What is Hypermobility?
Hypermobility in children (0-18 years old) is when there is extra range of movement or flexibility at multiple joints in the body for that child's age. Hypermobility is a connective tissue disorder. Connective tissue makes up thick bands of tissue (ligaments) that hold our joints together and keep them from moving too much or too far out of range. In people with joint hypermobility, those ligaments are loose or weak and the joints move further than usual.
Is it Low Muscle Tone or Hypermobility?
Hypermobility is linked to reduced joint position sense and low muscle tone. Joint position sense arises from stretch receptors located in muscles around joints. Muscle tone refers to the muscle's readiness for action. Muscle tone depends on the sensitivity of the stretch receptors. If the sensitivity to stretch is very low the muscles are slow to respond. Therefore joint hypermobility can result in low muscle tone and weakness and delayed developmental milestones in infancy and childhood.
How Common is Hypermobility?
It is really common in children and reportedly affects 25-50% of children under 10 years of age. It is a condition that is thought by experts to be under recognised and misunderstood. Joint hypermobility tends to decrease with age. It tends to run in families, affects more younger than older children, girls more than boys. Most children are asymptomatic and do not know they have it.
Common symptoms of Hypermobility
Joint hypermobility describes a wide range of children with flexible joints. Some children may benefit from their flexible joints and can excel in sports such as gymnastics, swimming, athletics, dance etc. However some children can experience pain, fatigue, headaches, recurrent injuries, muscle weakness, problems with balance, coordination and delayed developmental milestones due to their hypermobility. In addition, there may be symptoms related to the abnormal function of the autonomic (involuntary or automatic) nervous system including PoTS (Postural Orthostatic Intolerance) Syndrome and problems with gut and bowel function. There is also evidence of a link between hypermobility and anxiety.
Joint Hypermobility in Older Children
Hypermobility in children (2 years +) typically shows up clinically as increased range of movement in most joints. It becomes problematic if it causes developmental delay, balance, coordination problems, fatigue, muscle weakness, pain and other symptoms. In those children who are symptomatic, some may toe walk, appear uncoordinated, fall regularly, experience pain, fatigue, lack endurance for walking/running, and/or may fall behind their peers in physical and motor development.
How do I know if my child has hypermobility?
Unless you are a qualified healthcare professional with training and/or clinical experience in assessing and managing hypermobility in children you will not know for sure if your child has hypermobility. This is why it is best to get the relevant healthcare professional's (who has experience and training in the assessment and management of hypermobility in children) opinion. However as mentioned previously if your child does not tolerate tummy time, does not crawl, slow to reach developmental milestones, falls a lot, complains of pain, fatigue, lacks endurance, toe walks - do seek advice and assessment for joint hypermobility from a Chartered Paediatric Physiotherapist.
How can we help at Move Kids Physio
Here at Move Kids Physio, best practice including evidence based practice is always adhered to to ensure optimal outcomes for the child and family.
Younger children (0-4 years) - face to face clinic sessions
Initially there needs to be a physiotherapy assessment including background interview with parents. Infants' neurological, motor and physical development are assessed in a thorough and comprehensive assessment. Initial assessment can take 60 minutes. On the basis of the assessment findings and in discussion with parents, goals are established and a home programme tailored for the child and family is devised. A key component of the Move Kids Physio approach is parent education around hypermobility and it's management.
Older children (4 years+) - face to face clinic sessions
Initially there needs to be a thorough assessment including background interview with parents, diagnosis of joint hypermobility and assessing the extent of the hypermobility using the 'Brighton Criteria' and 'Beighton Score' as is recommended best practice. In addition, children undergo standardised tests of motor skills (which include tests of fine and gross motor skills). There is also a full assessment of the child's muscle tone, strength, flexibility and biomechanics. Initial assessments can take 90 minutes. On the basis of the assessment findings and in discussion with parents, goals are established and a home programme is devised. A key component of the Move Kids Physio approach is parent and child (age appropriate) education around hypermobility and management.
Follow up
Follow up physiotherapy is typically recommended fortnightly, monthly or once every few months depending on the extent of hypermobility and presence of developmental delay. It is recommended that younger children, children who are in pain and those with significant developmental delay are followed up more regularly.
Outcomes of Physiotherapy for Children with Hypermobility
Based on clinical experience here at Move Kids Physio, children progress significantly in their motor skills, balance, coordination, strength once they undergo a thorough initial assessment as described above and adhere to a play and physical activity based home programme tailored specifically for the child.
For more information on assessment and follow up physiotherapy go to www.movekidsphysio/services.