Hypermobility
Hypermobility is a term heard often in both the dance and other artistic and athletic industries. Research and awareness on hypermobility is growing, but I still find there is often a lack of clarity with terminology, diagnosis, and treatment options. The word hypermobility simply refers to the ability of a joint to passively (someone/thing moving the joint for you) or actively (moving the joint yourself) beyond its normal range of motion. Being hypermobile is not a diagnosis, but a finding. To have a diagnosis you need to have other symptoms.
The first step when addressing hypermobility is the combination of a physical examination and a history. The physical exam portion is called Beighton’s test. Beighton’s test was originally developed for research purposes, but is now being used as a part of a diagnostic algorithm. Beighton’s test is a score out of 9. It involves examining a few moves in which the person being examined is either able to perform the move or not. The first move is putting both hands flat on the ground from a standing position (forward fold). This gets you one point. The next move is pulling your thumb sideways to touch your forearm. Each thumb that can do this gives you a point. The next is pulling your pinky finger backwards 90 degrees. Each pinky is also worth a point. The final test is to examine the hyperextension of the knees and elbows. Any of these four joints that have more than a 10 degree angle of hypermobility gives you another point each. The total maximum is 9 points.
The score is now compared against the age minimums. For children, the minimum is 6, for adults under 50 it is 5, and for adults over 50 it is 4. If the score does not meet the minimum, then there is a set of criteria in which if two of the criteria are met, the person still qualifies as hypermobile. These questions are:
Can you now (or ever) place your hands flat on the floor without bending your knees?
Can you now (or could you ever) bend your thumb to touch your forearm?
As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
As a child or teen did your shoulder or kneecap dislocate more than once?
Do you consider yourself “double jointed”
If at this point you are still considered hypermobile, then the next step is to evaluate to see if there is what is called Hypermobile Ehlers-Danlos Syndrome. This includes a list of 4 criteria in which two out of the first three criteria must be met, plus the final and fourth criteria. These involve a set of comorbidities, symptoms, issues, and familial history. If the criteria is not met, then there are three choices from here. You may be eligible to be diagnosed with Ehlers-Danlos Syndrome (not the hypermobile one), or another condition, or one of the four Hypermobility Spectrum Disorders. Considering another condition may involve a referral to a specialist (if not at that point already).
Hypermobility Spectrum Disorder (HSD) is fairly simple. This is where the criteria for hypermobility has been met, and there is at least one secondary musculoskeletal manifestations. If there is a secondary MSK complaint, then the final step is to decide which subtype of HSD is most appropriate. Peripheral involves just the hands and feet. Localized is for one joint or joint group. Historical is for those who has a history of hypermobility, but this has decreased with age. Finally, General is what is left when none of these fit!
When dealing with hypermobility, it is important to have this diagnosis first when addressing other symptoms or conditions. Sometimes the big picture helps match the treatment plan, and saves the individual from delay in recovery and relief. The above mentioned conditions can involve multi-systems within the body leading to issues as diverse as headaches, abdominal pain, insomnia, depression, anxiety, hernias, GERD, IBS, nausea, constipation, Crohn’s, abdominal pain, pelvic pain, dysmenorrhea, incontinence, TMJ disorders, chronic fatigue, exercise intolerance and postexercise malaise.
For more information about hypermobility, seek out a care team that is familiar with these conditions, and up to date on diagnosis and treatment options. Chronic conditions are often stressful. Joining a support community or curating your own personal support team can make all the difference. For more information about Ehlers-Danlos, consult their Society at www.ehlers-danlos.com/ For more information on Hypermobility Syndromes, consult their Association at www.hypermobility.org.
For more information about Made To Move, please reach out to hello@madetomove.ca or better yet, book an in-person consultation (Toronto, Canada) through our website.
