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.
Hypermobility in Infancy
Hypermobility in infancy (0-2 years) is very common and can be a normal finding. It typically shows up clinically as increased range of movement in most joints. It becomes problematic if it causes developmental delay. Some infants will experience reflux and will not tolerated tummy time due to lack of joint stability and then do not crawl and bottom shuffle instead. Typically the infants who bottom shuffle tend to walk later than the infants who crawl. Infants with hypermobility also tend to be cautious and fearful of movement.
How do I know if my infant 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 some common signs to be aware of are:
Often and initially infants present with reflux as hypermobility can affect gut functioning.
Your infant tends to lie in a frog legged position or legs out wide and is not very active with arms and legs.
Your infant has low tolerance of tummy time due to lack of strength and low tone.
Your infant does not roll, crawl, sit or is slow to reach developmental milestones.
When your infant does achieve sitting he/she tends to sit with their back 'rounded' or in a 'C' shape and with their legs out wide.
Your infant bottom shuffles.
Your infant is cautious, fearful of movement.
How can we help
Here at Move Kids Physio, best practice including evidence based practice is always adhered to to ensure optimal outcomes for the child and family.
Preventative - Online Classes for Infants (Tiny Moves and Maestro Moves)
The online classes at Move Kids Physio are focused on educating parents and providing tips for individual babies on achieving successful tummy time which will help strengthen the upper body which in turn helps with the development of muscle tone, crawling and achieving developmental milestones. Tummy time when done correctly ie pushing up through straight arms is fantastic for strengthening the joint position sense, the core muscles and lessening the risk of joint hypermobility symptoms in future. Crawling in turn further strengthens the joint position sense, core strength, coordination, visual development and successful achievement of 'developmental milestones' as well as lessening the risk of hypermobility symptoms in future.