What is Hypermobility Syndrome and How is It Treated?

image of three people's legs.

If you’ve dislocated your joints more than once or you keep getting pain and stiffness in your muscles or joints, there’s a chance you have hypermobility syndrome.

If you have no idea what it is, you’re in for a factual treat. In this piece, we’re going to talk about this condition, what you can do if you have it, and when you should see a doctor.

Key Takeaways:

  • Hypermobility syndrome (HMS) is a condition characterized by unusually large joint movement, leading to joint pain, instability, and an increased risk of joint injuries. It is often inherited and can be associated with genetic mutations and other conditions like Ehlers-Danlos syndrome.
  • Symptoms of HMS can vary but commonly include joint pain and stiffness, frequent joint dislocations or subluxations, fatigue, joint hypermobility, easy bruising, poor proprioception, joint swelling, dizziness or fainting, osteoarthritis, and chronic pain.
  • Diagnosing HMS can be challenging due to its variability and similarity to other conditions. A physical examination, medical history review, and the Beighton score (assessing joint hypermobility) are commonly used. Imaging tests may also be ordered.
  • HMS and Ehlers-Danlos syndrome are related but are two distinct conditions. HMS involves joint hypermobility and increased risk of joint injuries, while EDS affects connective tissues and can have a broader range of symptoms.
  • Treatment for HMS aims to reduce pain, improve joint stability and function, and prevent further joint damage. Options include physical therapy, occupational therapy, medications (such as NSAIDs and muscle relaxers), assistive devices (like splints and braces), surgery (joint reconstruction or fusion), and lifestyle changes (avoiding excessive joint stress and maintaining a healthy weight). Podiatrists can also provide specialized foot and lower limb treatment for HMS.

What is hypermobility syndrome?

Hypermobility syndrome (HMS) is a condition in which a person’s joints have an unusually large range of movement. This can lead to joint pain and instability and can also increase the risk of joint injuries.

What causes hypermobility syndrome?

Hypermobility syndrome (HMS) is thought to be caused by a combination of genetic and environmental factors. The condition tends to be inherited, and it is estimated that up to 90% of people with HMS have a family history of the condition.

Certain genetic mutations have also been linked to HMS. Additionally, HMS can be associated with other conditions such as Ehlers-Danlos syndrome, which is caused by defects in the structure of collagen, a protein that provides strength and support to the body’s tissues.

Certain environmental factors, such as poor posture or repetitive motions, can also contribute to the development of HMS. Additionally, HMS can be caused by chronic conditions like Marfan syndrome, which is a genetic disorder that affects the body’s connective tissue.

HMS is also a spectrum disorder, meaning that it can range from mild to severe. Symptoms can vary greatly from person to person and can depend on the specific joints affected and the severity of the condition.

Symptoms of Hypermobility Syndrome

The symptoms of hypermobility syndrome (HMS) can vary depending on the individual and the specific joints affected. Common symptoms include:

  • Joint pain and stiffness, especially after prolonged periods of inactivity
  • Instability and frequent dislocations or subluxations (partial dislocations) of joints
  • Fatigue or chronic fatigue
  • Joint hypermobility, or the ability to move joints beyond the normal range of motion
  • Bruising easily
  • Poor proprioception (the ability to sense where and how your body is positioned)
  • Joint swelling
  • Dizziness or fainting
  • Osteoarthritis
  • Chronic pain

Symptoms can also be associated with other conditions such as Ehlers-Danlos syndrome which can include skin that is easy to bruise, scarring, and poor wound healing.

It’s important to note that many people with HMS may not have any symptoms at all or may only have mild symptoms. However, in some cases, the condition can lead to chronic pain and joint instability, which can affect a person’s quality of life.

How is hypermobility syndrome diagnosed?

Hypermobility syndrome (HMS) can be difficult to diagnose because the symptoms can vary widely from person to person and can be similar to those of other conditions. A diagnosis of HMS typically begins with a physical examination and a review of the person’s medical history.

The doctor may perform a series of tests to evaluate the joint range of motion and stability. The Beighton score, which is a 9-point scale that assesses joint hypermobility in different parts of the body, is often used to help diagnose HMS. A score of 4 or higher out of 9 is considered to be indicative of HMS.

