Joint hypermobility is used to describe joints that easily move beyond the normal range. It is commonly called being ‘double-jointed,’ although this is a misnomer, as these individuals do not have two separate joints.
Joints are areas of the body where two bones are held together by ligaments. Ligaments allow for mobility, so the bones can glide over one another smoothly and safely. Ligaments also provide stability, holding the bones together like hinges on a door, preventing dislocation. People with hypermobility syndrome have loose ligaments. This results in joints that are more mobile and less stable than normal. As a result, people with hypermobility syndrome are more prone to joint dislocations. They are also more prone to joint pain, as repeatedly moving a joint beyond its normal range puts stress on the joint and surrounding tissues.
Hypermobility syndrome is a condition that may be inherited or happen by chance. Normal ligaments are composed of a strong fibrous tissue called collagen. In people with hypermobility syndrome, there is a defect in collagen formation. This results in loose ligaments.
For many, there are no symptoms, but some people have recurrent joint pain and/or recurrent joint dislocations. The pain can be localized to the joint or include the nearby muscles. It tends to be worse with activity or at the end of the day and is usually relieved with rest. Joint dislocations can occur with minimal trauma, such as rolling over in bed or going from sitting to standing.
Your doctor will make the diagnosis by evaluating your symptoms and examining your joints to measure their range of motion. He/she will also assess your muscle strength and flexibility. X-rays and other imaging studies are not required to make the diagnosis of hypermobility syndrome. In some cases, blood tests may be helpful to rule out other causes of joint pain.
Treatment of joint hypermobility syndrome is focused on joint protection. Strengthening the muscles around the joints improves joint stability and reduces pain. Despite loose ligaments, many people with joint hypermobility will tightness in large muscle-tendon groups. Since tight muscles can contribute to joint and tendon pain, stretching to improve muscle flexibility is often recommended. Pain medications can be used to treat the pain symptoms, but do not change the stability of the joint or tension on the muscles and tendons, so they only provide temporary relief. In some cases, supportive devices such as shoe inserts or knee braces may be helpful.
Sometimes, Collagen is a major protein found in many body tissues. Its fibers give strength to ligaments, tendons, bone, skin, and cartilage. Many patients have isolated joint hypermobility, where the ligaments are the only tissues affected. In some patients, joint hypermobility is part of a more systemic collagen disorder, where other tissues are also affected. Ehlers-Danlos is a genetic syndrome that causes fragile skin, loose ligaments, heart valve defects, and eye problems. Tell your doctor if you have easy bruising, stretch marks, abdominal pain, chest pain, back pain, vision problems, or have been diagnosed with a heart murmur, as these may be signs of a more global collagen disorder.
Your doctor may initially advise you to modify your activities until the pain resolves and your strength and flexibility improve. High impact activities, such as gymnastics, football, basketball, soccer, and long distance running place a lot of stress on the joints and increase the risk for dislocation and pain. Activities such as swimming, bicycling, walking, and weight training are considered low impact and are safe to continue in most instances. Since people with hypermobility will vary with respect to the severity of symptoms and the spectrum of joints affected, talk to your doctor about which activities are best for you.
Most people with joint hypermobility who follow recommended guidelines for joint protection do not suffer any damage to their bones or joints as they get older. However, some people with joint hypermobility can develop early onset of osteoarthritis, due to damage from recurrent dislocations or cumulative joint stress from years of high impact activity.