Joint Hypermobility syndrome (JHS) in children
Not all kids that have hypermobility have the syndrome. Between 10 and 50% kids are hypermobile but far fewer have associated symptoms related to the syndrome.
Generalised joint hypermobility:
Connective tissue forms joint capsule and ligaments which hold joints together. Connective tissue is stiff but pliable and allows some movement in joints.
In joint hypermobility connective tissue has more give than usual and so there is more movement and less stability in the joint.
There are often tight muscles.
Joint hypermobility syndrome:
Common symptoms are fatigue in joints and mm, abdominal pains and headaches.
Pain, which is worse if the strength and fitness of the mm is poor. Pain is most prominent after activity, and at the end of the day and at night.
Rest can increase symptoms.
Using crutches, and wheelchairs can be detrimental. The muscles of kids with JHS get weaker more quickly and take longer to strengthen. It is therefore important to keep the muscles as strong as possible by using them as much as possible.
The body’s response to pain changes as it grows and for adolescents with JHS pain this can become out of control and dominate everything. Combined physical and psychological care is needed.
Constipation is common so lots of water, physical activity and possibly laxatives are important.
Dislocations are rare.
It is common to have clicky joints and this is the body’s solution to reducing pain therefore allow it to cont.
JHS kids are often fidgety and it is important to allow this as it keeps the joints moving
Often children with JHS have a cautious temperament which predisposes them to an active fear system. Areas in brain that normally process certain things to be aware of e.g. heat, pressure, but new sensations can be interpreted as life threatening or dangerous. This in turn creates a fear response and may activate the body’s fight and flight response. These children may dislike any changes in their life, and may react strongly to strangers and may not like taking on anything that involves hard work e.g. learning to crawl and walk, exercise as these create a strong sensation of effort within the body.
- A progressive resisted specific exercise programme has had a significant positive response.
- Progress the exercises from 5 repetitions per exercise to 30 then add 2.5kg weight. This may lead to a reduction in pain.
- All sport is possible as long as the child is strong enough for the activity.
- Psychological management is of benefit and should include a relaxed environment and music.
- The child does not respond to analgesia so it is of no benefit to give this.