Joint hypermobility - information for children and young people

What is hypermobility?

Joint hypermobility describes a situation in which one or a number of a person’s joints have an extra range of movement. If all or many joints are hypermobile it is termed generalised joint hypermobility. On its own it is not an illness or a disease, just the way someone is put together. It can also be referred to as joint laxity or being double jointed.

Hyper means more and Mobility means movement.

The science

Ligaments are made of connective tissue which includes collagen fibres, and their role is to stabilise the joints when they move. In hypermobility these ligaments are more lax due to variations in one or many of the collagen fibres. This allows the joint to move more. There are a number of factors which influence how much mobility we have. These include gender, race, age and family background.

How common is it?

Generally, children are flexible, some more than others. In the majority of children this will become less as they get older but a small percentage will remain very flexible. This is more common if their parents are still very flexible. In most cases hypermobility peaks at the age of five.

Common concerns related to being hypermobile

• ‘clicky’ joints
• clumsiness / falling over (more often than peers)
• flat feet (feet roll in)
• tiredness after walking long distances
• pain in muscles and joints
• joint swelling lasting less than a few days
• difficulties with handwriting, holding a knife and fork, and dressing
• children can move their joints and bodies into unusual positions

Is it a cause for concern?

Many children who are hypermobile experience no symptoms or difficulties and being hypermobile can be an advantage. Some of our best sportsmen and musicians are hypermobile. However, in these people their muscles around the joints are well trained and strong.

There are a small number of people who experience difficulties associated with hypermobility. It is not fully understood why these children have more symptoms than others and it is not necessarily related to how hypermobile they are. However, it is believed that these problems are related to poor muscle strength, poor muscle stamina and poor control of joint movement, not the hypermobility itself.

Joint swelling for a few days after activities in children and young people is not uncommon and will usually settle without any treatment. Unless there has been a specific injury it is not a sign of joint damage or long-term inflammation.

What can be done to help?

It is essential to increase the muscle strength around the affected joints, to provide additional support and improve the joint stability.

Low impact exercise, such as swimming and cycling, will help maintain muscle strength, physical fitness and well-being. Normal activities such as PE, playtime and dance should be continued and encouraged.

Pacing activity

If the child or young person reports pain after activity it is important not to give up and pacing will help. This involves planning your activities carefully throughout the day to keep the intensity low and having short rest breaks where required. If muscles are not used regularly, they will become de-conditioned and this will lead to further pain and discomfort the next time any activity is undertaken.

Pacing of physical activities is needed to ensure a person’s tolerance and ability is gradually increased according to their own capabilities. Avoid the “boom and bust” cycle of doing too much activity on one day and then nothing for a few days afterwards (due to pain). Spread activity throughout the week and build up strength and fitness gradually.

On busier days where there will be a lot of walking and activity, such as family days out, pacing can still be achieved by scheduling regular short pauses into the day. This will allow your child or young person to make it through the day whilst minimising fatigue and muscle aches associated with the “boom and bust” cycle.

Pain management

Children and young people may suffer aches and pains and these are usually a result of the muscles being used (to stabilise the joints) and fatigue, rather than the result of injury or damage. Muscle pain after activity, even for 1-2 days afterwards, is normal. It is expected that as muscles become stronger the pain will decrease.

Warm baths or a hot water bottle (wrapped in a towel) may help, particularly in the evenings and after activity. Try not to focus on pain and distract your child from dwelling on it. You could try encouraging them to engage in relaxation activities dependent upon the age from colouring to listening to music or an audio book.

Pain killers (analgesia) are unlikely to resolve the pain on their own but may help from time to time. Simple pain relief including Paracetamol or anti-inflammatories such as Ibuprofen can be taken – see manufacturer’s guidelines

Footwear

Supportive footwear is recommended. Key points to consider with footwear are:

• shoes which are stiff around the heel
• sturdy soles, which provide shock absorbance
• lace up / buckle shoes that support the whole foot

Avoid shoes with thin soles, no heel support, for example, flip flops, pumps or slip on shoes.

Recommended activities to develop muscle strength

Upper limbs: When pain is experienced in the wrists and hands with activities such as handwriting, gripping and using cutlery, certain aids and extra support can be helpful. Please speak to your child’s schoolteacher regarding support with providing pen grips or a writing board if needed. We also recommend the following activities:

• use of modelling clay.
• wringing out cloths / sponges – car washing, window cleaning etc.
• use of stress ball (squeezing) or putty to strengthen finger and wrist muscles.
• games or activities requiring fine manipulation e.g. Lego, wind-up toys or knitting.
• use bigger joints, such as the elbows, to carry large items, for instance textbooks, to spread the load.
• use a backpack to spread weight across the joints, rather than a shoulder bag.
• write for shorter periods of time when completing schoolwork, ensuring there are short intervals between writing to rest fingers and wrists.

Lower limbs:

• Try to remain as active as possible, e.g. walking to and from school, cycling, swimming and playing sport.
• Try yoga and Pilates. They build up core muscle strength and also provide skills in being calm and relaxed which can also help reduce pain.
• Keep feet in a stable position when completing table-top activities, such as drawing and typing (a footstool could be used if appropriate), to improve sitting alignment.

Physiotherapy and occupational therapy

Most children and young people’s pain and difficulties will improve with the measures listed above and for the majority hypermobility is unlikely to cause problems in the future providing they remain fit and strong.

Some children benefit from a single assessment with a physiotherapist and / or occupational therapist to provide a standard home exercise programme which will target their individual challenges or alignment variations.

A small number of children will require more detailed therapeutic involvement with these professionals. This includes if the child or young person is more prone to injuries, for example ankle sprains or kneecap (patella) discomfort, or if they have long standing (chronic) pain. In these situations, they will receive more regular appointments for review and a more detailed home exercise programme.

Useful further information

• Versus Arthritis website (opens in a new tab)
• NHS Choices website (opens in a new tab)