Joint Hypermobility Syndrome

A side view of a foot with a hand holding the ankle. The ankle is highlighted red signifying pain

Having Joint Hypermobility means that your joints are able to move beyond a ‘normal’ range of motion, and are very flexible. This is often referred to as being ‘double-jointed and is relatively common’. The most commonly affected joints are your elbows, wrists, fingers and knees.

For most people, having hypermobile joints doesn’t cause any pain or medical complications. For 3% of the population, however, severe hypermobility may be a sign of a more serious genetic condition named Joint Hypermobility Syndrome (JHS). JHS is accompanied by joint pain, joint and ligament injuries, fatigue, and digestive issues, alongside many other troubling symptoms. 

Being diagnosed with JHS can be daunting and confusing, and many people are unsure what the implications are for their overall health and wellbeing, their quality of life, and their ability to participate in work or exercise.  

Our podiatrists are experienced in working with many patients with JHS to support them in managing their joint hypermobility and any knee, hip or ankle problems that may arise, so they can continue to live and work as normally and safely as possible, and with as little pain as possible. As hypermobility can change over time, working with a trusted podiatrist who understands your unique situation and condition is important to ensure that you are future-proofing your body’s health and protecting your joints against any future injury.

What Is Joint Hypermobility Syndrome?

Joint Hypermobility Syndrome is a connective tissue disorder. Thick bands of tissue called ligaments are responsible for holding your joints together throughout your body, and prevent them from moving too much or too far out of a healthy range. In people with JHS, these ligaments stretch much more, and are weaker. If you have joints that are far more flexible than normal, and it causes you pain, it may be worthwhile to see if you have JHS.

Symptoms Of Joint Hypermobility Syndrome 

The most common symptom of JHS is extreme flexibility and pain in your joints and muscles, but other symptoms may include:

  • Frequent joint and ligament injuries, including dislocations and sprains
  • Joint and muscle stiffness
  • Fatigue
  • Clumsiness or poor balance
  • Bladder and bowel issues
  • Clicking joints
  • Easy bruising
  • Dizziness and fainting
  • Abnormal scarring
  • Thin, stretchy skin

What Causes Joint Hypermobility Syndrome?

The precise cause of JHS is not known, however, the condition tends to run in families. The genes that are responsible for creating collagen throughout the body are believed to play a role. 

Collagen And Joint Hypermobility

Collagen is the protein that adds flexibility and strength to your skin, joints, ligaments and tendons, and is otherwise known as the ‘glue’ that holds your entire body together. People with JHS have weaker and stretchier ligaments, which causes them to have looser and more hypermobile joints. These ligaments are stretchier because there is a defect in the way that their collagen is formed, leaving them with faulty or weak collagen. 

Risk Factors For Joint Hypermobility Syndrome

JHS often runs in families and therefore is an inherited condition. It is believed that if one parent has hypermobility, one in two of their children will also have it. Hypermobility can also be influenced by:

  • Muscle tone - the weaker or more relaxed your muscles are, the greater range of movement you will have
  • Gender - women are more likely to develop JHS  than men.
  • Age - the collagen fibres in your ligaments tend to bind more tightly together more as you get older, which is why many of us become stiffer with age. Hypermobile people who are very flexible and pain-free when younger may find that they’re less flexible when they reach their 30s or 40s
  • Ethnicity - people of different ethnic backgrounds have differences in the way their body is built, with people of Asian and West African descent being affected by JHS more often 
  • Research also suggests that if you have autism, attention deficit hyperactivity disorder (ADHD) or Tourette’s syndrome you are more likely to have symptoms associated with JHS

Assessing And Diagnosing Joint Hypermobility

To be diagnosed with JHS, you will need to undergo a physical exam with a podiatrist or other health provider to assess the range of motion in your joints. They may also request blood tests to rule out any other possible genetic conditions. 

Typically, a questionnaire called the Beighton score will be used to measure the flexibility of your joints, by placing it on a nine-point scale. You receive one point if you can do each of the following:

  • Bend forward and place your hands flat on the floor without bending your knees (one point for completion)
  • Bend your elbows backwards (one point each side)
  • Bend your knees backwards (one point each side)
  • Bend your thumbs backward to touch your forearms (one point each side)
  • Bend your pinky fingers backwards beyond 90 degrees (one point each side)

If you receive a score of four or more points and experience pain in four or more joints for at least three months, you may be diagnosed with JHS.

As everybody (including people with JHS) experience lessening flexibility as they get older, you may also be asked how hypermobile your joints were when you were younger. The five questions are: 

  1. Can you now (or could you ever) place your hands flat on the floor without bending your knees?
  2. Can you now (or could you ever) bend your thumb to touch your forearm?
  3. As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
  4. As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?
  5. Do you consider yourself double-jointed?

If you answered “yes” to two or more questions, this may be a sign of JHS.

Joint Hypermobility Treatment: Can Joint Hypermobility Syndrome Be Fixed?

Joint hypermobility syndrome is a genetic disorder that you inherit at birth, so it can’t be prevented or cured. The good news is that we can help you manage the symptoms, which tend to decrease with age. As the symptoms of JHS can range from mild to severe, it’s important to work with a trusted podiatrist team to learn ways to protect your joints and manage your pain.

You can help improve your joint and muscle strength by:

  • Learning about the ideal forms of exercise to support your joints safely (avoiding over-extending your joints which may cause more damage)
  • Strengthening specific muscles to improve balance and help stabilise joints
  • Using techniques such as muscular taping or braces to help to improve gait and prevent injury
  • Wearing ergonomic shoes or modified footwear, and custom-made orthotics
  • Participating in a tailored exercise programme to target physical needs
  • Exercising regularly with frequent breaks
  • Easing joint pain and stiffness with heat packs or warm baths

There is a wide variation in the shape of the foot in people who are hypermobile. Most tend to have flat feet but a few have a high-arched foot, which can cause pain and problems when walking. In addition to this, patients with JHS experience higher rates of osteoporosis in their joints. Hypermobility in your feet, knees and hips can also increase the likelihood of strains, sprains and dislocations in these areas. 

All of these preceding issues can be managed with the support of a podiatrist. A podiatrist can assess your gait as well as your joint strength and function. They can also prescribe custom foot orthotics or braces that can help support your feet and legs, by reducing harmful movements and preventing injury and deterioration. 

  • Orthotics may also help with balance and reduce pain in the foot, ankle, leg, hip and lower back, by re-aligning the foot and the way the body's weight passes through the legs. 
  • The Exo-Brace can help prevent ankle sprains and excessive movement at the ankle
  • The Exo-Up brace helps with symptoms of muscle weakness like foot drop, preventing the toes from hitting the ground and reducing the risk of injury
  • The Richie brace is another brace that yields fantastic results for the possible symptoms of JHS such as ankle instability, foot drop, and foot pain and problems

Managing the symptoms of JHS means that you can still live a full and active life.

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