What Is Hypermobility?

Visit any yoga class and you’ll observe a wide range of bendiness, though the person who can easily reach their toes in a forward fold doesn’t necessarily have hypermobility. “There’s a difference between flexibility and hypermobility,” notes Patty Stott, DPT, ATC, CHT, who works with hypermobile patients in Arvada, Colo.

Hypermobility means that joints can move beyond the normal range of motion. This can be an ability to put a foot behind the head, but more often it involves sensations of joint instability during everyday activities — like a shoulder slipping out of place while carrying groceries.

Flexibility, on the other hand, refers to the ability to lengthen muscles. Someone can be very flexible and still have stable joints. “And you can actually have very tight muscles while having symptomatic hypermobility at the joints,” Stott says.

Flexibility is an important com­ponent of overall fitness, but joint hypermobility caused by loose or weak ligaments comes with risks. These include dislocations and subluxations (partial dislocations), pain, and postural issues.

The ligaments that hold the joints in place are made of connective tissue, which is found in various forms throughout the body, so loose, hypermobile joints can signal bigger issues, Stott explains. “Hypermobility can be a symptom of an underlying connective-tissue disorder.”

This might be hEDS, or it might be hypermobility spectrum disorder. HSD shares many features with hEDS but has looser diagnostic criteria. The distinction between the two diagnoses may prove to be important for researchers as they continue to look for the genes responsible for hEDS.

A primary tool for diagnosing hypermobility is the Beighton score, a “snapshot of the joints” that looks at the range of motion in the knuckles, elbows, knees, base of the thumbs, and the spine. The higher one’s score, the more mobile their joints.

Still, for treatment purposes, hEDS and HSD are similarly managed, says Dacre Knight, MD, medical director of the Ehlers-Danlos Syndrome Clinic at Mayo Clinic in Jacksonville, Fla.

A primary tool for diagnosing hypermobility is the Beighton score, a “snapshot of the joints” that looks at the range of motion in the knuckles, elbows, knees, base of the thumbs, and the spine. The higher one’s score, the more mobile their joints.

Again, hypermobile joints alone don’t necessarily mean one has hEDS or HSD. “Just having dislocations or being able to do the splits doesn’t mean you have a problem,” Knight explains. Hypermobility becomes a concern when it’s one in a constellation of symptoms that manifest throughout the body.

To determine whether someone with hypermobility may also have a connective-tissue disorder, clinicians conduct a comprehensive exam and medical history. “We would look for things like, Have you had multiple hernias or pelvic organ prolapse? What does your skin look like? How do your scars heal?” Knight says. “And family history is very important — it’s the cheapest and quickest genetic test out there.”