What is Joint Hypermobility Syndrome?
Joint hypermobility syndrome (JHS) refers to a condition where joints move beyond the normal range of motion, causing pain, instability, and recurrent injuries. In 2017, the medical community updated the terminology. What was formerly called “joint hypermobility syndrome” or “benign joint hypermobility syndrome” is now classified under two categories:
- Hypermobility spectrum disorder (HSD): Symptomatic joint hypermobility that does not meet the criteria for hypermobile Ehlers-Danlos syndrome
- Hypermobile Ehlers-Danlos syndrome (hEDS): A specific clinical diagnosis with stricter criteria involving skin, systemic, and family history features
Both conditions share similar symptoms, and management is the same for both. Despite the name change, many patients and even some healthcare providers still use the term “joint hypermobility syndrome.” What matters most is that the condition is recognized and properly managed.
The combined prevalence of HSD and hEDS is estimated at 1 in 600 to 1 in 900 people, though general joint hypermobility (being “double-jointed”) without symptoms is far more common, affecting up to 10 to 20 percent of the population.
Understanding the EDS Spectrum
Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders. Connective tissue provides structure and support throughout the body, including in joints, skin, blood vessels, and organs.
There are 13 recognized types of EDS. Hypermobile EDS (hEDS) is the most common type. The key features that separate hEDS from HSD include:
- Joint hypermobility measured by the Beighton score (a standardized test of joint flexibility)
- Systemic features such as unusually soft or stretchy skin, easy bruising, chronic pain, and pelvic organ prolapse
- Family history consistent with autosomal dominant inheritance
- Exclusion of other connective tissue disorders
Many experts now view HSD and hEDS as part of the same spectrum rather than completely separate conditions. A person with HSD can be just as symptomatic as someone with hEDS.
Why Older Adults Should Know About Hypermobility
While hypermobility is often associated with younger people, it remains relevant for older adults for several important reasons:
- Lifelong condition: People who were hypermobile in youth carry the consequences into older age, including early joint wear and accumulated injuries
- Early-onset osteoarthritis: Hypermobile joints experience uneven stress, which can accelerate cartilage breakdown and lead to osteoarthritis decades earlier than expected
- Misdiagnosis: Many older adults with chronic joint pain were never diagnosed with hypermobility and may have been treated only for osteoarthritis
- Grandchildren and family: Understanding hypermobility can help identify the condition in younger family members, since it runs in families
Symptoms to Watch For
Joint Symptoms
- Joints that hyperextend: Elbows, knees, or fingers that bend backward beyond straight
- Chronic joint pain that worsens with activity and may improve with rest
- Joint instability: Feeling that joints are loose, wobbly, or “give way”
- Frequent subluxations: Partial dislocations where the joint slips out of place and then returns
- Full dislocations of the shoulder, kneecap, or other joints
- Recurrent sprains of the ankles, wrists, or other joints
- Clicking, popping, or grinding in multiple joints
Whole-Body Symptoms
- Chronic fatigue not explained by other conditions
- Muscle pain and stiffness especially after activity
- Poor proprioception: Difficulty sensing where your body is in space, leading to clumsiness or poor balance
- Easy bruising and slow wound healing
- Soft, velvety, or stretchy skin
- Digestive issues such as bloating, constipation, or reflux
- Dizziness upon standing (orthostatic intolerance)
- Anxiety (more common in people with hypermobility than the general population)
When to Seek Evaluation
Consider evaluation if you have:
- Joint pain in multiple joints without clear arthritis on imaging
- A history of frequent sprains, dislocations, or soft tissue injuries
- Family members who are unusually flexible or have similar symptoms
- Joint pain that started at a younger age than typical for osteoarthritis
- Pain that does not fully respond to standard arthritis treatments
Diagnosis
Beighton Score
The Beighton score is a simple screening tool that measures flexibility at 9 points:
- Can you bend each pinky finger back past 90 degrees? (1 point each)
- Can you bend each thumb to touch your forearm? (1 point each)
- Can each elbow hyperextend past straight? (1 point each)
- Can each knee hyperextend past straight? (1 point each)
- Can you place your palms flat on the floor with straight legs? (1 point)
A score of 5 or more out of 9 in adults (or 4 or more in those over 50) suggests generalized joint hypermobility. However, the Beighton score alone does not diagnose HSD or hEDS. Symptoms must also be present.
