A new British study suggests that adolescents with joint hypermobility are at a greater risk for developing certain types of musculoskeletal pain later in life, especially if they are obese.
Joint hypermobility at age 14, sometimes commonly referred to as “double jointedness”, led to increased musculoskeletal pain four years later in the ankle and foot, the knees, and the shoulders.
Even more interesting, the likelihood of musculoskeletal pain was significantly greater if the teens were considered obese. Researchers for Arthritis & Rheumatism found that double-jointed teens were 10 times more likely to suffer musculoskeletal pain if they were considered clinically obese.
For the study, British researchers enrolled over 14,000 pregnant women during the early 90’s, and asked that their children be examined for hypermobility around the age of 14. The children were then asked to report on their pain history when they were 18.
To determine if a child was hypermobile, they needed to score a 6 or higher on the nine-point Beighton scale, which measures mobility.
According to data, girls were five times more likely than boys to exhibit double jointedness. Of the participants who were considered hypermobile, 45% of them reported experiencing pain for at least one day in the past month. Similarly, girls were more likely to experience pain (47.5%) than boys (41.3%). The pain most commonly occurred at the ankle/foot, knee, shoulder and spine.
Regardless of sex, when compared to pain data for adolescents without hypermobility, researchers found that double jointed teens were almost twice as likely to suffer from musculoskeletal pain.
In addition, teens with hypermobility suffer from more intense pain. Researchers asked both groups to rate the pain on a scale of 1 to 10, with 10 indicating immense pain. Double jointed teens reported average scores of 5.92 for their worst pain in the past 6 months, while non-hypermobile teens reported a score of 5.41.
Both groups reported that the most immense pain was felt in their foot/ankle region, as their pain scores were 8.17 for hypermobile teens, and 6.98 for non-hypermobile teens.
“Certain joints may be more susceptible such as the shoulder (due to lack of inherent stability) or knee and ankle/foot (due to high forces exerted by weight bearing),” the researchers concluded.
Researchers suggested that obese children were at an increased risk to suffer pain because more weight was being placed on their knee and ankle joints.
Dr. Silverman comments
This is a very interesting study.
Hypermobility is a condition in which joints are loose. Some people refer to this condition as “double-jointedness.” They’re not really double-jointed, but their ligaments are loose and can stretch more than normal. Having increased ability to move your joints can have significant advantages during some athletics such as dance, gymnastics and skating. However, there is a healthy balance between excessive laxity and flexibility. Having hypermobility leads to problems.
In my practice, I see many patients with ankle ligament and hindfoot instability. These patients will roll their ankle on uneven ground, feel pain in the ankle when walking on many different types of surfaces, and develop arthritis and tendon tears over extended period of time. During an examination, I always check for signs of hypermobility. Excessive elbow or knee extensions are good ways to identify the condition, but my favorite and most reliable test is wrist flexibility. If your thumb can touch your forearm, you have hypermobility.
It’s important to identify patients with hypermobility prior to treating them. Surgical treatments have higher rates of failure if the hypermobility is not identified. Nonsurgical treatment, otherwise known as symptom modification, is also likely to fail. I make modifications to my surgical plan for many circumstances, including the discovery of hypermobility. For example, I will perform different types of bunion corrections, and I will be more likely to perform surgical arthrodesis for deformity corrections.
What is concerning about this study is that the most immense pain was in the foot/ankle region. This means that treatment of foot and ankle pain is poor in comparison to treatment of other joints in this patient population.
Related source: MedPage Today
