Hypermobility

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    Last Updated: October 6, 2024

    Hypermobility is the ability to move a joint beyond the normal range of motion. It can be limited to individual joints or occur more generally throughout the body. In most cases hypermobility is benign, but unstable joints are prone to injuries, dislocations, and subluxations which can cause significant pain.

    Hypermobility falls under the Joints & Bones category.

    What is hypermobility?

    Hypermobility is the ability to move one or more joints beyond the normal range of motion. In most cases, hypermobility is benign, but it can be accompanied by pain, soft-tissue trauma, and other features of Hypermobility Spectrum Disorder (HSD). Hypermobility is also present in some connective tissue disorders, such as Ehlers-Danlos Syndrome (EDS).

    What are the main signs and symptoms of hypermobility?

    Excessive joint range of motion is the primary sign of hypermobility, but common reasons for seeking medical support include pain, injury, and joint instability. Although the cause is unclear, hypermobility is also associated with increased prevalence of anxiety, fatigue, immune dysfunction, autonomic nervous system dysfunction, sleep disturbances, gastrointestinal problems, and gynecological complications.[1]

    How is hypermobility diagnosed?

    The Beighton Hypermobility Score is used to quantify hypermobility and includes a nine-point scoring system. Conditions such as EDS and HSD have specific criteria with additional features.

    What are some of the main medical treatments for hypermobility?

    Physical therapy is often prescribed to rehabilitate injured joints, and it may improve joint control in hypermobile patients.[2] Although more research is needed, prolotherapy injections in hypermobile joints may lead to reductions in pain and joint range.[3]

    Have any supplements been studied for hypermobility?

    There are no supplements which reduce hypermobility directly. However, some supplements may support goals related to the condition, such as protein for fueling resistance-training adaptations, or melatonin for improving sleep to support healing.

    How could diet affect high hypermobility?

    Although deficiencies in some nutrients (e.g., vitamin C) can result in compromised connective tissue, there is no single best diet for hypermobile individuals. More often, diets are tailored on an individual level to navigate conditions or sensitivities which may occur alongside hypermobility, such as gastrointestinal dysfunction.

    Are there any other treatments for hypermobility?

    Low impact exercise options such as swimming are popular, and research suggests that appropriately tailored resistance training may improve joint control, strengthen muscles and tendons, and reduce pain in hypermobile joints.[4] Symptom management varies between individuals, but may involve braces for affected joints, avoidance of high-impact jobs and hobbies, or scheduling around fatigue.[5]

    What causes hypermobility?

    Genetics play a role in hypermobility, and family history influences an individual’s risk.[6] Hypermobility is more common among women, as are many of the associated conditions.[7][8]

    Frequently asked questions

    What is hypermobility?

    Hypermobility is the ability to move one or more joints beyond the normal range of motion. In most cases, hypermobility is benign, but it can be accompanied by pain, soft-tissue trauma, and other features of Hypermobility Spectrum Disorder (HSD). Hypermobility is also present in some connective tissue disorders, such as Ehlers-Danlos Syndrome (EDS).

    What is Hypermobility Spectrum Disorder?

    A diagnosis of Hypermobility Spectrum Disorder (HSD) indicates the presence of hypermobility along with secondary musculoskeletal manifestations such as pain, soft tissue trauma, disturbed proprioception, or other musculoskeletal/orthopedic traits such as flexible flat feet or misaligned bones.[9]

    What is Ehlers-Danlos Syndrome?

    Ehlers-Danlos syndromes (EDS) are a group of inherited disorders that affect the connective tissues of the body. Hypermobile EDS (hEDS) is the most common type of EDS and is characterized by hypermobile joints, which may dislocate or be a source of chronic pain.

    Are hEDS and HSD the same condition?

    No. Although the two conditions often require similar care, there are important differences in the diagnostic criteria.[10] Whereas the HSD diagnosis is intended for patients with symptomatic hypermobility, the hEDS criteria is more specific. Physical features such as hyperextensible skin, an arm span-to-height ratio of ≥1.05, and atrophic scarring are considered, as well as family history of hEDS. These unique features facilitate research into the genetic basis of hEDS.[9]

    What are the main signs and symptoms of hypermobility?