In some cases, the doctor may also order imaging tests such as X-rays or MRI scans to rule out other conditions and to check for any joint damage that may have occurred as a result of HMS.

If a person has signs and symptoms of HMS and positive family history, then the doctor may refer the patient to a genetic counselor or a rheumatologist for further evaluation.

It is important to note that HMS is a complex and variable condition, and the diagnosis process may require multiple evaluations and assessments.

In some cases, it may be hard to differentiate HMS from other conditions like Ehlers-Danlos syndrome which shares some symptoms with HMS. A genetic test may be ordered to confirm the diagnosis if the doctor suspects EDS.

Hypermobility syndrome vs Ehlers-Danlos syndrome

Hypermobility syndrome (HMS) and Ehlers-Danlos syndrome (EDS) are related but distinct conditions.

HMS is characterized by an increased range of motion in the joints, which can lead to pain, instability, and an increased risk of joint injuries. The condition is thought to be caused by a combination of genetic and environmental factors and is inherited in a majority of cases.

EDS, on the other hand, is a group of inherited disorders that affect the connective tissues in the body. EDS is caused by mutations in the genes that produce collagen, the protein that provides structure and support to the skin, bones, and other tissues. Symptoms can include hypermobile joints, skin that is easily bruised or torn, and poor wound healing. Other symptoms such as scoliosis, chronic pain, and fatigue are also common in EDS.

Some forms of EDS, such as the hypermobility type, have symptoms that overlap with HMS. However, EDS is a more severe condition with a broader range of symptoms and can have a significant impact on a person’s quality of life.

Diagnosis of EDS is based on clinical criteria and genetic testing, while HMS is based on the Beighton score and clinical examination.

It is important to note that some people can have both HMS and EDS, and treatment will depend on the specific condition and the symptoms experienced by the individual.

Treatment for Hypermobility Syndrome

The treatment for hypermobility syndrome (HMS) aims to reduce pain, improve joint stability and function, and prevent further joint damage. Treatment options for HMS include:

Physical therapy

Physical therapy can be an effective treatment option for people with hypermobility syndrome as it aims to improve muscle strength, flexibility, and joint stability. Physical therapy can also help to reduce pain and prevent further joint injuries.

A physical therapist will typically start by conducting a comprehensive evaluation of the person’s joint range of motion, muscle strength, and overall physical function. Based on the assessment, the therapist will develop an individualized treatment plan that may include the following:

Strengthening exercises – can help improve muscle strength, particularly in the muscles that support the joints affected by HMS. This can help to improve joint stability and reduce the risk of dislocations or subluxations.

Stretching exercises – can also help improve flexibility and reduce muscle tightness. This can help to reduce pain and improve joint range of motion.

Balance and coordination exercises – can help improve balance and coordination, which can be particularly helpful for people with HMS who are at an increased risk of falling or injury.

Posture and body mechanics education – can help teach people with HMS how to sit, stand, and move in a way that reduces stress on their joints and prevent further injury.

Pain management – can also help manage pain associated with HMS, this can be done through various techniques such as ultrasound, electrical stimulation, or even dry needling.

Occupational therapy

Occupational therapy (OT) aims to help people with hypermobility syndrome perform everyday tasks and activities without causing further damage to their joints.

An occupational therapist will typically start by evaluating the person’s abilities and limitations. The therapist will assess the person’s ability to perform activities of daily living (ADLs), such as dressing, grooming, and cooking, as well as instrumental activities of daily living (IADLs), such as shopping, using the phone, and managing money.

This can help to teach the person with HMS how to perform everyday tasks without causing further damage to the joints.

Keep in mind that occupational therapy is a progressive process, and treatment may need to be ongoing to help the person with HMS maintain their independence and improve their quality of life. Occupational therapy may also be used in conjunction with other treatments such as physical therapy, medication, and assistive devices to achieve the best results.

Medications

Medications can be used as part of the treatment plan for people with hypermobility syndrome (HMS) to help reduce pain and inflammation and improve joint function. Medications that may be prescribed include:

Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help to reduce pain and inflammation, and are often used to treat the symptoms of HMS. Common NSAIDs include ibuprofen, naproxen, and celecoxib.

