Physical Therapy Guide to Benign Hypermobility Joint Syndrome
Benign hypermobility joint syndrome (BHJS) is a hereditary disorder of the connective tissues (ligaments) that results in joints becoming loose throughout the body (hypermobility). Although some degree of hypermobility in children is normal, individuals with BHJS may have persistent laxity (loose ligaments), resulting in long-term problems, such as pain and joint instability. BHJS can be a limiting disorder. Physical therapists help those with the syndrome develop strategies to increase joint stability, reduce pain, and improve function.
What is Benign Hypermobility Joint Syndrome?
Benign hypermobility joint syndrome (BHJS) is a hereditary disorder of the connective tissues (ligaments) that results in joints becoming loose throughout the body (hypermobility). Although some degree of hypermobility in children is normal, individuals with BHJS may have persistent laxity (loose ligaments), resulting in long-term problems, such as pain and joint instability. BHJS can be a limiting disorder; physical therapists help those with the syndrome develop strategies to increase joint stability, reduce pain, and improve function.
How Does It Feel?
Patients with BHJS often report:
- Joint pain.
- Looseness of the joints, resulting in sprains, dislocations, or spinal problems.
- Decreased "proprioception" (the sense of where a joint is in space), leading to decreased balance.
- Back pain (often related to prolonged static positions, such as standing or sitting).
How Is It Diagnosed?
The diagnosis of BHJS is often made when an individual reports having pain in multiple joints, along with hypermobility in multiple joints, and after other potential rheumatic disorders as well as conditions that result in joint laxity, such as Ehlers Danlos syndrome have been ruled out.
How Can a Physical Therapist Help?
Physical therapists play a vital role in providing treatment strategies and activities that help people experiencing BHJS improve their joint stability. Your physical therapist will develop an individualized plan of care to treat your condition. Your treatments may include:
Muscle Strengthening. Muscles also provide stability to joints. Your physical therapist will develop strategies to increase the strength of key muscles that aid in joint stability.
Balance and Proprioceptive Activities. Your physical therapist may work with you on treatment strategies to improve your balance and coordination.
Orthotics/Taping/Bracing. Your physical therapist may provide ankle taping, a custom orthotic, or bracing if a joint is deemed too loose, to help make it less susceptible to further injury.
Manual Therapy. Because pain is a common complaint of people with this disorder, your physical therapist may apply gentle hands-on treatments to reduce your discomfort and gently stimulate the nerves in your joints.
Can This Injury or Condition Be Prevented?
Because BHJS has a hereditary component, the condition cannot be prevented. However, early detection and treatment of the disorder (recognizing it in childhood and addressing it before symptoms are experienced) may enhance an individual's long-term well-being.
Upon diagnosis, your physical therapist will work with you to develop strategies to help you better understand and manage your condition.
Real Life Experiences
Charlie is 15-year-old avid soccer player who has just made his high school varsity team. At practice over the past couple of weeks, however, and in his first scheduled game, Charlie began to feel increasing pain in his joints, especially his ankles. During a recent checkup, his doctor noted that Charlie had "loose" joints, and recommended that he wear ankle braces while playing soccer.
Although Charlie now wraps his ankles in elastic bandages before he goes on the field, he reports that his pain seems to be getting worse. His mother calls their physical therapist.
At his initial evaluation, Charlie's physical therapist asks him to describe his symptoms. Charlie reports he has been recently experiencing aches throughout many of the joints of his body. His mother reports that he has a remarkable past medical history, with only a few ankle sprains from playing soccer.
Charlie's physical therapist also checks his general strength, and notices weakness in the muscles that support his knees, shoulders, and the outside of his ankles. Concerned that joint laxity may be affecting his performance, she checks his balance and notices significant deficits. She confirms that Charlie is experiencing benign hypermobility joint syndrome.
Over the next several weeks, Charlie works with his physical therapist to improve his condition. His treatments include:
- Exercises to build strength in the muscles surrounding the loose joints.
- Standing balance activities.
- Manual therapy to improve ankle mobility and reduce pain.
- An individualized home-exercise program to further develop strength and balance.
After 6 weeks of physical therapy, Charlie reports a significant reduction in his discomfort. He now is able to play soccer without pain and reports that his ankles feel more stable when he's running. At this week's game against a major rival team, Charlie "bends it like Beckham" and scores the winning goal!
This story highlights an individualized experience of BHJS. Your case may be different. Your physical therapist will tailor a treatment program to meet your specific needs.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat conditions, such as BHJS. However, when seeking a provider you may want to consider:
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
- A physical therapist who is well-versed in the treatment of BHJS or other joint disorders.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with painful conditions.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible. Keeping a journal highlighting when you experience pain will help the physical therapist identify the best way of approaching care.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence for the treatment of BHJS. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. Man Ther. 2007;12:298–309. Article Summary in PubMed.
Murray KJ. Hypermobility disorders in children and adolescents. Ped Rheumatol. 2006;20:329–351.
Lawrence A. Benign hypermobility syndrome. J Indian Rheumatol Assoc. 2005;13:150–155.