Hypermobility means increased tissue or joint extensibility. Hypermobility is only of concern if it is causing adverse symptoms that are effecting quality of life. Hypermobility disorders are connective tissue disorders which cause increase tissue and joint extensibility, ligamentous laxity, a propensity for bruising, poor scarring, muscle weakness.
The most common hypermobility syndromes are Benign Joint Hypermobility Disorder and Ehlers Danlos Syndrome. These can manifest in a number of ways. The child or young adult may have coordination issues, joint pain, greater incidence of growing pains and many small bruises in various stages of healing in “high contact” areas such as shins and forearms. On the other hand some children or young adults are very coordinated but suffer from frequent sprains, strains/subluxations/dislocations and/or tendinopathies.
The aim of a treatment programme for hypermobility is to provide as much information for the parent/carer to enable them to manage symptoms effectively at home. Often only 3 to 4 sessions are needed in early stages to get symptoms under control.
Parents then continue with the principles of management at home. The family might only return to physiotherapy when new symptoms occurs, for example, tendinopathy, back pain, subluxations.
A myriad of symptoms of which the child may have some or all
The treatment for hypermobility is usually a combination of the several areas. Symptoms at the time of presentation will determine the focus of the program.
Proprioception is the body’s awareness of the position of a joint in space in relation to another joint. It facilitates body’s ability to synchronise limb and trunk movements. This reduces risk of dislocation, subluxation, tripping over injuries. There are several ways to improve this such as:
Many children with hypermobility disorders have unusual or awkward looking gait patterns that contribute to trips/falls and not being able to keep up with peers in the playground. Pigeon toe, knock knees, inturned gaits are common place in children with hypermobility disorders. To a lesser degree the duck feet walker and tip toe walker are also reported in association with hypermobility conditions. Flexible bracing garments such as Spiral Skins are an ideal adjunct to physiotherapy to provide sustained biofeedback for motor learning and gait retraining, while limiting excessive internal rotation at the hip and thigh.
Many children with hypermobility suffer from postural muscle weakness. In sitting they may have a “c” shaped trunk posture. In standing the child may have slumped shoulders with an excessively sway back or an excessively flat lumbar region with hyperextension of the knees. Children suffer considerable body fatigue and pain from postural weakness. In younger children with very poor postural awareness the flexible bracing garments, balance disc and wobble chairs are excellent short term tools to facilitate improved postural awareness and allow the child to experience a more normalised body positioning.
Strengthen the weaker muscles and the muscles that stabilises body segments (usually the core and trunk).
Stretching of compensatory tight muscle groups. The hamstrings and calves sometimes tighten up as a compensatory balance mechanism.
Physiotherapists specialised in the management of hypermobility disorders can advise you of exercises that you can incorporate into general family life that will strengthen the child’s core stability.
Muscles are fatigued and often prone to spasm by end of day. The muscles are working hard to control movement. When it is time to sleep muscles are still in a state of semi tension. Relaxing before bed promotes muscle relaxation, better sleep pattern and reduces restless legs.
Short frequent bursts of activity are always better than longer durations. The length of time dependent on child’s age. Avoid 2 sports on 1 afternoon (eg footy training followed by swimming squad).
High impact sports such as rugby, touch rugby, ice hockey.
Kindy gym/toddler gym, indoor climbing gyms in winter (beach house/fun station), local park, baby swim or aquatic leisure centres, balance circuit in own backyard and normal play and exploration for younger child.
Podiatry to assess need for foot support such as orthotics or modifed footwear
Occupational therapy (OT) for hand management and exercises, pen grips, slope board, hand writing skills.