Do you have an undiagnosed pain, ongoing back or joint pain which just hasn’t been addressed with treatments or advice from your physio, chiropractor or GP? Hypermobility may be affecting you more than you know.
Here at The Twyford Clinic we see many patients who have chronic issues which have failed to respond to previous treatment from other clinicians. Hypermobility can be the missing factor, it means excessive movement, this can affect tendons, ligaments, muscle, skin, fascia, basically almost all the soft tissues in your body. Hypermobility is not an issue in itself and is very useful for certain sports which require a good range of movement, eg. Gymnastics, martial arts, dancing, the problem occurs if there is too much movement in your joints or tissues and this leads to pain which is then known as hypermobility syndrome (HMS).
It is very important to understand if you have the issue as then it is much easier to manage it on a daily basis. There are many other effects HDS can cause, there is a link to an increase in panic attacks and depression in HDS sufferers (Martín-Santos R et al. American Journal of Psychiatry 1998). At the extreme end of the spectrum other disorders such as Ehler Danlos syndrome also become apparent.
The majority of patients we see are young – teenagers to middle aged women who have had ongoing pains normally spinal and they can also suffer with other joint pains. Upon examination we use certain criteria which indicates if HDS is part of your issue. The first is Beighton score:
1. Touch the floor with your palms flat without bending your knees
2. Can you bend your left elbow back past straight
3. The same for your right elbow
4. When lying flat on floor with your left leg straight out in front of you can you lift your left heel off the floor approx 1-2 inches without lifting your knee or upper leg
5. The same for your right leg
6. Can you bend your left little finger back past 90 degrees
7. The same for your left little finger
8. Can you bend your left thumb under so that it touches your forearm
9. The same for your right thumb
We also use the Beighton criteria
• A Beighton score of 4/9 or greater
• Joint pain for longer than 3 months in 4 or more joints
• A Beighton score of 1, 2 or 3 (or 0, 1, 2 or 3 if aged 50+)
• Joint pain (> 3 months) in one to three joints or back pain (> 3 months).
• Dislocation or subluxation (slipping of a joint) in more than one joint, or in one joint on more than one occasion.
• Soft tissue problems, more than 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
• Marfanoid habitus (being tall, slim with an arm span/height ratio >1.03, or an upper: lower segment ratio less than 0.89, arachnodactyly (very long fingers compared to span of the palm)
• Abnormal skin: striae (stretch marks), hyperextensibility, thin skin, papyraceous scarring (purple stretch marks).
• Eye signs: drooping eyelids or myopia (short sighted) or antimongoloid slant (downward slant of eyes).
• Varicose veins or hernia or uterine/rectal prolapse.
If you have 2 major, or 1 major and 2 minor or 4 minor criteria, you more than likely (93% probability) to have hypermobility syndrome (HMS).
If you do have HMS, don’t worry, it I very common, the most important piece of advice I give to patient is to understand what the issue is then you can manage it long term, that doesn’t mean reams of exercises, rather a simple programme of targeted exercises and lifestyle choices to keep any pain at bay.
We have the time to fully assess you and build a picture which allows us to diagnose HMS. One study showed 60-75% of HMS cases were misdiagnosed by GP’s, this is not a criticism of their skills, rather it demonstrates how more time and expert physiotherapy skills are needed to recognise the issue.
Each patient is thoroughly assessed and if HMS is the cause of your issue we deal with you in a holistic manner which allows us to provide a specific treatment plan and exercise programme. Having HDS does not preclude you from sports and exercise but it may influence what you do to avoid injury, is also may guide you to a sport which you can excel at. I recently had a 23 year old male patient who was suffering with recurrent ankle sprains whilst he was performing Parkour (freerunning), he had incredibly flexible and therefore unstable ankles. I advised him to consider changing sport to gymnastics or capoeira the Brazilian martial arts dancing.
Many female patients also excel at ballet and gymnastics, I do not restrict them from this but encourage it with the correct advice on how to stabilise their body/ joints. More mature male and female patients can and do perform many activities including running, gym, cycling, rowing, all kinds of activities and some who choose not to train can also lead a pain free life with the help of bespoke exercises which can be easily carried out and we will provide here at The Twyford Clinic.