• Reference Number: HEY1543/2025
• Departments: Physiotherapy
• Last Updated: 30 June 2025

Introduction

This leaflet has been produced to give you general information about your condition. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor or therapist but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is Hypermobility Spectrum Disorder?

Most children are very bendy compared to older people, as children get older their joints usually become less bendy. Hypermobility refers to an increased range of movement in multiple joints, for their age. Hyper means ‘more’ and mobility means ‘movement’.

Ligaments offer stability to joints. In hypermobility, ligaments are lax, and joints have more flexibility. It is not an illness or a disease, just the way someone is put together. It is considered a normal finding by medical professionals. There are several factors which influence how much mobility we have. These include gender, race, age and family background.

How common is it?

Generally, children are flexible, some more than others. In many children this will become less as they get older, but a small percentage will remain very flexible. This is more common if their parents are still very flexible. In most cases hypermobility peaks at the age of five and many children are hypermobile, without symptoms. Some syndromes also have hypermobility of joints, like Ehlers-Danlos syndrome and Marfan syndrome.

Is it a cause for concern?

Many children who are hypermobile experience no symptoms or difficulties and being hypermobile can be an advantage. Some of our best sports people and musicians are hypermobile. However, in these people their muscles around the joints are well trained and strong.

There are a small number of people who experience difficulties associated with hypermobility. It is not fully understood why these children have more symptoms than others and it is not necessarily related to how hypermobile they are. These problems are often related to reduced muscle strength and stamina and control of joint movement.

Joint swelling for a few days after activities in children and young people is not uncommon and will usually settle without any treatment. Unless there has been a specific injury it is not a sign of joint damage or long-term inflammation.

Some difficulties related to being hypermobile

• More stumbles or falls, often called ‘clumsiness’
• Flat feet (feet roll in)
• Tiredness after walking long distances
• Pain in muscles and joints
• Joint swelling lasting less than a few days
• ‘Clicky’ joints
• Difficulty with fine motor skills e.g. handwriting, cutlery use, dressing
• Children can move their joints and bodies into unusual positions

What can be done to help?

 Everyday Life

Hypermobility often improves with age. Families should be aware that the main risk comes from preventing children to live normal lives. Children should be encouraged to maintain a normal level of activity.

Exercise

Doing generalised exercise and being active will help to maintain a healthy and strong body. Current evidence suggests that strengthening the muscles around a joint can improve control of your child’s movement and help to reduce the number of symptoms a child may have, such as pain or tiredness. Low impact sports such as swimming, children’s yoga or walking can help improve joint strength. It may take many months for stability and strength to improve, but consistency and avoiding inactivity is very important. Encourage a healthy balanced diet, as being overweight can put extra stress on joints.

Sport & P.E.

Some sports benefit from hypermobile joints such as dance or gymnastics, which will help to strengthen the joints. Some sports activities that may include heavy contact can be seen as potentially a higher risk of injury and the activity may need to be modified, such as rugby.

Unless told otherwise, children should continue P.E. as much as possible as this will help to keep the joints strong. Participation in P.E. may need to be modified and should be discussed with schoolteachers. Please see advice about footwear in this leaflet.

Sleep

It can be helpful to keep to the same bedtime routine, with set bedtime and wake up times. Children should avoid watching TV and playing on electronic devices for 1-2 hours before bedtime. Encourage other relaxing activities before bedtime, such as reading, colouring, craft activities or light house chores for older children. Try and discourage children from sleeping on their tummy with their head turned to one side on a pillow as this can strain the joints around the neck and shoulders.

Pacing and energy conservation

If the child or young person reports pain after activity it is important not to give up and pacing will help. This involves planning your activities carefully throughout the day and week to keep the intensity low and having short rest breaks where required. If muscles are not used regularly, they will become de-conditioned, and this will lead to further pain and discomfort the next time any activity is undertaken.

It can be helpful to complete an activity diary (see additional information for an example) to look at your child’s activity patterns across the day and week and note when symptoms are worse. Make a note of any days with lots of high intensity activities and see if you can spread them across the week (for example, P.E. and afterschool clubs on the same day). You may need to work out what is important and eliminate, reduce or reschedule tasks and activities.

• Encourage the child to work at a steady pace and avoid rushing.
• Allow a short period of rest or a movement break if the child feels tired or sore, and alternate light and heavier activities.
• Make several small trips instead of carrying one heavy item (e.g. when unloading shopping from the car or hanging out washing).
• Use lockers at school instead of carrying all belongings in one go
• Have a plan to allow children short periods of time to recover if they get tired or have pain and/or stiffness

Joint Protection

The stronger you are the more your muscles can protect your joints, encourage your child to get active, get physical, find a hobby they love and have fun!

