Is It Safe For Your Child to Have Hypermobile Joints?

August 16, 2021 The Ed Psych Practice No Comments Referrals Anxiety, Avoidant Behaviour, Cautious Children, EDS, Generalised Joint Hyper Mobility, Gross Motor Development, Hypermobility, Joint Exercises, Occupational Therapists, Sensory Processing Disorder

Takeaway: Joint hypermobility makes children very flexible but can also be a painful condition. It affects muscle tone, body posture, foot arches, and (indirectly) even a child’s personality. It’s relatively easy to diagnose it, though, and the right specialist can help your child manage her pain and discomfort.

Children are naturally quite physically flexible, but there’s a problem with being too flexible.

It’s rare to see an adult flexible enough to bend their thumb back to meet their wrist, or flex their fingers at impossible angles. But children can do some of these things because their bodies are still growing and pliable. Beyond a point, though, this flexibility becomes a problem. Joints are designed to have a fixed range of motion, so even if we can go past this acceptable range, it doesn’t mean we should. Push a joint too far, too often, and you’ll damage it.

We usually call this excess flexibility ‘double-jointedness,’ but orthopaedists (bone specialists) have different terms for it. For example, there’s ‘hyperlaxity.’

Most people describe themselves as ‘double jointed’ to explain away their incredible flexibility. But orthopaedists use more specific terms to describe the phenomenon. For example, there’s hyperlaxity, where ligaments (elastic tissue that connects bones) get extra stretchy. And this is dangerous because they’re more likely to tear during exercise or other types of strenuous activity.

In this post, though, we’ll explore the concept of hypermobility — a related type of double-jointedness.

Even if a child’s ligaments are fine, she can still be double-jointed if her bones connect unusually. For example, a joint might have extra space around it, giving it more room to bend. This often happens when joint sockets are shallower than expected, which changes the way bones hinge with each other. And a shallow socket makes it more likely that your child will dislocate the joint while playing. (Note: Over-stretching — either accidentally or on purpose — can also increase joint and muscle mobility. But it’s rarer for this type of over-stretching to cause the problems we’re discussing in this post.)

Hypermobility is relatively common and is usually harmless. But not always.

About 4 out of 10 teenage girls and 1 out of 10 teenage boys are hypermobile. But it usually doesn’t complicate their lives. In fact, it can sometimes help them — for example, if they’re enrolled in gymnastics or ballet classes that reward this kind of flexibility. But about 10% of children with hypermobile joints end up feeling a lot of pain (and injuring themselves) while playing or exercising. It’s a burning or throbbing type of pain, usually in their feet, ankles, legs, and knees. Note that this isn’t like the milder sort of ‘growing pains’ that children often experience — usually from overusing their muscles. It’s more frequent, much more intense, and can last for up to two days. Understandably, this makes children with hypermobility shy away from physical activity.

Think of joint hypermobility as a spectrum since it comes with a range of possible characteristics.

On one end of the hypermobility spectrum, we have children who are highly flexible but without any pain or related problems. These children don’t need any help or intervention. Meanwhile, on the other end of this spectrum are children with things like Ehlers-Danlos syndrome–hypermobility type (EDS-HT). They have highly stretchy supporting tissues, like ligaments, skin, internal organs, and blood vessels. And they’ll need a lot of help managing their symptoms. In-between these two extremes on the spectrum, we have children with varying degrees of pain and complications, such as joints that frequently get dislocated.

Physically, hypermobility primarily affects muscle tone and body posture.

In general, a child with hypermobility will have stretchy muscles. So, physical activity becomes harder because these loose muscles need to contract more intensely than usual to get arms and legs moving. Loose muscles also make it more trying to write or pick up small objects and move them around. But even as most muscles are loose and stretchy, some of them go the other way and tighten up. That’s because they have to work overtime to compensate for loose ligaments and supportive tissue. For example, if a child slouches because her hypermobile joints are less taut than usual, her back muscles have to tighten up to support her over-flexed spine. These sorts of imbalances mean that joints are often left unprotected, causing hypermobile children to get injured more often.

Hypermobility can also cause flat feet, which lead to other complications.

Because of their looser supportive tissues, children with hypermobility often have fallen arches. That is, the underside of their feet is less curved than usual. This changes how a child stands, walks, runs, jumps, etc., and puts a lot of pressure on her feet and joints. So, children with hypermobility often have swollen feet that tire easily.

But perhaps the most damaging thing about hypermobility is how it can change a child’s personality.

Children with joint hypermobility tend to be very cautious because of all their physical challenges. They’ve learned that they get injured easily, so they see their environment as full of mini dangers. And this leads to a hypervigilance that begins to alter their personalities. So, as babies, they might be more afraid of change or new people. As they grow older, they might fear being away from their parents. And, in school, they’re less likely to want to play sports or go on trips with their friends.

To help your child with these physical and emotional issues, we’ll first need to diagnose her.

One of the more common ways of diagnosing hypermobility is the Beighton hypermobility score. It’s a points-based scoring system that looks at how your child uses her fingers, wrists, elbows, knees, and other joints. For example, if your child places her forearm flat on a table, can she pull back her little finger, beyond 90 degrees? Or can she pull her thumb down to touch her forearm? Our specialists use these (and more) cues to score your child’s joint mobility and determine if she’s hypermobile.

Once diagnosed, we can then move on to helping your child manage her challenges.

Although she might have problems with exercise, your child will still need to move around to stay fit, healthy, and awake (a lack of exercise can cause daytime drowsiness). So, a physiotherapist can give her safe exercises for the most affected muscles and help rehabilitate her if she gets injured. Meanwhile, an occupational therapist can help her adapt her daily tools and activities to make them hypermobility-friendly. This might mean doing things like changing the type of chair your child sits on, the mattress she uses, or the pens/pencils she writes with.

If you’re concerned that your child is hypermobile and in pain, consider consulting a specialist.

At The Ed Psych Practice, we offer face-to-face and online assessments, consultation, advice, and problem-solving strategies for parents, nurseries, schools, and universities in London. We have psychologists, paediatricians, and therapists who can help assess your child and offer guidance and support. To consult with us or set up an appointment:

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com

Want to see how else you can help your child? You might enjoy some of our other posts.

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