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Hypermobility

  • 5-11 Years
  • 11-19 Years
  • SEND
  • Child development and growing up
  • Moving and being active
boy with hypermobility leaning on plinthe and over-extending his elbow

Hypermobility is when someone has very flexible joints. It is also known as 'loose joints', being 'double jointed' or 'flexible'. It is caused by loose ligaments. This means that the joints to extend beyond the typical range.

It affects children and adults. Hypermobility can affect people in different ways. It is very common in children, it can affect between 7% to 36% of all children.

Signs of hypermobility

A lot of children and young people are hypermobile and flexible. Hypermobility can affect people in different ways. Some children and young people may not notice that they are hypermobile but others may find it impacts their day-to-day life.

In children and young people hypermobility can look like:

Being very flexible - This can be an advantage if your child or young person wants to do sports like ballet or gymnastics. 

Weak hands and finger strength - Your child or young person may find it harder to use scissors and cutlery. They may also find doing up buttons and tying shoelaces harder. 

Difficulty with handwriting - Handwriting can be harder for children or young people with hypermobility. It can be tiring and painful for them to write for long periods of time. They may also have difficulties with holding the pen or pencil correctly or pressing too hard when writing.

Being clumsy or uncoordinated - A child or young person with hypermobility may fall over or lose their balance more often. They may also find it harder to hop or jump. This can lead to them being less confident. They may not want to try new things.

Getting tired easily - A child or young person with hypermobility has to work harder in everyday activities. It takes more effort for them to hold pens and pencils and keep a good seated position. The hypermobility also makes it harder for them to focus.

Discomfort or pain - It's common for hypermobile children and young people to have mild pain or discomfort. The pain will often be in their ankles, knees, hips, hands or wrists. They may feel pain when writing or exercising. This is because their muscles are tired also known as muscle fatigue.

Hypermobility and hypermobility syndromes

There are differences between being hypermobile and having an inherited genetic hypermobility syndrome. Most children are hypermobile. The management of hypermobility and a hypermobility syndrome are very similar.

Hypermobility is when some joints are more flexible. The joints move more than is expected or normal. 

Hypermobility syndrome is someone is hypermobile as well as other symptoms such as joint pain, joint instability and fatigue. 

Boom and bust cycles

Your child or young person can enter a 'boom and bust' activity cycle. This is when they may do a lot on one day, but then need to rest the next day.

If this cycle continues, your child or young person's energy will decrease over time. This will mean they will be able to do fewer activities. 


Line graph. There are 2 lines on the graph, a dashed line and a solid line. The vertical axis is labelled 'Amount of activity', the horizontal axis is labelled 'Time'. The dashed line is a wave form going up and down. The peaks of the dashed lines are labelled 'good day' the troughs are labelled 'bad day'. The dashed line is steadily declining as time passes. The solid line is an average of the dashed line. The solid line shows the downward trend in activity levels as time passes.

Finding a baseline

A baseline is the lowest level of activity that your child or young person can do every day, including the bad days. Baseline activities include:

  • getting up
  • getting dressed
  • attending school for a one hour lesson

It's okay for your child or young person's baseline to be low at the start. Try to encourage your child or young person to practice everyday. Over time they will slowly be able to do more. 

Helping with activity management 

Some tips you can use with your child or young person to help them manage their activity levels. 

  • Establish a routine
  • Record their activity until they are completely aware of what they can do as a baseline
  • Encourage them to keep their activity levels consistent each day
  • Don't push them to do more on a good day
  • Encourage them to practice every day to avoid the vicious cycle
  • Encourage them to do something they enjoy every day

With time your child or young person may slowly progress from their baseline and may be able to do more.

Pacing

Pacing is a way to slowly increase the amount of an activity your child or young person does. This is done in small steps to increase the amount of time on the activity. 

man kneeling down instructing child holding football

Remember, small steps are better than large steps. Larger steps can trigger the boom and bust cycle. This can make your child or young person feel more fatigued and more pain.

How to pace physical activities:

  1. Pick an activity your child or young person wants to do such as swimming, playing or writing.
  2. Find the minimum amount of time they can do the activity without pain or fatigue. Make sure to consider how long they can do it on a bad day too. 
  3. Do the activity regularly. Ideally this should be everyday for a specific amount of time that is comfortable for them. For example, 30 minutes a day (10 minute session 3 times a day) every day for 1 week, 
    • For some activity like swimming, it may not be possible to do it everyday.
    • Remember to think about your child or young person's pain and fatigue. Adjust how long they do the activity to meet your child or young person's needs. 
  4. Let your child or young person take regular short breaks throughout the activity. These breaks should be before they feel tired or in pain. You can do this by breaking up the activity into smaller tasks and taking a short rest between each task.
  5. You can increase the length of the activity when your child or young person is consistently finding the amount of time doing an activity easy to achieve. For example you move from 30 minutes a day (10 minute session 3 times a day) to 40 minutes a day (10 minute session 4 times a day). 

You can keep upping the time they spend doing the activity until they have reached their goal. This could be the amount of time they spend doing their activity or how much they participate in the activity.

Strategies and equipment to help reduce pain and tiredness


Last reviewed: 1 November, 2024

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