Hypermobility - a superpower or not?


A while back a mother came to see me at our development centre, very worried about her three year old daughter. She told me that she had already seen a urologist, pediatrician and an occupational therapist, and they all seemed to think that her child was just fine. 

Nonetheless, she had a nagging feeling that this was not the case.  At first I thought this mother was just a bit paranoid with her child's development, seeing that I was the fourth professional they were consulting with.  A teacher from the little girl’s preschool was worried about her being clumsy, and I have learned over the years to listen to a mother's instinct.

As we went through their medical history form, I noticed the following symptoms: severe constipation, continuous bladder problems, bruises easily, battles to sleep through the night, and complains of pain. As the mother gave me more detail about her own development as a child, it started to sound like a cookie-cutter pattern, with the child going through what her mother had gone through when she was a child.

I took the little girl by her hand (which immediately gave me another clue) and started to play various gross motor games as part of our formal assessment. I soon noticed that this child was indeed very clumsy.  Although she could engage all the skills that I was busy testing, it was her execution that finally gave me a clue of what this family may have been dealing with for years.  Holding her hands out to catch a ball, I noticed that her arms made an X when she lifted her arms in front of her, her elbows coming very close to one another.

I walked up to her and had a proper look at the range of all her movements.  Indeed, this child was extremely flexible. Her skin, full of bruises, had a velvety texture and it stretched further than normal.  Although flexibility in itself is not always a bad thing, it was all the other symptoms that were present with her extreme flexibility that made me suggest that she sees a paediatric rheumatologist.  To cut a long story short: this little girl was diagnosed with Ehlers Danlos Syndrome and immediately thereafter started with physiotherapy at a practice that specialized in hypermobility.

What is hypermobility?
Hypermobility is a term used to describe how flexible someone is.  Some people may refer to it in layman's terms as being 'double jointed'.  Hypermobility is quite common in children as they possess an inherently greater range of motion in their joints than adults.  According to the Hypermobility Syndrome Association, between 10 - 50 % of all children are hypermobile, with girls being more flexible than boys.

Most of these children do not experience any symptoms but rather see themselves as having super powers like Elasti-Girl in the movie 'The Incredibles'.  Their bodies allow them to do crazy stunts like putting their feet behind their necks.  Flexibility can also be an advantage in activities and sports such as athletics, dancing and gymnastics.

However, sometimes being hypermobile or bendy can cause problems or symptoms.  This is what the word ‘syndrome’ means.  Syndrome means ‘other symptoms’.  In the past, children with mild symptoms were often diagnosed with Joint Hypermobility Syndrome.  However, since March 2017 this terminology has been changed internationally to Hypermobility Spectrum Disorder.  Some hypermobile children may go on to be diagnosed with more serious disorders such as Ehlers-Danlos syndrome or Marfan syndrome.  Joint hypermobility can also be seen in children with Down Syndrome. In the next article we will have a look at the causes of hypermobility as well as the signs and symptoms to look out for.  Until then, happy moving moments!