Hypermobility Spectrum Disorders

What is Hypermobility Spectrum Disorder?

Spectrum disorders encompass a range of conditions with a wide range of symptoms and varying levels of severity. Hypermobility spectrum disorders are connective tissue disorders that result in joints being excessively flexible. Hypermobility spectrum disorder (HSD) was previously referred to as hypermobility syndrome.

• People with hypermobility spectrum disorder may experience symptoms in different parts of their body.
• Localised joint hypermobility: Hypermobility is present in one particular joint or joints in the same area of the body.
• Peripheral joint hypermobility: Hypermobility of the joints specifically in the hands and feet.
• Generalised joint hypermobility: Hypermobility of different joints throughout the whole body, not limited to one area.

What causes Hypermobility Spectrum Disorder (HSD)?

There is uncertainty around the cause of HSD, however it appears to be linked to certain genes that produce collagen. Many cases of hypermobility are inherited in an autosomal dominant pattern, meaning one affected parent can pass the trait on to their child. Hormones can also play a role in increased laxity of joints, for example during pregnancy, a hormone called relaxin is secreted to assist during labour and delivery. However, in cases like this hypermobility tends to be temporary.

Symptoms of HSD

Many individuals with hypermobility will not experience any detrimental symptoms and hypermobility can be advantageous in certain sports, including gymnastics and dancing. However, due to the excessive flexibility of connective tissues in people with hypermobility, the following symptoms may be present:

• Joint instability, potentially leading to subluxations and dislocations
• Increased risk of sprains and strains
• Joint and muscle pain
• Poor proprioception (sense of joint and body position) and coordination
• Stretchy skin
• Excessive tiredness
• Irritable Bowel Syndrome
• Gastroesophageal Reflux (GERD)
• Pelvic floor weakness

How is it diagnosed?

Healthcare practitioners will make a diagnosis of hypermobility spectrum disorder based on a combination of subjective history and an objective assessment. Your subjective history will include your current symptoms and details about the onset and pattern of these symptoms. An objective assessment will entail checking your active and passive range of motion, your strength and possibly tests for instability. If you have an injury at the time of the assessment, your objective assessment may be more specific to that injury.

Your healthcare provider may use an objective measure like the Beighton Score, a widely recognised assessment for hypermobility syndrome. The Beighton Score involves five physical manoeuvres performed on different body parts, with one point awarded for each positive result on both the left and right sides. One of the manoeuvres—placing both hands flat on the floor while bending forward with extended legs—awards a single point since it is not side-dependent. This provides a maximum possible score of 9 points. Generally, a score of 5/9 or higher in adults is considered indicative of hypermobility. You can see the Beighton Score assessment here: https://www.ehlers-danlos.com/wp-content/uploads/2017/03/Beighton-Score-2017.pdf

Your doctor may consider X-rays to rule out other conditions that may cause similar symptoms to what you are experiencing.

What treatment can be done for Hypermobility Spectrum Disorder?

There is no cure for hypermobility spectrum disorder, however treatment can be done to manage symptoms and prevent adverse effects of hypermobility.

Pain related to hypermobility of the joints can be managed using analgaesic medication, however if you experience chronic pain, it is best to consult with your doctor regarding medication, or with a physiotherapist for other methods of pain relief. Your physiotherapist may recommend using a TENS machine or hot or cold-water baths.

In recent years collagen supplements have become popular, particularly for effects of aging on our skin and hair, however there is currently no evidence that collagen supplements help with hypermobility. Collagen tablets get broken down to amino acids as they are ingested, and there is no proof that these proteins are then reassembled into collagen to be utilised in tissue structure.

Physiotherapy Treatment for Hypermobility

As well as assisting with pain management techniques, a physiotherapist will be helpful in managing joint laxity and instability. A physio will create a tailored programme involving stability and proprioception exercises which will enable the muscles to provide more support for the joints. They may also recommend splints or other orthotic devices in more severe cases. With HSD, it is recommended to avoid overstretching as this will be counteractive and increase laxity of the joints.

CITATIONS

Ehlers-Danlos Society. (n.d.). Myths and facts about EDS and HSD. Retrieved February 19, 2025, from https:// www. ehlers -danlos. com /myths-and-facts-about-eds-and-hsd/ Ehlers-Danlos Society. (n.d.). What is HSD? Ehlers-Danlos Society. Retrieved February 19, 2025, from https:// www. ehlers -danlos. com /what-is-hsd/