Joint Hypermobility
Joints that move beyond the typical range of motion
Quick Facts
- Type: Connective tissue / joint condition
- Common term: Double-jointed
- Range: Harmless to symptomatic
- Support: Physiotherapy and strengthening
Overview
Joint hypermobility means some or all of a person's joints can move further than usual, often described as being 'double-jointed.' It is very common, especially in children, and for many people it causes no problems and may even be an advantage in activities like dance or gymnastics.
For others, hypermobility comes with pain, frequent sprains, joint instability, and fatigue. When loose joints cause these kinds of symptoms, doctors may call it hypermobility spectrum disorder. In some people, hypermobility is part of a wider connective tissue condition such as Ehlers-Danlos syndrome or Marfan syndrome. Understanding which type a person has guides how it is managed.
Symptoms
Many people with hypermobile joints have no symptoms. When symptoms do occur, they may include:
- Joint pain, often in the knees, fingers, hips, or elbows, especially after activity
- Frequent sprains, strains, or joints that slip or dislocate
- A feeling that joints are unstable or 'give way'
- Stiffness and aching, sometimes worse in the evening or after exertion
- Fatigue and reduced stamina
- Clumsiness or poor coordination
- Soft, stretchy skin or easy bruising in some connective tissue conditions
Symptoms can change over time and may improve or worsen with activity levels and age.
Causes
Joint hypermobility relates to the connective tissue that supports and stabilizes joints, particularly the proteins like collagen that give ligaments their strength and flexibility. Causes include:
- Inherited differences: Hypermobility often runs in families and is linked to the make-up of connective tissue.
- Connective tissue conditions: Such as Ehlers-Danlos syndrome and Marfan syndrome.
- Shape of the joints: Differences in the bones and ligaments around a joint.
- Muscle tone: Low muscle tone can contribute to looser joints.
In most people, hypermobility is simply a normal variation rather than a disease.
Risk Factors
- A family history of hypermobility or connective tissue conditions
- Younger age, as flexibility decreases with maturity
- Female sex
- Certain ethnic backgrounds, in which hypermobility is more common
Diagnosis
Joint hypermobility is usually assessed through examination rather than a single test:
- Physical exam: A doctor checks how far joints move, often using a simple scoring system that looks at the thumbs, fingers, elbows, knees, and spine.
- Symptom and family history: Asking about pain, dislocations, skin changes, and relatives with similar features.
- Assessment for connective tissue conditions: If features suggest Ehlers-Danlos or Marfan syndrome, further evaluation or genetic testing may be considered.
The goal is to tell harmless flexibility from hypermobility that needs treatment, and to identify any wider condition.
Treatment
If hypermobility causes no problems, no treatment is needed. When it causes symptoms, management focuses on stability, strength, and pain control:
- Physiotherapy: Strengthening the muscles around joints improves stability and reduces pain and injury.
- Low-impact exercise: Activities like swimming and cycling build fitness while protecting joints.
- Pacing and joint protection: Avoiding overextending joints and balancing activity with rest.
- Pain management: Simple pain relief and good posture; bracing or supports for unstable joints when advised.
Care is tailored to the individual, and most people manage symptoms well with the right exercise plan.
Self-Care
Symptoms cannot always be prevented, but flare-ups can be reduced:
- Keep the muscles around joints strong with regular, gentle exercise
- Warm up before activity and avoid pushing joints to their extremes
- Maintain good posture and supportive footwear
- Pace activities and rest when joints ache
- Seek physiotherapy guidance for a tailored program
When to See a Doctor
See a doctor if hypermobile joints cause ongoing pain, frequent dislocations, instability, or fatigue, or if symptoms limit daily life. A doctor can recommend physiotherapy and check whether a connective tissue condition is present.
Seek prompt care for a joint that has clearly dislocated and will not go back, or for severe pain, swelling, or deformity after an injury. Mention any chest pain, fainting, or vision changes, as these can be important in certain connective tissue conditions.
Frequently Asked Questions
Is being double-jointed harmful?
For most people, no. Hypermobile joints are common and often cause no problems. They only need attention when they lead to pain, frequent dislocations, instability, or other symptoms.
What is the difference between hypermobility and Ehlers-Danlos syndrome?
Hypermobility means joints that move beyond the usual range, which is often harmless. Ehlers-Danlos syndrome is a group of inherited connective tissue disorders in which hypermobility occurs along with other features like stretchy skin, easy bruising, and tissue fragility.
Can joint hypermobility cause pain?
Yes. Some people develop joint pain, frequent sprains, instability, and fatigue, sometimes called hypermobility spectrum disorder. Strengthening exercises and physiotherapy usually help manage these symptoms.
Does hypermobility go away with age?
Joints generally become less flexible as people get older, so hypermobility often lessens with age. However, symptoms such as pain can change over time and may need ongoing management.
What exercise is best for hypermobile joints?
Strengthening the muscles around the joints is key, ideally guided by a physiotherapist. Low-impact activities such as swimming and cycling build fitness while protecting the joints from overextension and injury.
References
- MedlinePlus, U.S. National Library of Medicine. Hypermobile joints.
- Mayo Clinic. Ehlers-Danlos syndrome.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
- American Academy of Orthopaedic Surgeons.