What it is?
Hypermobility can affect various joints in the body. Children with hypermobile joints have increased flexibility caused by laxity in the ligaments, resulting in joints extending beyond the normal range of movement. There is a wide spectrum of impact hypermobility has on everyday life.
Symptoms
For many hypermobility does not cause any issues or impact on everyday function. For some hypermobility has positive impacts. Some athletes, such as dancers and gymnasts, train hard to achieve hypermobility around certain joints. For many, flexibility and hypermobility is an asset e.g. for participation in sports including ballet, gymnastics, swimming, and cricket.
For others it has drawbacks and makes life a bit more difficult. Others may experience:
- Reduced strength in hands and fingers; difficulties using scissors, and completing self-care activities including buttons, shoelaces, use of cutlery
- Handwriting difficulties Children experience pain when writing or will struggle to keep up with written work. Handwriting can become less legible over time. Children may struggle to maintain or achieve pencil grasp or may hold the writing utensil tightly and press hard when writing, drawing, colouring
- Clumsy, falling frequently, difficulties with hopping /jumping
Management strategies
There are strategies and equipment available to support skills and help reduce pain and fatigue including:
Protective joint strategies
Pacing – gradually increasing the amount your child does in small planned steps, until they complete the whole activity, without getting too tired or experiencing too much pain.
- Let your child choose the activity; this means they will have genuine interest and will want to do more e.g. swimming, running or writing
- Time how long they can comfortably manage
- Practice this activity, preferably every day for the specified time period. This will help to increase their stamina level. E.g. 15 minutes per day for 1 week.
- During long activities allow short, regular rest breaks throughout before pain or tiredness occurs. You can do this by breaking between manageable parts of the activity.
- When the child is easily managing the full time without pain or discomfort, increase the time they spend doing the activity. For example 20 minutes. Practice this until it is easy for them to achieve.Small increases are better than large increases.
- Increase the time they spend doing the activity until they have reached the goal or level of participation that is acceptable for them.
Posture
Some children who have hypermobility can struggle to maintain a functional position when sitting, due to poor postural stability. Ensuring your child is sat with hips, knees and ankles at 90 degrees to provide a stabilise base of support, will help support posture. Equipment is available to also help improve and support sitting posture. Areas which may be impacted by hypermobility are handwriting, cutlery, scissor skills and dressing.
School tips
- Don’t walk for too long, take rest breaks when needed
- Try not overload bags making them heavy, use smaller, easier to carry bags. Leave bags in cloak room
- Use a rucksack on both shoulders, or a cross body bag to help spread weight across the body
- Allow rest breaks when completing physical activities in school and at after school clubs.
Symptoms which may impact everyday activities
Fatigue
This could be fatigue within joints or muscles due to working harder. General fatigue due to the body having to work harder to complete tasks.
Pain
Some pain and discomfort may be experienced when exercising, due to muscle fatigue. Pain may be felt in lower limb joints and within the hands and wrists when completing activities such as writing, this could be due to tight grasp of pencil or when pressure used when writing.
Strategies
- Completing activities regularly, followed by a break period, will help the reduce fatigue and pain. This is also known as the boom and bust approach.
- Good planning such as use of a diary, schedule and timetables can help with activity demands.
- Completing activities in the morning when your child has more energy.
- Being active physically can help to maintain muscle strength, low impact activities such as yoga/swimming/cycling/gym can help.
- Regular breaks and rest periods are important, especially when completing repetitive activities.
- A healthy sleep pattern and a good diet is important for muscle rest and recovery.