Joint hypermobility factsheet

Introduction

Joint hypermobility is a condition where some joints in a child’s body can move further than normal outside of the average range of movement. When multiple joints are affected, it is called generalised joint hypermobility.

Joint hypermobility is a condition that children are born with. It can affect joints like the:

  • wrist
  • ankle
  • elbow
  • fingers
  • knees.

Joint hypermobility is common in children and can be helpful with activities that require a lot of flexibility and movement, for example:

  • gymnastics
  • swimming
  • ballet.

In some children, joint hypermobility can cause issues like weakness and instability of the joints.

 Signs and symptoms

Children with joint hypermobility might show signs like:

  • being able to bend their thumbs and elbows back
  • being able to extend their knees and elbows further than normal
  • a slight delay in movement milestones, like sitting or crawling.

Older children who are more active, play sport or do activities where they don’t have full control of their bodies (for example, trampolining) might find they have weakness and instability of some joints. This can cause repeated injuries like:

  • muscle tears, strains, and sprains
  • joint subluxations - when joints slipping out of their sockets slightly
  • joint dislocations – when joints slip out of their sockets completely.

They might also have pain that happens during and after physical activity. Usually, this pain will get better over time, but it is long-lasting for some children.

Other signs and symptoms of joint hypermobility can include:

  • muscle pain and weakness that does not go away
  • fatigue and poor sleep
  • dizziness
  • low fitness levels
  • chronic constipation or hard poos
  • gastro-oesophageal reflux
  • abdominal pain or stomach ache that does not go away
  • irritable bowel syndrome – a bowel condition that causes cramping, pain, bloating, gas, diarrhoea and constipation
  • urinary tract infections or issues that do not go away
  • weak pelvic floor muscles.

Issues with the digestive and urinary system can happen with joint hypermobility because these systems are also made up of muscle and connective tissue. When muscle and connective tissue is more flexible, it may not work the way it needs to. For example, the digestive tract may have issues moving food through and the pelvic floor muscle may be unable to hold in urine when coughing, jumping, and sneezing.

Children are at a higher risk of joint hypermobility if they:

  • have a genetic condition like Down syndrome or Marfan syndrome
  • are born female
  • have other family members with joint hypermobility.

Diagnosis

Your child’s doctor will take a medical history, including family history, and do a physical examination. This is to rule out any other conditions that may be related to their joint hypermobility. There are not usually any other tests that are done to diagnose joint hypermobility.

If your child has joint hypermobility in more than 4 joints, you should talk to their doctor about any related conditions. This is to help minimise future injuries and check any other related health issues.

Your child’s doctor may investigate other conditions like Joint hypermobility syndrome or Ehlers-Danos Syndrome if they have symptoms like:

  • ongoing joint and muscle pain
  • fatigue
  • pain that limits their ability to go to school, play sport or participate in other activities.

Treatment

Joint hypermobility is treated with a program that involves:

  • building strength
  • conditioning exercise
  • pain management
  • management of mental health symptoms like stress and anxiety
  • management of other related health issues, like digestive problems.

Children with joint hypermobility need to protect their muscles and joints from injury. They can do this by being supported in safe exercise and having good nutrition. Your child’s treatment team may include:

  • physiotherapists – to support exercise and strengthening
  • dieticians – to support nutrition and digestive issues
  • occupational therapists – to support fine motor and self-care skills that can be impacted by muscle issues (for example, handwriting)
  • psychologists – to support mental health
  • gastroenterologists – to manage related issues with the digestive system.

If your child has joint hypermobility and injured, it may take them longer to heal and build back muscle strength and endurance. Your child’s doctor and physiotherapist will be able to help them recover using treatments like:

  • rest
  • immobilisation – holding a joint in place using a cast, brace, or splint
  • gentle movement in water
  • pain management.

 Management

Physical Activity

Physical activity is important for the health and wellbeing of all children, especially those with joint hypermobility.

Joint injuries are more common in children who do not exercise as they do not have the muscle strength to support and protect the joints.

Speak to your child’s doctor or physiotherapist about the types of sport, exercise and activity that will be best for their joint hypermobility. Some children will need to avoid certain sports and activities depending on their joint hypermobility, while other may need to pace their levels of activity throughout the day to avoid pain and fatigue.

Some activities are excellent for increasing physical strength and joint mobility, like:

  • swimming
  • pilates
  • bike riding
  • walking
  • water aerobics.

If your child has hypermobility of their neck, contact sports and activities where your child cannot fully control their body, like trampolining, should be avoided.

Pain

Your child’s treatment team will work together to help them manage chronic, complex pain from joint hypermobility. This can include physiotherapy for strength building and psychology for pain-focussed mental health strategies. Depending on your child’s specific issue, their doctor may discuss the use of appropriate pain relief and other management strategies.

Digestive issues

Digestive issues linked to joint hypermobility can often get better with:

  • plenty of water
  • supported, safe physical activity
  • a high fibre, whole food diet.

These changes will make poo larger and softer, which makes it easier for the digestive system to push through.

Speak to your child’s doctor if they are experiencing constipation, as laxatives should only be taken under their guidance. Probiotic supplements, yoghurts, and drinks (like kefir) can also be useful for cramping and gas.

Functional difficulties

Some children with joint hypermobility may have issues with fine motor skills development, like handwriting and self-care skills. Issues with skills like handwriting can affect pain, learning, school performance and self-esteem, so it is good to see an occupational therapist about strategies and equipment to support your child.

Mental health and well-being

Children with joint hypermobility are more likely to have:

  • anxiety
  • panic attacks
  • depression
  • issues with chronic pain
  • fatigue.

A psychologist can help your child to manage mental health and wellbeing through therapies, education and strengthening emotional resilience. You can support your child at home by helping them to learn about their condition, what they can do to keep themselves strong and even some of the advantages to having increased flexibility, like gymnastics.

Your child will also need to learn how to pace themselves and avoid “boom and bust” cycles with activity and exercise. “Boom and bust” can be periods of excessive activity which are followed by periods of no activity. Doing this can cause issues with muscles, fatigue and pain and can make mental health worse.

Last updated Monday 11th December 2023

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024


This factsheet was produced with support from John Hunter Children's Hospital.