Ask Ann: Joint Hypermobility

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Hi Ann,

I’m reaching out because I have recently begun to notice more and more joint pain, especially in my knees. I have always been “double jointed” and very flexible. I can hyper-extend my knees and elbows, and my spine is very flexible, too, so I’m wondering if these things may be related? Do you have any thoughts on what might be going on?

Thanks,

KC

Great question, KC. While it is impossible to know exactly what is going on without evaluating you in person, this is a great opportunity to talk about joint hypermobility.

When people say that they are “double jointed,” what they are referring to is joint hypermobility, which is the ability of a joint to move beyond its normal range of motion. It isn’t uncommon for people to have a few hypermobile joints, and in most people this doesn’t cause any problems.

Some hypermobile people may experience more dislocations and sprains due to looseness of the stabilizing structures such as tendons, ligaments, and the joint capsule. Activities that place stress on loose joints can sometimes cause irritation. Joint hyperextension can cause discomfort, swelling, and pain in the area.

When hypermobile joints occur in otherwise healthy and normal children, it is referred to as Benign Hypermobility Joint Syndrome (BHJS). Children or young adults with BHJS may have joint pain in the late afternoon, at night, or after exercise or activity. Pain is more common in the lower extremities and most often involves large joints such as the knees. Appropriate exercise and joint protection techniques can be helpful in alleviating some of the symptoms.

Less commonly, joint hypermobility can be a sign of something else. For example, for 1 in 2,500 to 1 in 5,000 people, joint hypermobility may be one sign of a condition called Ehlers-Danlos Syndrome (EDS).

The Ehlers-Danlos National Foundation explains that individuals with EDS have a genetic defect in their connective tissue (the tissue that provides support to many body parts such as the skin, muscles, and ligaments). The fragile skin and unstable joints found in patients with EDS are the result of faulty or reduced amounts of collagen. Collagen is a protein that acts as “glue” in the body, adding strength and elasticity to connective tissue.

The EDNF goes on to explain that EDS is a group of heritable connective tissue disorders, characterized by joint hypermobility, skin extensibility, and tissue fragility. There are six major types of EDS, which are classified according to their signs and symptoms.

Type III EDS (hypermobility type) is the most common type. Generalized joint hypermobility is present, and dislocations and subluxations can occur frequently, especially in certain joints such as the shoulder, the patella, and the jaw (TMJ). Chronic pain is a well-established finding in Type III EDS. Pain can be due to muscle spasms, degenerative arthritis, or neuropathic (nerve) pain.

EDS is typically diagnosed through clinical examination. The patient’s skin is assessed for signs of increased extensibility. The joints are assessed using the Beighton Scale, which evaluates hypermobility at several joints. A score of at least 5/9 on this scale defines hypermobility.

Genetic testing is available for most types of EDS, although not for the most common type, Hypermobility. Genetic tests vary in accuracy; in most cases genetic testing should be used conservatively to confirm a diagnosis rather than to rule one out. More information on diagnostic criteria can be found here.

Quite often, EDS is first suspected by a physical therapist who notices the patient’s joint hypermobility when the patient comes in complaining of joint pain. I have treated many patients with EDS over the years, and have found that physical therapy is very helpful in educating patients on how to protect their joints and how to perform appropriate strengthening exercises.

I hope this information is helpful, KC! If you would like to have a physical therapist evaluate you, a listing can be found here.

What’s Next

A condition such as EDS usually requires specific treatment and training protocols. If you are not diagnosed with a particular condition and following a specific protocol for it, we strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.

If you’d like to learn more, check out our our Injury Prevention Handbook, which includes exercises you can do in less than 10 minutes, before your workout or any time.

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