What is it and how is it assessed?
Connective tissue forms ligaments, tendons, joint capsules, skin and vessel walls. With the specific structure of collagen, it becomes more extensible, and the joints receive a greater range of movements. The assessment uses a simple five-point Beighton scale: hyperextension of the little finger, adduction of the thumb to the forearm, hyperextension of the elbows and knees, and bending over with the palms touching the floor. Each side is counted separately. However, a high score in itself is not a diagnosis: it occurs in children, women and people who have been involved in gymnastics or dancing for many years.
- Asymptomatic hypermobility is a normal variant
- Hypermobility syndrome with complaints
- Hereditary connective tissue diseases
- Beighton score
- Flexibility decreases with age
Why do complaints appear?
If the ligaments do not hold the joint securely, the muscles take on all the work. They are constantly under tension, get tired quickly, and by the end of the day there is aching pain. Excessive mobility makes the joint vulnerable: subluxations, sprains, damage to the meniscus and ligaments occur more often, and the cartilage wears out faster. The foot flattens, the gait changes, and the load is incorrectly distributed on the knees and spine. Some people also have vegetative manifestations: palpitations when standing up, a tendency to faint, increased fatigue.
- Overload of the muscles holding the joint
- Frequent subluxations and sprains
- Flat feet and foot deformities
- Back and neck pain
- Early wear of cartilage due to improper loads
- Fatigue, dizziness when standing up
- Tendency to bruises and slow wound healing
Symptoms
Typical pain is in the knees, ankles, hands and back, which appear after exercise or in the evening and go away after rest. Children complain of pain in their legs in the evenings, ask to be carried in their arms after a walk, and get tired quickly during physical education. Characterized by repeated twisting of the ankle, clicking in the joints, and a feeling of knee instability. The skin is often soft and velvety, bruises easily, and scars heal thin. In adults, varicose veins, prolapse of internal organs, and hernias are often encountered.
- Pain in joints and back after exercise
- Frequent subluxations and sprains
- Clicking and feeling of joint instability
- Flat feet, tired feet
- Easy bruising
- Fatigue and poor exercise tolerance
- Evening leg pain in children
Survey
The diagnosis is clinical: the doctor evaluates the range of motion on the Beighton scale, examines the skin, feet, spine, asks about injuries and family history. The goal is not so much to confirm flexibility, but to exclude hereditary syndromes with a high risk of complications, in which the blood vessels, heart and eyes are affected. Very tensile skin, wide scars, dislocations of large joints, tall stature with long fingers and deformation of the chest are alarming. In such cases, echocardiography, examination by an ophthalmologist and genetic consultation are prescribed. Ultrasound of the joints helps assess the consequences of injuries.
- Beighton score
- Examination of the skin, feet and spine
- Family history
- ECG and echocardiography according to indications
- Examination by an ophthalmologist if the syndrome is suspected
- Ultrasound of joints for injuries
- Consultation with a geneticist in some cases
What helps
The main method is regular exercise to strengthen the muscles around the joints and train the sense of body position. Swimming, exercise cycling, and bodyweight exercises in the middle range of motion are suitable. It is important not to stretch yourself to the limit: the habit of “reaching farthest” increases instability. Orthopedic insoles for flat feet, comfortable shoes with a fixed back, and elastic support for the joint during loads are useful. Painkillers are used briefly and as needed. Sports are not prohibited for children, but sports are selected where there is no hyperextension or impact loads.
- Strengthening the muscles around the joints
- Balance and coordination training
- Swimming and exercise bike
- Avoid stretching to the limit
- Orthopedic insoles and proper shoes
- Weight-bearing support orthoses
- Body weight control
- Short course painkillers if necessary