Hypermobility (double jointedness) is surprisingly common in the adult population. 10-20% of the adult population in fact. Which as a Chiropractor, I find it concerning that Hypermobility is not routinely screened for during most injury assessments. Why is it always worth testing for? Well when a patient is hypermobile, they experience pain and stiffness in a very different way.
Let me explain...
Here is how the NHS defines Hypermobility - "Joint hypermobility syndrome is where you get pain and stiffness from having very flexible joints".
Read that definition again carefully… why would a person who has ‘very flexible joints’ get ‘stiffness’?
The answer is that the body overcompensates for the excess joint flexibility by telling the muscles they need to secure the joint more, by tightening.
The tightness is particularly worse if the patient’s muscles are ‘weak’ throughout their full (bigger than 'normal') range of motion as the body overcompensates even more.
There are many different types of hypermobility and severity can vary a lot.
One consistent piece of advice I give all my clients that have signs of hypermobility is to regularly go swimming, aqua aerobics or to Hydrotherapy. This allows the joints to get a good work out through their wide range of motion. Positional Isometrics are the go to exercises to use at home, working through the passive range of motion.
So, why is their experience of pain sometimes different? Particularly with Sciatica.
This is something I am not exactly sure about. My theory is that because there is excess movement with the joints of the spine (excess passive range of motion), this allows more room for the nerves to function. Therefore, if a disc has 'slipped' and the body has reacted with inflammation, rather than the nerve getting 'pinched' or excessively irritated by the swelling, the extra space available to the nerve is greater than your average person and the patient is able to cope better.
This is not to say they don't experience symptoms, they do, they are just not as severe as what you would expect based on their presenting history.
The Beighton Scale has been developed as part of an assessment protocol to help identify individuals that have hypermobility.
A total of 9 points are collated from 5 maneuvers comprising:
Passive dorsiflexion of the little fingers beyond 90° - 1 point for each hand
Passive apposition of the thumbs to the flexor aspects of the forearm - 1 point for each thumb
Hyperextension of the elbows beyond 10° - 1 point for each elbow
Hyperextension of the knee beyond 10° - 1 point for each knee
Forward flexion of the trunk with knees fully extended so that the palms of the hands rest flat on the floor – 1 point
Scoring for each of these tests is as follows: ≥6 - Pre-pubertal children and adolescents
≥5 - Pubertal Men and Women up to the age of 50
≥4 - Pubertal men and women over the age of 50
The 5-point Questionnaire – an answer in the affirmative to a 2 or more of the questions has 85% sensitivity and specificity (tested internationally and in different languages)
Can you now (or could you ever) place your hands flat on the floor without bending your knees?
Can you now (or could you ever) bend your thumb to touch your forearm?
As a child did you amuse your friends by contorting your body into strange shapes or could you do the splits?
As a child or teenager did your shoulder or kneecap dislocate on more than one occasion?
Do you consider yourself double-jointed?
If musculoskeletal clinicians want to do one thing to start understanding why their patient's lower back pain is not improving. Start using the Beighton scale more often and it might explain why. Remember 10-20% of the adult population are hypermobile - If you're not looking for it, you won't find it.