Is Hypermobility a Disability?

Unraveling the link between hypermobility and disability. Discover the impact on health and treatment approaches. Is hypermobility a disability?

Understanding Hypermobility

Hypermobility refers to a condition where some or all of a person's joints have an unusually large range of movement. This means that individuals with hypermobility are particularly supple and can move their limbs into positions that others find impossible.

Definition and Causes

Joint hypermobility syndrome (JHS) is the term used when hypermobility occurs alongside symptoms such as joint pain, dislocations, and digestive system problems. Hypermobility is often hereditary and is thought to be caused by genetically determined changes to collagen, a type of protein found throughout the body that makes ligaments and joints loose and stretchy [1].

Symptoms and Diagnosis

Joint hypermobility is thought to be very common, particularly in children and young people. It is estimated that around one in every five people in the UK may have hypermobile joints [1]. Joint hypermobility syndrome (JHS) can cause a wide range of symptoms, including joint pain, digestive system problems, and abnormalities in the autonomic nervous system that control bodily functions such as heart rate.

The diagnosis of joint hypermobility syndrome is typically made through physical examination and specific tests or questionnaires to assess joint flexibility. Healthcare providers may use tests such as the Beighton score and a five-point hypermobility questionnaire to aid in the diagnosis [2]. These assessments help determine the extent of joint hypermobility and the presence of related symptoms.

Understanding the definition, causes, symptoms, and diagnosis of hypermobility is crucial in order to provide appropriate care and support for individuals with this condition. By recognizing the signs and symptoms, healthcare professionals can develop personalized treatment plans to manage the challenges associated with hypermobility and improve the overall quality of life for those affected.

Types of Hypermobility Syndromes

Hypermobility syndromes encompass a range of conditions characterized by increased joint mobility beyond the normal range. Three common types of hypermobility syndromes are Joint Hypermobility Syndrome (JHS), Ehlers-Danlos Syndrome (EDS), and Hypermobility Spectrum Disorders (HSDs).

Joint Hypermobility Syndrome (JHS)

Joint Hypermobility Syndrome (JHS) refers to the presence of hypermobility along with symptoms such as joint pain, dislocations, and digestive system problems. It is often hereditary and associated with genetically determined changes to collagen, a protein that provides flexibility and strength to ligaments and joints [1]. Joint hypermobility is thought to be very common, particularly in children and young people, with an estimated prevalence of around one in every five people in the UK having hypermobile joints.

Ehlers-Danlos Syndrome (EDS)

Ehlers-Danlos Syndrome (EDS) is a group of genetic connective tissue disorders that affect collagen production. While there are different subtypes of EDS, some of which are not primarily characterized by joint hypermobility, joint hypermobility is a common feature in several subtypes [2]. EDS can cause a wide range of symptoms, including joint hypermobility, joint pain, skin fragility, and abnormalities in various body systems. It is important to note that not all individuals with joint hypermobility have EDS, and a proper diagnosis is necessary to distinguish between different hypermobility syndromes.

Hypermobility Spectrum Disorders (HSDs)

Hypermobility Spectrum Disorders (HSDs) is a term used to describe individuals who experience symptomatic joint hypermobility but do not meet the diagnostic criteria for a specific subtype of EDS, including hypermobile EDS (hEDS) [3]. HSDs are considered to encompass a broad range of hypermobility-related symptoms that may not fit within a specific EDS subtype. This classification allows for a more inclusive and comprehensive approach to diagnosing and managing individuals with symptomatic joint hypermobility [3].

Understanding the different types of hypermobility syndromes is essential for accurate diagnosis and appropriate management of individuals with hypermobility-related symptoms. It is important to consult with healthcare professionals who specialize in these conditions to determine the most suitable treatment and support options based on an individual's specific needs.

Impact of Hypermobility on Health

Hypermobility can have various effects on an individual's health, ranging from musculoskeletal symptoms to extra-articular manifestations.

