Hypermobility 101

Do you work with children with hypermobility conditions? Do you have questions about hypermobility? You’ve come to the right place. This blog is designed to give you bite sized info that you can apply to your clinical work today!

Let’s start at the very beginning… I don’t want to assume what you know, so we are going to start from scratch.

What is Hypermobility?

According to Grahame (2003), “hypermobility implies a range of joint movement that exceeds what is considered to be normal for that joint taking into consideration the individuals age, gender and ethnic background”. Generally, we talk about hypermobility as being an excess of movement at a joint, but we must always consider age, gender and ethnic background if we are to be accurate with our observations. 

  • We know that children are generally more hypermobile than adults.
  • We know that females are generally more hypermobile than males.
  • We know that those of Asian and African backgrounds are more hypermobile than Caucasians.
  • We also know that joint hypermobility can be an acquired trait or maintained by activities that continue to stretch joints, such as participating in dance or gymnastics (Tinkle, 2010).

Hypermobility is not a diagnosis, despite it being thrown about as one by a lot of health professionals and their patients. “I’ve got hypermobility” is often used as a diagnosis, like “I have diabetes”. Hypermobility is simply an observation about the range of movement at any given joint. You will find that it can be isolated to one joint, for example, the thumb MP joint, localised to the upper limbs or lower limbs, be unilateral, or be widespread. 

Regardless of how widespread or limited the hypermobility is, it’s still only an observation. It’s not a diagnostic label, like Cerebral Palsy or Muscular Dystrophy. Hypermobility can be found as a symptom or sign in many different syndromes and disorders… or it can just be, without symptoms, without significance. While it’s not “normal”, it doesn’t mean that it’s necessarily a “problem”.

Which conditions commonly involve hypermobility?

  • Down Syndrome 
  • Autism Spectrum Disorders
  • Tay-Sachs Disease
  • Prader-Willi Syndrome 
  • Cerebral Palsy (Hypotonic)
  • Hypermobility Spectrum Disorders
  • Ehlers-Danlos Syndromes
  • Loeys-Dietz Syndrome
  • Marfan Syndrome
  • Osteogenesis Imperfecta
  • Stickler Syndrome
  • Coffin-Lowry Syndrome
  • Morquio syndrome (MPS IV)
  • Any condition that involves hypotonia 

Of the above conditions, the following are considered connective tissue dysplasias (CTDs). There are over 600 connective tissue dysplasias, only some of which have hypermobility as a symptom. Some of them include:

  • Hypermobility Spectrum Disorders (although not genetically proven)
  • The Ehlers-Danlos Syndromes
  • Loeys-Dietz Syndrome
  • Marfan Syndrome
  • Osteogenesis Imperfecta
  • Stickler Syndrome
  • Coffin-Lowry Syndrome
  • Morquio syndrome (MPS IV)

Do you treat them all the same?

Yes and no. With the CTD related hypermobility presentations there are usually extra precautions that need to be in place due to the co-morbidities that are often found with them, as well as in some cases, the propensity for vascular, immune and cardiac issues.

With the remaining presentations of hypermobility, we look at it more from a neurological/brain perspective where something is different in neurological functioning causing hypotonia. The hypotonia then causes hypermobility, rather than a problem with connective tissue synthesis. 

How does hypermobility impact on function?

Joint hypermobility often causes poorer proprioception at that joint, so less awareness of where it is in space and in relation to other things. This can lead to difficulties with fine motor and gross motor development.

Hypermobility can also lead to subluxation or dislocation of joints either via traumatic or atraumatic means. Some children with hypermobility may experience muscular fatigue and poor activity endurance due to muscle weakness and/or the muscles around the joints working overtime to stabilise hypermobile joints. 

In children (and adults) with connective tissue dysplasias, systemic fatigue is often an issue which needs to be addressed. Chronic or widespread pain is often associated with these conditions and requires careful management to enable maximal function. 

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  • Claire Bennett

    Hi Michelle,

    I’m a paediatric OT in the UK – I’ve recently taken on a 10yr old child with Ehlers Danlos Syndrome, which is largely out of my experience. My query relates to ICT recommendations – my thinking is that he would be better with an external keyboard & mouse, rather than the laptop he currently has, we can also then achieve better positioning. In your experience though, are there particular set ups which are better i.e. split keyboards, an ergonomic mouse?
    Any thoughts / information would be much appreciated.
    Many thanks,


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