint capsule are the primary cause of hypermobile joints. The condition is largely hereditary, resulting from longer than normal ligaments, or from overly elastic connective tissue. Weak or overstretched muscles and connective tissue can contribute to hypermobility.
Joints that are most prone to hypermobility include:
  • ankles
  • knees
  • shoulders
  • wrists
  • fingers
  • elbows
While hypermobility imposes the greatest risk to joints of the extremities, it can also affect the head, neck, trunk and low back. Activities that demand extreme joint range of motion like dance, gymnastics and yoga can increase joint hypermobility.
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Joint hypermobility syndrome symptoms

Many hypermobile people never report health problems associated with lax joints, while other experience symptoms ranging from nagging to severe.
Hypermobility symptoms include:
  • Stiff painful joints and muscles
  • Joints that click or pop
  • Frequent dislocated joints
  • Fatigue
  • Recurrent sprains or other injuries
  • Digestive issues
  • Thin stretchy skin
When occurring in conjunction with hypermobility, these symptoms indicate JHS.
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Ehlers-Danlos Syndromes (EDS)

One unique subset of JHS are Ehlers-Danlos Syndromes, a group of connective tissue disorders characterized by hypermobile joints, hyperelastic skin and fragile tissues. To date, 13 subcategories of Ehlers-Danlos Syndrome have been identified, each with its own peculiar characteristics. The syndromes are thought to be hereditary, and many symptoms overlap from one category to the next.
Most symptoms of Ehlers-Danlos Syndromes affect the joints and skin, which are often fragile and painful:
  • Joints: Joints are loose and unstable, and often painful and prone to dislocation.
  • Skin: Skin is velvety-soft and tears and bruises easily; wounds heal slowly.
  • Less common: Fragile arteries, intestines and uterus; scoliosis, poor muscle tone, mitral valve prolapse and gum disease.

Diagnosis of JHS

In addition to a health history and clinical exam, your therapist may ask you a number of questions, including:
  • Can you bend forward and place your palms flat on the floor without bending your knees?
  • Does your thumb bend back far enough to touch your arm?
  • Can you perform a full split
  • Are you prone to dislocation of shoulders, elbows or knees?
  • Have you been called “double jointed?”
Your therapist may use a goniometer to measure your joint angles, and they may use diagnostic ultrasound to view your joints and muscles in motion.

Hypermobility physical therapy treatment

There is no cure for JHS, but you can manage your condition with physical therapy and exercises designed to balance muscle tension and increase joint stability. Your therapist may use real time ultrasound to help you activate and retrain deep muscles to improve overall stability. Postural correction therapy can help protect your joints by putting them in proper alignment to reduce excessive stress. Gait analysis and retraining can identify and correct motor deficiencies that increase your risk of injury while walking or running.
One promising new therapy for JHS leverages the benefits of aquacise to provide a pain-free and effective method of joint stabilization. Kineo viscous water therapy applies the principles of water viscosity for concentric and eccentric loading, where the load adapts precisely to the actual strength of the patient. The water viscous method is particularly effective for the knee joint, providing progressive increases in the viscous load to promote strength and stability.

Following are the most beneficial characteristics of the viscous method:
  • The resistance load increases or decreases according to speed of movement and level of viscosity.
  • Speed depends on the amount force applied by the patient, allowing them to avoid pain.
  • Due to buoyancy, there is no inertia. Once movement stops, joint loading resets to zero, increasing patient safety.
  • Biphasic load: concentric and eccentric loads can be adjusted independently.
  • The ability of the patient to adjust the load by altering speed empowers them to actively participate in their own rehabilitation.
For athletic and physically active individuals, a therapist can design an individualized training program specific to your sport or activity, to increase joint stability and reduce your risk of injury. Athletic taping, elastic bandages or padding may add increased protection.
If you are hypermobile, you can take a proactive approach to increase your joint stability and reduce your risk of injury. A physical therapist can prescribe a personalized exercise regimen to help you achieve optimal joint function and mobility.
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Hypermobility specialist NYC

If your hypermobile joints are causing you pain or keeping you from being physically active, the sports medicine team at NYDNR can help. We combine state-of-the-art technology with world-class expertise to give our patients the very best care and treatment. Make an appointment with NYDNR today, and see why we are the very best rehabilitation clinic in NYC.
130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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