Hypermobility in performing arts
Hypermobility refers to the ability of a joint to move beyond its normal range of motion. This can be due to various factors, including genetics, laxity of ligaments and joint capsules, or underlying medical conditions. While some degree of joint flexibility is normal and desirable, hypermobility can sometimes lead to instability, pain, and an increased risk of injury.
Hypermobility is often categorized into two main types:
Benign Joint Hypermobility:
This type of hypermobility is not associated with any underlying medical condition and is relatively common. People with benign joint hypermobility tend to have joints that are more flexible than average but may not experience any negative symptoms or consequences as a result.
Hypermobility Syndrome (HMS):
This refers to a more significant degree of hypermobility that is associated with symptoms such as joint pain, instability, and increased risk of injury. In these cases, hypermobility may be accompanied by connective tissue abnormalities that affect the skin, blood vessels, and other organs.
Here are some different types of HMS:
Generalized Hypermobility: This is the most common form of HMS, characterized by excessive joint flexibility affecting multiple joints throughout the body. Individuals with generalized hypermobility often exhibit a high Beighton score (scoring 4 or more out of 9 on the Beighton scale) and may experience symptoms such as joint pain, instability, and muscle weakness.
Localized Hypermobility: In some cases, hypermobility may be limited to specific joints or regions of the body rather than being generalized. For example, an individual may have hypermobile joints in the hands and fingers but normal joint mobility elsewhere. Localized hypermobility can still cause symptoms and may require targeted management strategies.
Hypermobility Spectrum Disorders (HSD): The term “Hypermobility Spectrum Disorders” is used to describe a continuum of hypermobility-related conditions ranging from asymptomatic hypermobility to symptomatic hypermobility without meeting the criteria for a specific connective tissue disorder like Ehlers-Danlos syndrome (EDS). HSD acknowledges the variability in symptom severity and presentation among individuals with hypermobility.
Secondary Hypermobility: In some cases, joint hypermobility may be secondary to another underlying condition or factor. For example, hypermobility may occur as a result of ligament laxity following injury, as a side effect of certain medications, or as a feature of other genetic or systemic disorders.
Hypermobile Ehlers-Danlos Syndrome (hEDS): While technically a subtype of Ehlers-Danlos syndrome (EDS), hEDS is closely related to HMS and shares many features, including joint hypermobility, musculoskeletal pain, and soft tissue fragility. Individuals with hEDS may exhibit additional symptoms such as skin hyperextensibility, easy bruising, and gastrointestinal issues.
Marfan Syndrome: Marfan syndrome is a genetic connective tissue disorder characterized by aortic enlargement, skeletal abnormalities, and other systemic features. Joint hypermobility is common in Marfan syndrome and may contribute to musculoskeletal symptoms such as joint pain and instability.
Symptoms of hypermobility can vary widely from person to person but may include:
- Joint pain or stiffness, especially after physical activity
- Joint instability or frequent dislocations or subluxations • Chronic fatigue
- Brain fog
- Reduced spatial awareness – poor balance/ co-ordination
- Sensitivities
- Gut issues
- Bladder/bowel problems
- Muscle weakness or joint stiffness
- Recurrent sprains or strains
- Chronic pain in the muscles or soft tissues surrounding the hypermobile joints
- Thin, stretchy skin
- Easily bruised
- Slow wound healing
Diagnosis of hypermobility typically involves a physical examination to assess joint flexibility and stability, along with a review
of medical history and any associated symptoms. In some cases, additional tests such as imaging studies or genetic testing may be ordered to rule out underlying conditions or complications.
Management of hypermobility depends on the severity of symptoms and their impact on daily life. Treatment may include:
- Physical therapy to strengthen muscles around hypermobile joints and improve stability and joint proprioception
- Joint protection techniques to minimize the risk of injury
- Pain management strategies such as medication, heat or cold therapy, and lifestyle modifications
- Orthotic devices or supportive bracing to provide stability and reduce strain on hypermobile joints
- Education about joint protection, ergonomics, and lifestyle modifications to manage symptoms and prevent complications
In more severe cases or when hypermobility is associated with an underlying medical condition, a multidisciplinary approach involving rheumatologists, orthopaedic specialists, and other healthcare professionals may be necessary to address the full range of symptoms and complications.
Why is this relevant to Performing Arts Medicine?
Hypermobility is more common in the Asian population and is more prevalent in women than men. It is also common in
gymnasts, athletes, dancers and musicians.
Research done on various performing arts disciplines indicates the prevalence of hypermobility with the following statistics:
- In studies of elite ballet populations, prevalence was 74-95% in adolescents, 81% in adult pre-professionals, and 82-95% in adult professionals.
- In professional Jazz dancers the prevalence rate was found to be 65%
- Adult pre-professional and professional circus artists showed a prevalence of 41% and 48%
- Prevalence of 5-34% in instrumentalists
- No defined prevalence rates in singers has been published in the literature thus far, however, there is research to show how hypermobility can affect the voice.
Given the high incidence of hypermobility in the performing arts population and the large variation in symptoms between
each individual, it is important to identify the effects hypermobility has so as to effectively form strategies to best manage it
and increase the longevity of one’s career.