More often than we probably imagine, children develop with several joints that are more flexible than others. This is usually called ‘Hypermobility’, and it happens when the connective tissue, which is an integral part of the joint, is more easily stretched than usual. Hypermobility is not always a problem, in fact it is almost necessary for some athletes, gymnasts and dancers, particularly ballet dancers. Children’s joints almost always have a greater range of movement than that we would expect to see in an adult, and this flexibility usually limits with age. Interestingly, girls are usually more prone to Hypermobility than boys too. So if Hypermobility is normal, and even seen as a advantage in some fields, why is it an issue, and why are we discussing it here?
Well, a large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.
Hypermobility is often easiest to identify visually in the knee, as increased ligament flexibility in the knee, allows it to ‘hyperextend’, and the child, when stood, has their knee behind the pelvis, if this makes sense. Where this is present, there is an increased likelihood of flat feet (which I wrote about last month), and ankles more susceptible to damage due to the lack of support that hyperextension creates. Kids with Hypermobility, also often have some tighter muscles, and whilst this sounds contradictory, it can often be a product of posture, due to the flexible joints themselves. Take for example, if children sit on a floor with their legs wide apart, sometimes with their spine flexed, then they will experience stiffness and find it difficult to sit with their legs outstretched.
There are a couple of more serious conditions where Hypermobility is present, but this alone is not a specific indicator of Ehlers Danlos Syndrome or Marfan’s Syndrome, and parents should not automatically assume the worst case scenario.
So, how can an Orthotist help a child with Hypermobility? The simple answer is by not attempting to ‘over-brace’ the child. Hypermobile ankles or Hyperextended knees for example, can often be best treated starting at the foot, and this would be with an insole, or sometimes even a heel lift. The key is not to automatically reach for the brace that would hold the joint in a corrected position, as this may then hinder muscle development, which could rectify the problem by itself. Allowing the muscles to develop, will often bring about reduced flexibility in the affected areas, but if a brace is used, then the muscles might not do their job correctly. Of course, in cases where the flexibility remains, and a Functional Foot Orthosis is not providing the stability required, then of course options such as braces, or boots are available, but the best person to give this advice is your Orthotist.
If you think your child is a little too ‘bendy’ then, it would be a good idea to make an appointment to see an Orthotist sooner rather than later, because whilst it might be the muscles that are developing to tighten the joint, the pain will need to be managed, and the foot and ankle will be held in a corrected position, to allow the muscles to develop as they should. After all, this is what your Orthotist is there for.