Connective Tissue Disorders

Hypermobility spectrum disorders are a largely undiagnosed group of conditions that can affect a child’s development and can often lead to other health concerns. Current research shows that many children/teenagers with hypermobility disorders go undiagnosed for many years, some up to 10 years after their initial symptoms. These disorders tend to affect the elasticity of connective tissue, making joints, tendons/ligaments and muscles more extensible/flexible. Whilst this extra range of motion available at joints may be of benefit (particularly in some sports), it can also increase the risk of injury and can lead to other musculoskeletal concerns as they age. With greater extensibility at the tissue level, there is a greater demand for stability and strength around the joint to reduce the risk of injury. Care must be taken to avoid taking joints to the end of range, especially in an uncontrolled manner, and stretching/flexibility training must be paired with strengthening exercises at that joint to manage injury risk and pain.

Hypermobility spectrum disorders, such as Ehlers-Danlos syndrome, tend to have a familial influence, and can result in more frequent joint dislocations, can lead to chronic pain, and may be associated with cardiac and gastrointestinal problems. People with hypermobility spectrum disorders tend to require more energy to for postural control and to move (due to the increased demand on the muscular system to stabilise a joint), and this may present differently in children (i.e. easily fatigable, reduced tolerance to exercise, poor concentration/attention, inability to sit still for long periods/fidgeting, poor postural endurance (sits slumped in chair, or leaning on arm-rest), reduced body awareness and clumsiness).

As paediatric physiotherapists, we can educate parents and their children about hypermobility spectrum disorders and can give advice on management (in the classroom and on the sporting field) and provide exercises to improve strength, core stability and reduce injury risk. Reformer-based exercises (such as our Clinical Exercise Rehab classes) may be of benefit for older children/teenagers to improve core stability and strength and joint awareness (proprioception) without excessively loading joints.