Are you Hyperflexible? Problems of Joint Hypermobility. Beyond the Flexible

Can You be Too Flexible?

YES!

  • Hyperflexibility in a joint means you can extend a joint beyond the normal range expected for that particular joint.
  • Being abnormally flexible may indicate a disorder of connective tissue, sometimes called hypermobility.
  • Often, people with this have a childhood history of doing funky things with their body (such as clicking joints out of place or putting feet behind the head). Very commonly they enjoy participating in yoga or circus-style acrobatics.. because doing these exercises/poses is not difficult.
  • Other indicators may include easy dislocation, sprains or strains. Pain in the knees, fingers, hips, and elbows is more likely if there has been excessive stretching or injuries.
  • Sometimes there are no symptoms – this is more likely in older adults, especially if you’ve not been particularly acrobatic, which allows for a bit of stiffening of the joint capsules.
  • Treatments are customised for each person depending on his or her particular manifestations.

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How do I Know if my Joints are “Hypermobile”, not just “Very Flexible”?

Symptoms of joint hypermobility include:

  • Pain in joints, such as knees, fingers, hips, and elbows
  • Susceptiblity to injury, such as joint dislocation and sprains of involved joints
  • Scoliosis (curvature of the spine), which can lead to back pain

While people with normal flexible joints have often had to work at it – gently and gradually stretching so that, over time, they can move more freely, those with hypermobile joints have no problem with some of these stretches.

Joint hypermobility tends to decrease with aging as we become naturally less flexible, as long as the joints are not constantly stressed.

Signs of hypermobility disorders include (but are not limited to) being able to:

  • Place the palms of the hands on the floor with the knees fully extended
  • Hyperextend the knees or elbows beyond 10 degrees
  • Passively touch the thumbs to the forearm.

These, and other indicators, are best assessed by a practitioner experienced at identifying hypermobility (Sharon Erdrich & Emma Gardiner are both experienced in this area). Be aware, likelihood of hEDS or HSD can be confirmed by a physiotherapist or osteopath, but a formal diagnosis of the condition is done by a Rheumatologist or Musculoskeletal Specialist.

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How Common is Joint Hypermobility?

Joint hypermobility commonly runs in families, as it is genetic.

Approximately 3% of the general population have hypermobility syndrome. Many are undiagnosed.

This may be higher in young people – one estimate is that up to 10-15% of children have hypermobile joints or joints that can move beyond the normal range of motion. These joints are sometimes referred to as “loose” and affected people may be referred to as being “double jointed”.

It is not unccommon to see higher numbers of people with hypermobility disorders participating in sports or the arts that require a higher degree of flexibility, such as yoga, dance, gymnastic, and acrobatics. They simply find these poses and postures easier than most folk!

Digestive Problems are Incredibly Common in People with Hypermobilty

High rates of conditions knowns as “disorders of gut-brain interaction” (DGBI), previously called “functional gastrointestinal disorders” (FGID) occur in thsoe with hypermobililty.

Examples include:

  • Dyspepsia (sometimes called heartburn or indigestion) occurs at about double the rate in hypermobile patients compared to others.
  • Early satiety is feeling full before finishing a regular meal. This, or feeling bothersomely full after a regular meal, are both signs of postprandial distress syndrome, which is more likely to occur in people with both hypermobility and irritable bowel syndrome (IBS).
  • Constipation (or constipation-dominant IBS) is also common. This is also an early sign in children, particularly if the condition is not helped (or made worse) by osmotic laxatives (such as Movicol, Molaxole, lactulose, and magnesium preparations).

Abdominal Pain

The accumulation of gas in the intestines of someone with altered connective tissue (such as in hypermobility syndromes) may cause a greater degree of distension of the intestine.

Normally, intestinal distension stimulates pressure receptors that result in bowel contractions. However, when over-stretched, the contracting muscles cannot function normally.

Subsequently, excessive stretch creates bloating and is a major stimulus to abdominal pain.