Muscle relaxers: These medications can help to reduce muscle spasms, which can be helpful for people with HMS who experience muscle tightness or stiffness.

Analgesics: These medications can help to relieve pain, such as acetaminophen which is a mild pain reliever and fever reducer.

Anticonvulsants: These medications can be used to help manage pain and improve sleep for people with chronic pain conditions such as HMS.

Corticosteroids: These medications can be injected directly into a joint to reduce inflammation and pain.

Medication should be used in conjunction with other treatments such as physical therapy, occupational therapy, and lifestyle changes to achieve the best results.

Also, medications should only be used under the guidance of a physician and should be used at the lowest effective dose for the shortest duration of time.

You should also be aware of potential side effects and to inform the doctor of any other medications the person is taking to avoid any interactions.

Assistive devices

Assistive devices can help to support and protect the joints and prevent further joint injuries. These devices can be especially helpful for people with joint dislocations or subluxations. Some examples of assistive devices that may be used include:

Splints: Splints can be worn to help support and stabilize the joints, particularly the fingers, wrists, elbows, and knees. They can also be used to prevent dislocations or subluxations.

Braces: Braces can be worn to help support and stabilize the joints, particularly the ankles, knees, and hips.

Orthotics: Orthotics are devices that are worn inside the shoes to help support and align the feet and ankles.

Cane or walker: These devices can help to improve balance and stability and reduce the risk of falls.

Crutches: Crutches can be used to help a person with HMS move around while minimizing the stress on their joints.

Adaptive equipment: These devices can help a person with HMS to perform daily tasks more easily and safely, such as extended shoehorns and other adaptive equipment.

Surgery

In some cases, surgery may be necessary particularly when a joint has been damaged and is causing chronic pain or instability. Surgery can help to repair or stabilize the joint, which can improve function and reduce pain.

The type of surgery will depend on the specific joint that is affected and the extent of the damage. Some examples of surgery that may be used to treat HMS include:

Joint reconstruction: This type of surgery can be used to repair or reconstruct a joint that has been damaged by HMS. This may include ligament reconstruction, joint replacement, or osteotomy (cutting and repositioning of a bone).

Joint fusion: This type of surgery can be used to fuse (join) two or more bones together to reduce pain and improve stability.

Arthroscopy: This is a minimally invasive surgical procedure in which there is an examination of an area, such as a joint. This can help to diagnose and understand the extent of an injury or condition or it can also include treatment of a damaged area such as joint damage and synovitis (inflammation of the lining of the joint).

Lifestyle changes

People with HMS should avoid activities that put excessive stress on their joints and maintain a healthy weight, this can help to reduce the risk of joint damage and improve overall joint health.

How Watsonia Podiatry can help

Our podiatrists specialise in the diagnosis and treatment of conditions that affect the feet and lower limbs. We can help treat hypermobility syndrome by addressing any foot or lower limb issues that may be caused or exacerbated by the condition.

We can help you by:

Assessing and treating foot and lower limb problems – we can assess your feet and lower limbs and provide treatment for any problems such as foot pain, calluses, and corns. We can also advise on how to prevent these problems from recurring.

Prescribing orthotics – we can also fit and prescribe custom-made orthotics, which are devices worn inside the shoes to help support and align the feet and ankles. This can help to reduce stress on the joints and improve overall foot and lower limb function.

Providing advice on footwear – aside from orthotics, we can also provide advice on the appropriate footwear you should wear to reduce stress on the joints and prevent injuries.

Providing advice on exercise – we also provide advice on exercises that can help to improve foot and lower limb strength and stability, which can be beneficial in managing HMS symptoms.

Referring to other specialists – if we identify other issues that may be related to HMS, such as arthritis, we may refer you to other specialists such as rheumatologists or orthopedic surgeons for further evaluation and treatment.

If you are suffering from HMS and it’s affecting your foot and lower limbs, book an appointment with Watsonia Podiatry for an assessment! You can also call us at (03) 9432 2689 for enquiries or to book an appointment.

Aaron

Aaron Dri