Musculoskeletal Symptoms

Joint hypermobility syndrome (JHS) can cause a wide range of musculoskeletal symptoms. Patients with JHS may experience joint pain, particularly in the knees, hips, and shoulders. This pain can be chronic and may worsen with physical activity or prolonged periods of standing or sitting.

In addition to joint pain, individuals with JHS may also experience joint instability, leading to frequent joint dislocations or subluxations. Ligaments and tendons, which are responsible for joint stability, may be weaker and more prone to injury in individuals with hypermobility.

Muscle stiffness and fatigue are also common symptoms associated with hypermobility. These symptoms may result from the body's compensatory mechanisms to stabilize hypermobile joints, leading to muscle overuse and increased muscle tension.

Extra-Articular Manifestations

In addition to musculoskeletal symptoms, hypermobility can manifest in various extra-articular ways. For example, individuals with JHS may experience digestive system problems, such as irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD). The autonomic nervous system, which regulates bodily functions like heart rate, may also be affected, leading to abnormalities in the autonomic control of the body.

Moreover, hypermobility can have an impact on other body systems, including the skin, eyes, and cardiovascular system. For instance, individuals with Ehlers-Danlos syndrome (EDS), a hypermobility spectrum disorder, may have stretchy or fragile skin that bruises easily. Some individuals with hypermobility may also experience vision problems, such as myopia (nearsightedness) or astigmatism. Cardiac abnormalities, such as mitral valve prolapse or aortic root dilation, can occur in certain types of hypermobility syndromes.

It's worth noting that the impact of hypermobility on health can vary depending on the specific hypermobility syndrome or disorder an individual has. While some individuals may experience mild symptoms that do not significantly affect their daily life, others may have more severe symptoms that require ongoing management and support.

Understanding the musculoskeletal symptoms and extra-articular manifestations associated with hypermobility is crucial for healthcare providers in diagnosing and managing the condition effectively. By addressing these symptoms and providing appropriate treatment, individuals with hypermobility can improve their quality of life and minimize the impact of this condition on their overall well-being.

Treatment Approaches for Hypermobility

When it comes to managing hypermobility, a comprehensive treatment approach is necessary. This typically involves a combination of lifestyle modifications, physical therapy, and pharmacologic therapies. Let's explore each of these treatment approaches in more detail.

Lifestyle Modifications

Lifestyle modifications play a crucial role in managing hypermobility. These modifications may include:

  • Weight management: Maintaining a healthy weight can help reduce the strain on joints and minimize discomfort.
  • Exercise: Engaging in regular exercise, under the guidance of a healthcare professional, can help strengthen the muscles surrounding the joints. This can provide better support and stability to the joints.
  • Joint protection: Practicing proper joint protection techniques, such as avoiding repetitive movements or excessive stress on the joints, can help prevent further damage and reduce pain.
  • Rest and pacing: Balancing rest and activity is important to prevent overexertion and manage symptoms effectively.

Physical Therapy

Physical therapy is a cornerstone in the management of hypermobility. A qualified physical therapist can develop a personalized exercise program tailored to the individual's needs and goals. The goals of physical therapy for hypermobility may include:

  • Strengthening exercises: Targeting specific muscle groups to improve joint stability and reduce the risk of injury.
  • Joint stabilization techniques: Teaching techniques to enhance joint stability and control.
  • Range of motion exercises: Gentle stretching exercises to maintain flexibility and prevent muscle tightness.
  • Pain management strategies: Educating individuals on pain management techniques, such as heat or cold therapy, to alleviate discomfort.

Pharmacologic Therapies

Pharmacologic therapies may be recommended to manage pain and other symptoms associated with hypermobility. The specific medications prescribed will depend on the individual's symptoms and overall health. Some common pharmacologic therapies include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These medications can help reduce pain and inflammation in the joints.
  • Acetaminophen: Used for pain relief, especially in individuals who cannot tolerate NSAIDs.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These medications may be prescribed to manage widespread pain and improve mood.

It's important to note that medication should always be prescribed and monitored by a healthcare professional.

