Some interesting facts about Joint Hypermobility and Low Muscle Tone

A while ago we brought you a newsletter article on M-Sitting. A child that M-Sits is typically “double-jointed” or has hypermobile joints. Low muscle tone and joint hypermobility often co-exist, and joint hypermobility is often the underlying reason for low muscle tone. Hypermobility affects 15-20% of the population. Children who experience Hypermobility are at risk for developing movement-related issues, as well as being at greater risk for experiencing anxiety. This is relatively new information to most of us even though the research on the link between anxiety and hypermobility has been around for a while. In this newsletter, we will discuss both these issues and offer some suggestions of what can be done to assist children who present with hypermobility in an effort to reduce the effects of their hypermobility, and to consider how we might be able to better address any anxiety that is now understood to be a possible associated factor.

So how do we recognise children who are hypermobile? These children will often be inclined to M-Sit. They might also be able to bend their elbows and knees backwards. When pulling the thumb down towards the forearm, the thumb touches the forearm. The little finger can often be pulled backwards to a 90° position. They might also be able to place their hands flat on the floor while standing with their knees straight. Younger children are naturally more hypermobile than older children. The term “hypermobile” should not be confused with being “hyperactive”.

Children who are hypermobile and have lax connective tissue may have difficulties with bowel and bladder control as there may be increased compliance in the walls of the bladder and the bowel. Children who are hypermobile are three times more likely to experience joint pains in adolescence than their typical peers.

We can often also recognise these children as they have difficulty in maintaining postural control against gravity. For these children, keeping their heads, arms, and legs up against gravity while lying on their tummies in an “aeroplane” position is really hard for them. Similarly, rolling their bodies into a little ball and holding this positon with their heads held off the floor is super-strenuous for them. They tend to lean and to hang on things for support, and they are often seen propping their heads up in the hands. Most often, they prefer simply to lie on the floor rather than to adopt a nice upright posture.

As babies, they generally dislike being on their tummies and will make their objection to this position well known! As a result, they often do not develop strong neck and shoulder muscles as this very important tummy position is completely avoided. Since the development of crawling depends on strong trunk and shoulder muscles, they are then also likely to avoid crawling, preferring to bum-shuffle or to scoot around in some other way. All babies should therefore be given the opportunity to romp on a floor surface, on their tummies, sides and on their backs, rather than to be propped up or seated in various “seating devices". Such seats restrain movement and do not encourage the development of strong muscles. Babies, who spend time on floor surfaces, will be more likely to crawl.  Furthermore, babies who crawl for several months before they walk will likely develop more typical movement patterns, as well developing stronger muscles. For hypermobile babies, this is particularly important as stronger muscles around their joints will better support their joints.

Lax ligaments are generally more vulnerable to the effects of trauma and injury. It is important that we support children who are hypermobile by encouraging active movement and good development of gross motor skills, while ensuring that their joints are safeguarded from excessive stretching. Strong muscles around a joint ensure that the joint is held in an optimum position and is less likely to be damaged during active movement or exercise.

Avoid letting a child M-Sit as they will tend to further stretch their knee ligaments. This position is also not a good position to encourage as it hinders good rotation movements of the trunk, and gets in the way of the development of good movement patterns. Playing on gross motor playground equipment, such as trapezes and monkey bars is also to be encouraged. Always ensure that the child uses active hand, arm and shoulder muscles to pull himself up onto such equipment, as simply “hanging on” by clutching with hands will not prevent possible stretching and damage to the hypermobile joint tissues.

We can assist children who experience joint hypermobility by encouraging them to enjoy an active lifestyle by  avoiding too much sedentary play and avoiding long periods of time watching TV or playing with phones, tablets, and other screen devices. Since children who have low muscle tone and lax ligaments often tire more quickly than most other children, they may be inclined to avoid activities that would develop good gross motor skills. They often also experience tasks requiring endurance as being particularly difficult.

Some precautions to take with hypermobile children would include ensuring that the child is picked up and carried properly. Never pull a child up by their arms when picking them up, rather hold them more securely around their chests with your hands under their arms.  So often, we see young children being picked up by pulling them up by one arm to swing them up to be carried on their backs. We also see children being swung around playfully by holding onto their arms and swinging them around. Children just love to do this, but it can result in injury to children who have hypermobile joints. Pulling children up or picking them up habitually by their arms can contribute to increased joint laxity as the ligaments and connective tissues are continually stretched. The joints can also sublux (partially dislocate), or dislocate completely in such situations. Any sudden pulling of either arms or legs can result in injury in children who are double-jointed.

Hypermobility, Anxiety, and other related issues:

It is most interesting that being double-jointed has been linked with having a cautious temperament in children. There is also an increased risk for asthma, gastro-oesophageal reflux and Irritable bowel syndrome. Research has shown that adult patients diagnosed with anxiety are 16 times more likely to have lax ligaments than the normal population. Research has linked anxiety with Hypermobility. Other studies have found that people who have hypermobile joints also have larger amygdala. The amygdala are small paired structures in the brain involved in processing emotions, especially those related to fear. These children are therefore more likely to respond more readily to fear in everyday situations. They will also be more likely to be susceptible to fear. It has also been found that hypermobile people also display greater sensitivity to sad and angry scenes, and that this tendency is on account of them experiencing greater anxiety.

Since we know that hypermobile children may experience greater anxiety than most children, we should ensure that we do take particular cognisance of any anxiety or fears which the child may present. Validate feelings and where possible, reassure the child in a realistic and practical manner. Take the time to listen to children as they express their fears and anxieties without also focussing unduly on these negative emotions. In many instances the anxiety that a child experiences may also result in the child experiencing poor, sensory regulation. Take care to address this, remembering that early intervention and professional help can assist immensely in giving parents direction in assisting their child. The key to assisting the anxious, hypermobile child lies in offering both emotional and physical support to address the Hypermobility and the possible related emotional difficulties.