Clinical Evaluation
- Complete medical and family history
- Physical examination of joint range of motion
- Assessment of skin quality, bruising, and scarring
- Evaluation for associated conditions
- Ruling out other causes of joint laxity (Marfan syndrome, other EDS types)
Imaging
- X-rays: Usually normal in hypermobility but may show early osteoarthritis
- MRI: May reveal soft tissue damage, labral tears, or meniscal injuries
- Genetic testing: Available for some EDS types but not currently for hEDS
Treatment and Management
There is no cure for hypermobility spectrum disorders, but symptoms can be effectively managed. Treatment focuses on strengthening muscles to compensate for loose joints, protecting joints from injury, and managing pain.
Physical Therapy (Primary Treatment)
Physical therapy is the cornerstone of hypermobility management:
- Targeted strengthening: Building muscle around hypermobile joints to provide stability that loose ligaments cannot
- Proprioception training: Exercises that improve body awareness and balance
- Controlled range of motion: Learning to use joints within a safe range rather than pushing into hyperextension
- Core stability: Strengthening the trunk muscles to support the spine
- Low-impact exercise: Swimming, cycling, Pilates, and walking are generally well-tolerated
- Avoiding hyperextension: Learning not to lock joints into extreme positions
Finding a physical therapist experienced with hypermobility is important. Standard physical therapy that emphasizes flexibility over stability can worsen symptoms.
Bracing and Supports
Orthotic devices can protect vulnerable joints:
- Knee braces to prevent hyperextension and support stability
- Ankle supports to reduce sprains
- Wrist splints for repetitive tasks
- Ring splints to prevent finger hyperextension
- Supportive footwear with arch support and cushioning
- Compression garments to improve proprioception
Bracing should be used strategically. Over-reliance on external supports without strengthening exercises can lead to further muscle weakness.
Pain Management
- Pacing activities: Alternating activity with rest to avoid flare-ups
- Heat therapy: Warmth can ease muscle pain and stiffness
- Over-the-counter pain relievers: Acetaminophen or NSAIDs for acute pain
- Topical treatments: Anti-inflammatory creams or gels applied to painful areas
- Low-dose amitriptyline: Sometimes prescribed for chronic pain and sleep improvement
Lifestyle Modifications
- Regular, gentle exercise is essential. Avoid prolonged immobility
- Ergonomic adjustments at work and home
- Good sleep hygiene to combat fatigue
- Stress management including mindfulness or relaxation techniques
- Adequate hydration and nutrition to support connective tissue health
Prevention of Complications
- Avoid high-impact or contact sports that increase dislocation risk
- Warm up thoroughly before any physical activity
- Strengthen before stretching. Prioritize stability over flexibility
- Use proper body mechanics when lifting, carrying, and bending
- Monitor for early osteoarthritis with regular check-ups
Questions to Ask Your Healthcare Provider
- Could my joint pain be related to hypermobility rather than (or in addition to) osteoarthritis?
- How do I find a physical therapist experienced with hypermobility?
- Would bracing or orthotics help protect my joints?
- Should my children or grandchildren be evaluated for hypermobility?
- What exercises are safe, and which should I avoid?
- How often should I be monitored for osteoarthritis progression?
Frequently Asked Questions
Is joint hypermobility the same as being double-jointed?
Being “double-jointed” is a common term for joint hypermobility, the ability of joints to move beyond the normal range. Many people are hypermobile without any problems. Hypermobility spectrum disorder is diagnosed only when hypermobility causes symptoms such as pain, instability, or recurrent injuries. Not everyone who is flexible has a medical condition.
Does hypermobility go away with age?
Joint flexibility typically decreases with age, but the underlying connective tissue differences remain. Older adults with hypermobility may notice less extreme flexibility but continue to experience joint pain, instability, and the effects of accumulated joint wear. Many develop osteoarthritis earlier than their peers.
Can hypermobility cause osteoarthritis?
Yes. Hypermobile joints experience uneven mechanical stress because the ligaments do not adequately stabilize the joint surfaces. Over time, this abnormal loading can accelerate cartilage breakdown and lead to osteoarthritis, particularly in the knees, hips, and hands. Strengthening exercises help reduce this risk.
Is joint hypermobility syndrome hereditary?
Yes. Both HSD and hEDS run in families. If you have hypermobility, there is a significant chance your children or grandchildren may also be affected. Early identification allows for preventive strategies such as appropriate exercise, joint protection, and avoiding high-risk activities.
This content is for educational purposes only and does not replace professional medical advice. If you suspect you or a family member has joint hypermobility syndrome or a hypermobility spectrum disorder, consult a healthcare provider experienced in connective tissue conditions for proper evaluation.