What clinicians use is the Beighton Scoring System, a nine-point screening tool to measure joint hypermobility, said Lim. “A score of four or more out of nine may indicate hypermobility, although a full clinical assessment is recommended to confirm,” she said. And the “tests” are very similar to the 5PQ:
- Being able to bend your pinky back beyond 90 degrees.
- Bending your thumb to touch your forearm.
- Being able to hyperextend your elbows beyond 10 degrees.
- Being able to hyperextend your knees beyond 10 degrees.
- Being able to bend forward and placing your palms flat on the floor with the knees straight.
WHAT CAUSES HYPERMOBILITY? HOW IS IT DIFFERENT FROM FLEXIBILITY?
“The underlying cause of hypermobility is thought, in part, to be genetic factors,” said Dr Oey. However, hypermobility comes in a “spectrum” and “often cannot be ascribed to any particular gene”. “Most of the time, we cannot know for sure what is the cause of hypermobile joints,” he said.
As for the difference between hypermobility and flexibility, UK osteopath Stephen Makinde wrote on Perfect Balance Clinic that the latter is a broad term referring to the available range of movement in your body. “(Flexibility) is determined by the level of give in your muscles, fascia and nervous system. We are all born with a high level of flexibility and this naturally declines as we age.”
Makinde wrote that your daily flexibility can be affected by activity levels, temperature and hormonal changes. But “hypermobility remains relatively consistent with only minor age-related changes”.
Hypermobility is also more about your joints and ligaments rather than your muscles. “Hypermobility occurs when the connective tissues that support your joints, such as ligaments, are more elastic than usual,” said Lim. “This allows the joint to stretch further, often without pain.”
According to Lim, hypermobility can affect a few joints (localised hypermobility) or throughout the body (generalised hypermobility). “Joint hypermobility tends to be more common in women than men, and also within the younger population as hypermobility decreases as you get older,” said Lim.
CAN YOU BECOME HYPERMOBILE FROM STRETCHING MORE?
Not exactly, said Dr Oey. “You can increase flexibility with stretching but true hypermobility is usually genetic – you’re born with looser collagen in your ligaments.” Lim agreed: “It is linked to how your connective tissues are formed, particularly the collagen.”
In fact, those who already have some joint looseness can push their joints into unsafe zones, which may lead to instability or injuries, if they over-stretch, warned Dr Oey. “Think of a rubber band left stretched out too long.”
He added that “yoga or gymnastics won’t change your genetics but they can push your joints into unstable ranges if you’re not strengthening alongside stretching”. “That’s why ‘flexible but weak’ often leads to injuries,” he said.
WHEN DOES HYPERMOBILITY BECOME A PROBLEM?
For some people, hypermobility can lead to pain or injuries, according to Dr Oey. In his practice, he often sees such issues in people who practise yoga, dance or sports where flexibility is overemphasised.
Lim also sees hypermobile patients sometimes, “although it is often not the main reason why they are referred”. “Many of them only discover they are hypermobile after an injury or persistent joint issue,” she said.
