Joint Hypermobility: Symptoms, the Beighton Score and Exercises

9 pointsThe total score of the Beighton examination, which assesses joint flexibility

4 or moreThe score usually regarded as hypermobile in adults

30–55%Reported rate among adults attending physiotherapy with musculoskeletal problems

Strength and balanceThe basis of treatment: supporting the joints with muscle

When is it a problem?

Frequent tiredness, even after rest.
Ongoing joint or muscle pain and stiffness.
Repeated sprains and strains.
Joints that dislocate or “pop out”.
Poor balance and coordination.
Thin, stretchy skin; bladder or bowel problems.

What causes it?

Because the collagen that strengthens the supporting ligaments is different, the ligaments are loose and stretchy.
It can run in families and cannot be prevented.
It is seen as part of a spectrum of hypermobility disorders that also includes Ehlers-Danlos syndrome.
It mostly affects children and young people; symptoms can ease with age.

What helps?

Strengthen

Inactivity can make symptoms worse. You can start slowly with low-impact exercise such as swimming or cycling and build up muscle strength and fitness.

Do not overdo it

Avoid stretching your joints to their limit and repeating the same movement for a long time. Take care not to lock your elbows and knees backwards.

Pace yourself

Take regular breaks through the day. Rather than doing everything on a good day and crashing the next, try spreading tasks across the day.

Support

Keeping a healthy weight, supportive shoes and, if needed, insoles recommended by a podiatrist reduce the load on the joints. A warm bath or hot water bottle can ease stiffness.

Exercises at home

Six exercises to protect the joints

Start with few repetitions, slowly and with control; do the movements in the middle of the joint’s range, not pushing to the end. If pain or tiredness is clearly worse the next day, reduce the amount, then build up again slowly.

Standing on one leg

Stand upright in front of the worktop, holding on lightly with one hand if needed. Lift one foot; keep the standing knee slightly bent rather than locked back. As it gets easier, try without holding on or with your eyes closed. It improves joint position sense and balance.

30 seconds, 3 times each foot

Bridge

Lie on your back with your knees bent and feet on the floor. Squeeze your buttocks to lift your hips, making a straight line from your shoulders to your knees; do not arch your lower back too much. Hold for 3–5 seconds and lower slowly.

10–15 reps, 2–3 sets

Bird dog

Kneel on your hands and knees; keep your elbows slightly bent rather than locked. Stretch one arm forward and the opposite leg back; do not let your lower back sag or your hips rotate. Hold for 5 seconds and switch.

8–10 reps on each side

Half squat against the wall

Stand with your back against a wall and your feet half a step in front of it. Keep your knees pointing the same way as your toes, not caving in. Slowly squat a little and come back up; do not lock your knees back as you straighten.

10 reps, 2–3 sets

Shoulder blade squeeze

Stand or sit upright. Without lifting your shoulders towards your ears, draw your shoulder blades back and slightly down towards each other. Hold for 5 seconds and relax. It helps the muscles around the shoulder support the joint.

10–15 reps, twice a day

Brisk walking

Low-impact activity

Start with activities that are gentle on the joints, such as walking, swimming and cycling. Increase the time slowly and build regular breaks into your day; try not to overdo it on a good day and crash the next.

Start with 10 minutes and add a few minutes each week

Frequently asked questions

Is being flexible a disease?

No. Many people with flexible joints have no problems at all. But in some people, flexibility comes with pain, frequent sprains or dislocations and tiredness; in that case it is called joint hypermobility syndrome or hypermobility spectrum disorder.

What is the Beighton score?

It is a simple 9-point examination doctors use to assess joint flexibility: bending the little finger back more than 90 degrees, touching the thumb to the forearm, the elbow and the knee bending backwards more than 10 degrees (one point each for right and left), and placing the palms flat on the floor with the knees straight (one point). In adults, a score of 4 or more is usually regarded as hypermobile. It is not a self-diagnosis test; the diagnosis is made by a doctor.

Should I do stretching exercises?

If your joints already move too far, stretches that push them to their limit are generally not recommended. The aim is not to increase flexibility but to strengthen and protect the joints with the muscles around them. It is also recommended to avoid repeating the same movement for a long time.

Has exercise been proven to help?

The evidence is limited but encouraging. In the few studies available, strength, balance and endurance exercise reduced pain and improved strength; but it is not yet known which type of exercise is best. That is why programmes are tailored to the person and increased gradually.

For frequent dislocations and widespread pain, you can look at the shoulder dislocation, ankle sprain and fibromyalgia guides.

When should you see a doctor?

If you suspect joint hypermobility in yourself or your child and have pain, tiredness or frequent sprains
If your joints dislocate often
If the pain is severe and limits your daily life
If you feel dizzy, have palpitations or feel faint when you stand up

Sources

NHS. Joint hypermobility syndrome. Page last reviewed 30 August 2023.
Engelbert RHH, Juul-Kristensen B, Pacey V, et al. The evidence-based rationale for physical therapy treatment of children, adolescents and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. American Journal of Medical Genetics Part C. 2017.