The Hypermobile “Flexy” Child
When our children are first born they present with much more hypermobile or “flexible” joints. Picture your child as a baby with their toes in their mouth and you quickly realise that’s a super big range of motion most adults could only dream of! As children get older a lot of this hypermoblie joint motion normalises. This is due to muscles, ligaments and tendons that grow in strength to tighten the range of motion parameters. For some kids however, the hypermobility remains.
It’s quite common for younger children between the age of 3 -6 years to have multiple joint hypermobility. Beyond this age range many children can continue to present with a few hypermobile joints throughout childhood, adolescence and adulthood.
As a Podiatrist, I see hypermobility a lot in the ankles, knees and hips of children presenting with lower limb fatigue or pain. This can be attributed to the higher level of work required of muscles and tendons supporting unstable and hypermobile joints during activity.
When hypermobility still appears excessive and within most joints between the age of 6-12 years old, specific testing is done to identify and rule out possible diagnosis responsible for multiple joint hypermobility syndrome. Podiatrists and Physiotherapists are skilled in assessing multiple joint hypermobility using a Testing system called the Beighton scale. The Beighton score aims to quantify the range of motion in the 5th finger, wrists, elbows, knees and back giving the practitioner an overall score out of 9.
Your practitioner may ask investigatory questions about your child’s :
Gastro-intestinal health,
General well being and fatigue,
Level of joint pain and emotional anxieties.
These are all normal questions when assessing a child with a high Beighton’s score test result.
Where a child is suspected of having Joint Hypermobility Syndrome they will also be referred to a Pediatrician to rule out further soft tissue systemic concerns such as Ehler’s Danlos Syndrome.
Having a child with Joint Hypermobility syndrome is quite different to a child with multiple joint hypermobility. Joint Hypermobility is specific to just the joints. It does NOT coincide with other systemic and emotional symptoms. It presents via fatigue or pain in muscles/tendons of some children whilst other kids can remain completely symptom free. This depends on the strength and capacity for endurance of their soft tissue structures around the joints effected.
How can Podiatry help a child with joint Hypermobility?
Orthotics
Children commonly present to a Podiatrist with a hypermobile foot and ankle. The Podiatrist will see the Range of Motion excessively move in all directions. Under weight bearing this foot can drop all the way down to the floor through the arch and appear quite flat. During sports and general activity the work required of leg and foot muscles increases.
Your child may complain of:
Tired legs
Pain specific to an area of the foot eg. heels or arches
You may also notice
Your child lags behind their peers in the school yard and finds running/walking awkward
They trip often
Orthotics can be placed into shoes to limit the end Range of Motion the joints of the foot and ankle can move within. Therefore, reducing load on surround tissues which have to work much harder to create changes to movement. Kidzoles specifically work at assisting these parameters.
Strengthening and stretching
As a child with joint hypermobility is assessed the Podiatrist will establish which muscles may be stronger, weaker, tighter or lax. If assessed early your Podiatrist can guide you towards sports that will work to strengthenig around these joints and benefit your child. My favourites are swimming, dancing and gymnastics. UUf you have a cilds pilates/yoga class availble near you that is a fabulous option.
In children not managed It is not uncommon to see multiple joint hypermobile kids with super tight hamstrings as they hit the 8-9 age range. As activity and sporting demands increase for these children the hamstring will tighten around a hypermobile pelvis to control hip mechanics. It’s important to work on strengthening the trunk, glutes and hamstrings, rather than allowing tightening of the hamstrings to control hip flexion and extension. As that will ultimate effect pelvic tilt and posture in your child.
A strengthening and stretching program should always be issued alongside any orthotic device with hypermobile kids. Here are my favourite 4 exercises for the lower limb.
Referrals
Your Podiatrist or Physiotherapist will be the gait way to provide more clarity around your child’s Hypermobility. Their sound knowledge in Medicine will ensure you are referred through the appropriate channels should your child require a team management approach.