Advice and resources : Hypermobility in children

Overview

Joint hypermobility means there is increased movement in the person’s joints. They are often described as having 'loose or clicky' joints or being 'double-jointed'. With hypermobility, ligaments are relaxed, and the joints they support are more flexible and move easily beyond the normal range expected for their age.

Joint hypermobility is often hereditary (runs in families). Many people with joint hypermobility experience no symptoms or difficulties and therefore will not require any medical treatment or support. However, some people who may experience symptoms can usually self-manage through living a healthy lifestyle and pacing their daily activities.

What you might see

Young people who have joint hypermobility may take longer to achieve their motor milestones, for example, crawling/bottom shuffling and walking.

Children and young people with hypermobile joints may:

• Have frequent falls
• Struggle with balance
• Struggle to walk longer distances, therefore can show reluctance
• Tire easily compared to their peers
• Experience pain/discomfort whilst completing or after carrying out certain tasks e.g. handwriting, participating in physical and sports activities

Activities and strategies to try

• Focus on having a healthy lifestyle and maintaining a healthy weight to reduce the stress on your muscles and joints. 
• Do some low impact activities as they place less stress on your joints and muscles such as swimming, cycling, walking, yoga, pilates or Tai chi.
• For young people who visit the gym, stick with equipment such as the exercise bike, treadmill, cross trainer, rowing machine.
• Avoid weights, especially free weights, that place increased strain on your joints.

Pacing and managing fatigue

If you experience muscle pain after exercise or activity, try pacing your activity.

Pacing means gradually increasing an activity to achieve a goal. Don’t do too much activity on one day; spread it out throughout the week and focus on building muscle strength and fitness.

• Gradually increase the time spent on the task, until you can complete the whole activity, without getting too tired or experiencing too much pain.
• Building muscle strength takes time and practice. Don’t expect to see changes in the first few weeks. Aches and pains associated with hypermobility are usually a result of muscle fatigue, not damage or injury. A warm bath or hot water bottle may help.
• Some young people may need adult support to help them pace their activities throughout the day/week to include rest breaks.

Other things to consider

Footwear

• Wear well-fitted, supportive footwear. When purchasing shoes, ensure shoes are stiff around the heel, have a sturdy sole, soft uppers and preferably with laces or straps which will support the whole foot.
• If the ankles are particularly unstable, boots or high-top trainers will provide additional support.

School bags

• Using rucksack type bags with padded straps is recommended.
• Discourage carrying the bag over one shoulder to reduce strain on the joints.   
• Do not carry more than you need. If you notice red marks on your shoulders after wearing the bag, or any tingling or numbness in your hands/arms, this is an indication the bag is too heavy.
• If you have access to a locker, use it to store/leave PE kit, lunch box etc.

Seating posture

Good seating and positioning are essential.

• Make sure the size of the chair and table is suitable for the child/young person’s height. The table should be at just below 'resting elbow' level with forearms resting comfortably on the tabletop.
• Make sure they are sitting upright with their bottom against the back of the chair, and hips and knees at a 90-degree angle, with the chair tucked well in under the tabletop.
• Feet should be flat on the floor. Use a footrest if their feet don’t touch the floor.
• A wedge move ‘n sit cushion may help if the child/young person often slouches or slumps in their chair. You can also try getting them to use an angled writing slope or an A4 ring binder with a matt surface to help create a more upright posture.
• Long periods of sitting can cause fatigue, pain or stiffness, therefore, it's important to offer a short movement or rest break.
• Avoid the 'W' sitting position (when a child sits on their bottom with their knees bent and feet positioned outwards) because this can cause increased stress on your hip joints. 

Classwork

• It is useful to break down homework/classwork into small, manageable chunks.
• Encourage the child to complete hand warm-up exercises before the writing task.
• Consider using alternatives to writing when recording longer pieces of work, e.g. use of a laptop or a scribe.
• Using a pencil grip can help a child or young person hold the pen/pencil more effectively.

Cutlery

• If the child/young person finds holding or using cutlery difficult, you can try using cutlery with larger handles or Caring/Kura Cutlery.

External support

The Hypermobility Syndromes Association

The Hypermobility Syndromes Association (HMSA) has a holistic, solution-focused approach to living well with a hypermobility syndrome.

• Learn more