By incorporating lifestyle modifications, physical therapy, and pharmacologic therapies, individuals with hypermobility can effectively manage their symptoms and improve their quality of life. It is recommended to work closely with healthcare professionals to develop a personalized treatment plan that addresses the specific needs and goals of each individual.

Genetic and Hereditary Aspects

When discussing hypermobility, it is important to consider the genetic and hereditary aspects of the condition. Understanding the inheritance risk and the role of genetic counseling can provide valuable insights for individuals and families affected by hypermobility syndromes.

Inheritance Risk

Hypermobility syndromes, such as Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSDs), have a genetic component. However, the inheritance patterns can differ depending on the specific syndrome.

For example, in Ehlers-Danlos Syndrome, the inheritance pattern can vary. Some forms of EDS are inherited in an autosomal dominant pattern, which means that an affected individual has a 50% chance of passing on the gene to each of their children. On the other hand, vascular Ehlers-Danlos Syndrome is usually inherited in an autosomal dominant pattern as well, but it carries a higher risk of serious complications, such as ruptures in major blood vessels and organs like the uterus and intestines, which can be life-threatening.

Similarly, Joint Hypermobility Syndrome (JHS) can be a sign of a more serious underlying genetic condition known as Heritable Disorders of Connective Tissue (HDCT), which includes rare medical conditions. The inheritance pattern for HDCT can also vary depending on the specific condition.

Genetic Counseling

Genetic counseling is an important aspect for individuals with hypermobility syndromes, especially those with a personal or family history of Ehlers-Danlos Syndrome, who are considering starting a family. Genetic counselors are healthcare professionals who specialize in assessing and providing information about genetic conditions, inheritance patterns, and associated risks.

Genetic counseling offers individuals and families the opportunity to understand the underlying genetic factors of hypermobility syndromes and the potential risks for their children. Counselors can provide information about the inheritance patterns, genetic testing options, and reproductive choices. This can empower individuals to make informed decisions and manage their health effectively.

It is worth noting that having a hypermobility syndrome does not automatically classify an individual as having a disability. The Americans with Disabilities Act (ADA) defines a disability as a physical or mental impairment that substantially limits one or more major life activities. While hypermobility can present challenges, the determination of disability is made on an individual basis and depends on the impact of hypermobility on the person's daily life activities [5].

In conclusion, understanding the genetic and hereditary aspects of hypermobility syndromes can provide valuable insights for individuals and families. Genetic counseling plays a crucial role in assessing the inheritance risk and providing information to guide reproductive choices. By seeking appropriate genetic counseling, individuals can gain a better understanding of their condition, its impact on their family, and make informed decisions for their future.

Hypermobility in Different Populations

Hypermobility is a condition that can affect individuals from various demographic backgrounds. It is important to understand the demographic variances as well as the prevalence and incidence of hypermobility in different populations.

Demographic Variances

The prevalence of hypermobility syndrome, such as Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (EDS), may vary among different demographic groups. According to the Cleveland Clinic, Joint Hypermobility Syndrome is more common in children and young people, and it affects individuals assigned female at birth (AFAB) and people of Asian and Afro-Caribbean descent more often. Furthermore, it is noted that Joint Hypermobility Syndrome usually improves with age.

Prevalence and Incidence

Hypermobility, including Joint Hypermobility Syndrome (JHS), is considered to be quite common, especially in children and young individuals. Estimates suggest that around one in every five people in the United Kingdom may have hypermobile joints, according to NHS Inform.

The prevalence of Hypermobility Spectrum Disorders (HSDs) and hypermobile Ehlers-Danlos Syndrome (hEDS) is estimated to be approximately 1 in 600 to 1 in 900, although the actual prevalence may be higher due to underdiagnosis. Additionally, benign joint hypermobility syndrome (BJHS) affects about 3%-4% of the general population, with a higher prevalence among women (3.3%) compared to men (0.6%).

Understanding the demographic variances and prevalence of hypermobility in different populations can aid in raising awareness, improving diagnosis rates, and providing appropriate care and support for individuals affected by hypermobility.