BENIGN HYPERMOBILITY SYNDROME
Benign hyper mobility syndrome is a syndrome where individuals have excessive joint laxity, or ‘flexible/double-jointed joints’. This syndrome often carries a strong family history and these people typically display their joint laxity as “Party Tricks” at the family BBQ.
It is most common in females (up to 85% of cases) and will often present in young children. It is common in women who start dancing/gymnastics/dancing from an early age and then have hypermobility later in life.
Diagnostic criteria are as follows:
| Table 17: Diagnostic Criteria for Hypermobility Syndrome |
| Beighton Criteria: Screening maneuvers for hypermobility |
| 1. Passive hyperextension of fifth metacarpophalangeal joint >90 degrees |
| 2. Passive apposition of the thumb to flexor aspect of forearm |
| 3. Hyperextension of the elbows >10 degrees |
| 4, Hyperextension of the knee >10 degrees |
| 5. Flexing the trunk and placing hands flat on the floor while keeping knees locked/extended |
| 1998 Revised Brighton Criteria for Benign Joint Hypermobility SyndromeMajor criteria |
| 1. Beighton score >4 (of 9) current or historic |
| 2. Arthralgia (>4 joints) for at least 3 mo |
| Minor criteria |
| 1. Beighton score of 1–3 (0–3 if >age 50 y) |
| 2. Oligoarthralgia, back pain, spondylosis for >3 mo |
| 3. Dislocation/subluxation in >1 joint more than once |
| 4. Soft tissue rheumatism >3 lesions (bursitis, epicondylitis, tenosynovitis) |
| 5. Marfanoid habitus |
| 6. Abnormal skin striae, hyperextensibility of skin, papyraceous scarring |
| 7. Drooping eyelids, myopia, or antimongoloid slant |
| 8. Varicose veins or hernia or uterine/rectal prolapse |
Most often in the clinic, the common complaint will be low back pain or neck tightness, particularly in an active individual. However, this is not limited to pain in any peripheral joint or soft tissue structures (ligaments, muscles, tendons). We also find specific segmental areas of the spine can actually have stiffness despite excessive overall movement.
Treating benign hyper mobility syndrome often involves avoidance of exacerbating exercise/changes in exercise, targeted joint mobilisation and manipulation (avoiding excessive movement at some areas), but most importantly strength and rehabilitation regimes. NSAID’s can often be used for pain and inflammation control (however these should be prescribed by your family doctor).
“Stretching techniques that are targeted to isolate tight muscles without stressing the surrounding joints may reduce symptoms by improving balance and control.14
Strength training should consist of a combination of both open kinetic (distal extremity moves freely) and closed kinetic chain (distal extremity meets resistance) exercises. Closed kinetic chain exercises often simulate functional demands of an extremity, while open kinetic chain activities are better for more targeted strength training.14
Focusing on improving:
- the proprioception of a joint may improve symptoms (eg, using a wobble board)
- supportive joint taping improves joint proprioception.21 Focused exercises to improve muscle strength
- balance, and coordination may help improve joint stability and proprioception.
Whats the GOAL ?
Improvement of proprioception may reduce strain to the ligaments surrounding the joint and avoid further injury.21,22
Along with exercise therapy, Manual Therapy is a useful adjunctive treatment modality for BJHS. Thrust treatment techniques applying high velocity/low amplitude forces are the most widely used, but because of the increased tissue fragility seen in BJHS and weak supporting structures of the joint, gentler techniques are often used.
References: http://www.rheumaknowledgy.com/hypermobility-syndrome/
https://jaoa.org/article.aspx?articleid=2093276
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