    Excessive joint range of motion is the primary sign of hypermobility, but common reasons for seeking medical support include pain, injury, and joint instability. Although the cause is unclear, hypermobility is also associated with increased prevalence of anxiety, fatigue, immune dysfunction, autonomic nervous system dysfunction, sleep disturbances, gastrointestinal problems, and gynecological complications.[1]

    How is hypermobility diagnosed?

    The Beighton Hypermobility Score is used to quantify hypermobility and includes a nine-point scoring system. Conditions such as EDS and HSD have specific criteria with additional features.

    What are some of the main medical treatments for hypermobility?

    Physical therapy is often prescribed to rehabilitate injured joints, and it may improve joint control in hypermobile patients.[2] Although more research is needed, prolotherapy injections in hypermobile joints may lead to reductions in pain and joint range.[3]

    Have any supplements been studied for hypermobility?

    There are no supplements which reduce hypermobility directly. However, some supplements may support goals related to the condition, such as protein for fueling resistance-training adaptations, or melatonin for improving sleep to support healing.

    How could diet affect high hypermobility?

    Although deficiencies in some nutrients (e.g., vitamin C) can result in compromised connective tissue, there is no single best diet for hypermobile individuals. More often, diets are tailored on an individual level to navigate conditions or sensitivities which may occur alongside hypermobility, such as gastrointestinal dysfunction.

    Are there any other treatments for hypermobility?

    Low impact exercise options such as swimming are popular, and research suggests that appropriately tailored resistance training may improve joint control, strengthen muscles and tendons, and reduce pain in hypermobile joints.[4] Symptom management varies between individuals, but may involve braces for affected joints, avoidance of high-impact jobs and hobbies, or scheduling around fatigue.[5]

    What causes hypermobility?

    Genetics play a role in hypermobility, and family history influences an individual’s risk.[6] Hypermobility is more common among women, as are many of the associated conditions.[7][8]

    Is there a hEDS gene?

    A July 14, 2021 press release from the Medical University of South Carolina announced that a candidate gene was being investigated in mouse models of the condition, and final results would be forthcoming. Previous efforts to find a genetic basis for hEDS revealed some contenders, but were limited by small sample sizes. [11]

    References

    1. ^Hakim A, Grahame RJoint hypermobility.Best Pract Res Clin Rheumatol.(2003-Dec)
    2. ^Engelbert RH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JVThe evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome.Am J Med Genet C Semin Med Genet.(2017-03)
    3. ^Nagori SA, Jose A, Gopalakrishnan V, Roy ID, Chattopadhyay PK, Roychoudhury AThe efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis.J Oral Rehabil.(2018-Dec)
    4. ^Liaghat B, Skou ST, Jørgensen U, Sondergaard J, Søgaard K, Juul-Kristensen BHeavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study.Pilot Feasibility Stud.(2020)
    5. ^Russek LN, Stott P, Simmonds JRecognizing and Effectively Managing Hypermobility-Related Conditions.Phys Ther.(2019-09-01)
    6. ^Remvig L, Jensen DV, Ward RCEpidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature.J Rheumatol.(2007-Apr)
    7. ^Rek M, Kaczmarek K, Cygankiewicz I, Wranicz JK, Ptaszyński PPostural orthostatic tachycardia syndrome (POTS)--pathophysiology, diagnostics, and treatment.Przegl Lek.(2014)
    8. ^Borba VV, Zandman-Goddard G, Shoenfeld YProlactin and Autoimmunity.Front Immunol.(2018)
    9. ^Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, Bloom L, Bowen JM, Brady AF, Burrows NP, Castori M, Cohen H, Colombi M, Demirdas S, De Backer J, De Paepe A, Fournel-Gigleux S, Frank M, Ghali N, Giunta C, Grahame R, Hakim A, Jeunemaitre X, Johnson D, Juul-Kristensen B, Kapferer-Seebacher I, Kazkaz H, Kosho T, Lavallee ME, Levy H, Mendoza-Londono R, Pepin M, Pope FM, Reinstein E, Robert L, Rohrbach M, Sanders L, Sobey GJ, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Wheeldon N, Zschocke J, Tinkle BThe 2017 international classification of the Ehlers-Danlos syndromes.Am J Med Genet C Semin Med Genet.(2017-03)
    10. ^What is HSD?
    11. ^Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RAHypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes.Dev Dyn.(2021-03)