Introduction: Joint Hypermobility Syndrome (JHS) is a heritable disorder of connective tissue characterised by increased laxity of the joints associated with chronic and widespread arthralgia, along with many other extra-articular symptoms1. The hypermobility cannot be changed; instead treatment focuses on the management and improvement of symptoms and expectations of the patient2. Physiotherapy is the mainstay intervention, although there is no consensus, and little evidence, to say that a particular type of physiotherapy is effective3. Part of the problem is that it is unknown how the symptoms and factors of JHS interplay to affect movement and pain. This is important to understand as without understanding the deficits it is not possible to target treatment. Comparing how people with JHS move to people who are hypermobile and do not have symptoms (GJH), or to people with normal flexibility (NF) may highlight impairments and differences in movement, which could then be targeted with physiotherapy.
Aim: This thesis investigated movement of people with JHS, with the aim to provide information about how people with JHS move during activities of daily living. This information may help clinicians to target differences in movement with the physical therapies, and further our knowledge of this under-recognised condition.
Methods: A systematic review was conducted; research investigating kinematics and/or kinetics of hypermobile movement were reviewed. To progress to measuring movement in JHS, a reliability study was performed; 14 GJH and 13 normal flexibility participants completed three sessions of 3D gait analysis. The main study used 3D movement analysis and EMG to compare 23 JHS participants, 23 GJH participants, and 22 NF participants. Participants completed perturbation, prolonged standing, gait and stair-climbing activities.
Results: The systematic review identified a lack of investigation into any activity other than gait, and in gait there was no consensus as to how people with JHS move differently to NF/GJH. There was no difference in the reliability of 3D movement analysis in GJH people compared to NF people. The main study found differences in movement parameters in each of the tasks. People with JHS had different reactions to perturbations, different behaviour during prolonged standing, and showed impairments in gait and stair climbing. Many of the differences between JHS and NF/GJH were in ankle movement parameters.
Conclusion: Movement during the activities investigated differs between JHS and GJH/NF groups, whereas there is no difference in movement between GJH and NF groups. Since there was only one significant difference between GJH and NF across all tasks, hypermobility per se does not cause the change in movement and therefore pain. It is not clear whether the differences in movement of JHS cause the pain, or are due to pain avoidance. Either way, the results provide guidance to physiotherapists to normalise the movement in treatment.