Hypermobility in Children: What Families Should Know

What is hypermobility?

Hypermobility refers to having more movement than expected at one or more joints. This increased range of motion often relates to differences in connective tissue, including ligaments, which connect and stabilize bones. Hypermobility exists on a spectrum. Some individuals may have increased movement at only a few joints, while others may have generalized joint hypermobility involving multiple areas of the body. Generalized joint hypermobility can occur on its own or as part of a broader connective tissue or genetic condition, such as Ehlers-Danlos syndromes, Marfan syndrome, or other genetic conditions.

Joint hypermobility is common in children, and children generally have greater joint mobility than adults. Joint laxity can change as children grow and develop, typically reducing between ages 9-12. Hypermobility is also more commonly observed in girls, and changes associated with growth and puberty can influence joint mobility.

What Might Hypermobile Joints Look Like at Different Ages?

• Infancy: Very flexible joints, wide leg positions, or joints that seem to move beyond a typical range during tummy time, sitting, or crawling.
• Preschooler: Frequent “W” sitting, unusual bendy positions, or tiring easily during running and playground activities.
• Child: Flexibility that stands out compared with peers, knees or elbows that appear to bend backward, or aches after physical activity.
• Teenager: Recurrent joint aches, clicking, instability, or frequent ankle/knee issues, especially with sports or prolonged activity.

Importantly, hypermobility does not necessarily mean something is wrong. Many children with joint hypermobility have no pain, limitations, or other symptoms and do not require treatment. This is sometimes referred to as asymptomatic joint hypermobility. For some individuals, however, joint hypermobility is associated with symptoms such as joint pain, instability, fatigue, recurrent injuries, subluxations, or dislocations. When these symptoms occur alongside generalized joint hypermobility and other clinical features, an individual may fall within the spectrum of hypermobility spectrum disorders (HSD).

HSD can affect people differently. Some individuals may primarily experience joint-related symptoms, while others may experience additional concerns such as fatigue, headaches, or gastrointestinal symptoms. It is important to remember that no two individuals with hypermobility will experience it in the exact same way.

How is joint hypermobility assessed?

Joint hypermobility can be assessed by a healthcare professional, including a physiotherapist or physician.

In addition to assessing individual joint range of motion, one commonly used screening tool for generalized joint hypermobility is the Beighton Score. The Beighton Score assesses movement at several joints and provides a score out of 9. For children who have not yet reached puberty, a score of 6/9 or higher is commonly used as an indicator of generalized joint hypermobility.

It is important to understand that the Beighton Score does not assess every joint in the body. A child may have increased mobility in other joints even if it is not reflected in their Beighton Score. The score is therefore a screening measure and should be considered alongside an individual’s symptoms, medical history, physical examination, and other clinical findings. If a healthcare provider suspects an underlying genetic or systemic condition, additional medical assessment and diagnostic testing may be required.

How can hypermobility impact gross motor development?

For some babies and young children, increased joint mobility can make certain gross motor skills more challenging. Skills such as sitting, crawling, standing, and walking require children to develop strength, coordination, balance, and body awareness. When joints are more mobile, a child may need to use additional muscular effort to stabilize their body and maintain a position.

As a result, some hypermobile infants may become fatigued more quickly or take longer to develop certain motor skills. However, hypermobility does not automatically mean that a child will experience developmental delays. Every child’s development is unique, and many hypermobile children achieve their milestones without significant difficulty.

How can physiotherapy help?

Physiotherapy can play an important role in helping children and families understand and manage symptoms associated with hypermobility.

Depending on the child’s individual needs, physiotherapy may include:

• Education: Helping children and families understand hypermobility and how it may affect movement and activity.
• Self-management strategies: Teaching strategies to incorporate into daily routines to help manage symptoms.
• Activity modification: Finding ways to participate in school, sports, and recreational activities while managing symptoms and avoiding unnecessary overload.
• Fatigue management: Identifying factors that contribute to fatigue and developing strategies to balance activity and rest.
• Equipment recommendations: Determining whether supportive equipment or modifications may improve participation and function.
• Pain management: Providing strategies to help manage musculoskeletal pain and improve participation in daily activities.
• Strengthening: Developing individualized strengthening programs to improve muscular support and joint stability.
• Proprioceptive exercises: Using activities that help improve body awareness and a person’s ability to sense joint position and movement.
• Movement and motor skill development: Supporting children in developing strength, coordination, balance, and confidence with movement.

The goal of physiotherapy is not necessarily to “correct” hypermobility. Instead, treatment focuses on helping children build strength, improve control and stability, manage symptoms, and participate in activities that matter to them.

How Does Pelvic Floor Physiotherapy Fit In?

Hypermobility can sometimes affect the pelvic floor as well. Some children and teens with hypermobility may experience bladder or bowel concerns, pelvic discomfort, or difficulty coordinating their pelvic floor muscles. A pelvic floor physiotherapist can assess how the pelvic floor is working alongside the rest of the body and provide age-appropriate strategies to support strength, coordination, and function.

When should you seek help?

Hypermobility on its own is not necessarily a cause for concern. However, it may be helpful to speak with a healthcare professional if your child is experiencing:

• Persistent or recurrent joint pain
• Frequent sprains or injuries
• Recurrent subluxations or dislocations
• Significant fatigue related to physical activity
• Difficulty keeping up with peers during activities
• Challenges with gross motor development
• Concerns about balance, coordination, or strength
• Ongoing bowel or pelvic health concerns

A physiotherapist can help determine whether hypermobility affects your child’s movement and function and develop an individualized plan to support participation in everyday activities.

If you have questions about your child’s flexibility, joint stability, pain, or physical development, our physiotherapy team at Boomerang Health is here to help. Contact us to learn more or book an assessment to better understand your child’s needs and how we can support them.