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Common Digestive Problems in Hypermobile Patients [2]

Other Gastrointestinal Problems

Increased connective tissue laxity and weakness predisposes to a variety of abnormalities. Some specific ones are:

  • Prolapses (such as of pelvic organs). These are about twice as common in hypermobile individuals.
  • Rectal hyposensitivity. This means that a person is less likely to notice that they need to empty their bowels. This can lead to more severe constipation. It is also a risk factor for incontinence, or “leaking” of faecal matter [4].
  • Sluggish digestion. Slow transit time (as discussed above) increases the population of unhealthy bacteria, called dysbiosis. A simple test to assess the transit time is available here, and you can do a stool test to assess your microbiome here.
  • Hiatus hernia, which increases the risk of acid reflux.
  • “Visceroptosis”. In this condition, abnormal connective tissue “sticks” internal organs to the walls of the abdominal cavity. So organs aren’t exactly where they should be.
  • Elongated or redundant colon (large bowel), which is often congenital. Essentially, the colon is unusually long, with extra loops and kinks.  Understandably, the movement of faecal matter is much slower, which leads to abdominal pain, bloating, and constipation. Unfortunately, with overfilling (such as with chronic constipation), the muscles of this long large bowel can get stretched, and the bowel can become increasingly dysfunctional [2].
  • There has been little research investigating the rates of other types of digestive disorders in hypermobile syndromes. However, the following conditions do appear to be more common:
    • Coeliac Disease. In this condition, the body sets up an immune reaction to gluten (found in wheat, barley & rye). This causes inflammation in the lining of the small intestine, and increases the risk of poor absorption of nutrients. Coeliac disease occurs at rates about 50% higher in hypermobile conditions than in those without.
    • Inflammatory Bowel Diseases (IBD), such as Ulcerative Colitis and Crohn Disease

    the anatomical effects of connective tissue laxity and weakness per se, their functional consequences, and the influence of non‐gastrointestinal issues that include autonomic dysfunction, medication effects or comorbid mental health disorders.

Mast Cell Activation Disorder

In mast cell activation syndrome (MCAS), mast cells, (a type of immune cell that is packed with inflammatory chemicals such as histamine), release their stored chemicals, causing allergy-like symptoms. This can occur anywhere in the body.

Increased rates of MCAS may be linked to some types of HDS. There is more information about his on the EDS website.

Symptoms of activation of mast cells can include shivering, abdominal cramps, dizzyness, weakness, rapid heart rate, flushing of the skin, allergic symptoms (like hayfever) and diarrhoea.

Because histamine is also released in the intestines, foods can aggravate the release, and thus increase the likelihood of histamine intolerance. Some people with MCAS have lower levels of reactivity by adhering to a low histamine diet. While the food does not cause  the problem, some foods are more likely to aggravate it.

It is important to discuss your food and nutrition with a qualifed practitioner before eliminating any food groups from your diet.

What Else Might a Person with Hypermobility Experience?

Not uncommon are a number of other symptoms or problems. The most common ones include:

  • Skin changes
  • Fatigue
  • Headaches
  • Food intolerances or allergic responses to some foods
  • Digestive disturbances – see below
  • Recurring, or chronic small intestinal bacterial overgrowth (SIBO)
  • Impaired autonomic reflexes. This includes a large list of possible symptoms, or other conditions, such as Raynaud’s, abnormal sweating, altered heart rate with postural changes and others.
  • Fibromyalgia (generalised chronic pain)
  • Prolapses (e.g. of bladder, uterus or other tissues)
  • Endometriosis and other uterine disorders
  • Super-stretchy skin
  • Stretch marks in unusual places (e.g., elbows, chest, under the arms, and on the inner thigh)
  • Easy bruising or unusual scars
  • Altered vascular compliance:
    • Increased arterial elasticity is associated with lower blood pressure, which may contribute to dizzyness or rapid heartrate when changing position. This is known a orthostatic intolerance.
    • The pooling of blood in the lower limbs (causing lower leg and ankle swelling) is likely to also be related to altered connective tissue of blood vessels.
    • Alterations in the circulation of blood to gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine may also contribute to gastrointestinal symptoms.

What Causes Hypermobility Syndromes?

Hypermobility common runs in families. This is because it is a genetic, and therefore inherited, disorder. There are many different genes that code for the production of collagen in the body and the different presentations depend on which genes are affected.

What Can be Done to Help Hypermobility Conditions?

Sometimes a person with hypermobility has no symptoms and requires no treatment. Over time, and with conservative management, symptoms can improve. This means NOT doing things that stretch or put strain on the joints.

Treatments, when necessary, are tailored for each person according to their symptoms.

Examples include:

  • Herbal medicine for joint pain or inflammation
  • Coaching to ensure optimal physical fitness while avoiding injury to joints
  • Nutritional assessment and guidance
  • Support for digestive distress requires a comprehensive approach to address functional problems, food-related reactions and so on.
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