• Understand the differences between normal levels of discomfort and pain from overusing a joint. Make a note of which movements or activities stress a joint too much and help the child learn how to avoid repeating that movement.
• Don’t let joints become stiff, encourage the child to move their joints at least once a day as this will help maintain range of movement and freedom of the joints.
• Avoid sudden jerking or bouncing movements as this can hurt the joints. Try not to sit in one position for too long and ensure frequent movement breaks, especially when watching TV or during long car journeys.
• Encourage children to use their strongest and largest joints to complete a task or activity. For example:
  • Reduce the need to lift objects by sliding them across a table
  • Carry heavy objects close to the chest, supporting weight on the forearms
  • Carry objects e.g. book, plate or mug with palms open to spread the load across the hand.
  • Use your arm or body to push open a door
• Avoid making a tight fist and using narrow handled objects. Try objects with a larger handle that are easier to hold and will reduce additional stress through the joints of the hand. For example, thick handle cutlery, electric toothbrush.
• Discourage children from resting their head on their hands when sitting at a desk.
• Help the child learn how to be careful when using their hands. The joints in the fingers, thumb and wrist can easily be stressed from repetitive or forceful movements.
• Try and discourage children from showing ‘party tricks’ of over stretching joints.

Writing

• When writing or other fine motor activities try and release the grip every 5 to 10 minutes. It can also help to complete hand warmups:
  • Shake hands – to relax joints in the wrist, fingers and thumb
  • Finger taps – gently tap each finger and thumb on a tabletop
  • Finger flicks – on a tabletop, pretend to flick something with each finger
  • Praying position – push hands together, holding hands close to the chest for a gentle stretch to the wrists and fingers / thumbs

• It is easier to hold pens and pencils with a thick / grippy barrel. This reduces pressure on fingers and thumb joints and can help prevent hand pains.
• The triangular pencil grip may give better control of the pen or pencil whilst allowing your hand to relax more. Specific triangular pencils/pens can be purchased commercially.
• Ergonomically friendly pen/pencils can ease writing stress and fatigue.
• Writing and colouring is easier with a gel pen or felt tip as the ink flows easily over the paper, avoid scratchy ball point pens which take more effort to use.
• Writing on a sloping surface can help relieve pain and achiness in the wrist and hand. This will also help your child’s posture, neck and shoulder position when writing. It may be useful to try this at home as well as at school.

Footwear

Children should try to wear supportive trainers and shoes, especially when their feet or knees are achy. A good foot position can help to relieve knee and leg pain. It may be helpful to wear trainers for PE instead of plimsolls (school pumps). The trainers should have a firm back at the heel and offer good support.

 Sitting and Posture

Good posture is always important. Slouching may hurt your child’s back and lead to weak core muscles, which affects the way they can use their shoulders and hips.

• Encourage sitting and standing “tall”
• When sitting at a desk, the feet should be flat on the floor, the thighs and forearms should be horizontal and the desk just below elbow height
• Increase the height of the chair to reduce stress on the hips and knees
• Consider chairs with arm rests
• A wobble cushion may help the joints to move if it is not possible to stand up and/or move from static sitting
• Sitting on the floor with crossed legs can be difficult or painful. Children may need to sit on a chair or bench
• Discourage sitting with the legs in the extreme range of movement, where joints may be stressed

 Fine motor control and strengthening

Muscle strength of the arm, hands and fingers generally improves as children grow and participate in everyday activities. Hand strengthening activities help to improve a child’s grip and pinch strength for functional tasks such as fastening buttons, scissors, cutlery, writing etc.). The activities below all help to increase muscle strength in the hands:

• Fun activities e.g. using tweezers or tongs to pick up objects, brick models, popping bubble wrap, finger painting, playdough, threading, path chalking (where appropriate)
• Everyday household tasks e.g. hanging up washing with pegs, baking, tearing up paper, squeezing sponges, wringing out flannels, watering plants with a spray bottle

Other suggestions:

• If reading for a long time, try a book holder
• Try a grippy material such as ‘Dycem’ to help stabilise objects e.g. paper when writing or a mixing bowl when baking, or to increase grip when opening items e.g. bottles or jars
• Use a backpack with wide padded straps to distribute weight inside the bag more evenly. Pack heavier items e.g. books closest to the back of the bag (near the back)
• For children finding self-care tasks difficult, try Velcro, elastic laces, electric toothbrush, pull on clothing
• There are different types of scissors that can help improve grip when cutting e.g. self-opening scissors, long handle scissors and loop scissors

Pain Management

Muscle pain after activity, even for 1 to 2 days afterwards, is normal. It is expected that as muscles become stronger the pain will decrease. Warm baths or a hot water bottle (wrapped in a towel) may help, particularly in the evenings and after activity. Try not to focus on pain and distract your child from dwelling on it. You could try encouraging them to engage in relaxation activities such as colouring, listening to music or an audio book.

Seeking advice

• Seek advice from your child’s GP if you have any major concerns about your child, or if they are having frequent and severe pain.
• Some children benefit from a single assessment with a physiotherapist and / or occupational therapist to provide a standard home exercise and activity programme which will target their individual challenges or alignment variations.
• A small number of children will require more detailed therapeutic involvement with these professionals.
• Orthotics or Podiatry may be appropriate if further control of your child’s joints is required.

Further information

http://hypermobility.org/

https://www.ehlers-danlos.org/

https://apcp.csp.org.uk/documents/parent-leaflet-choosing-right-school-bag-updated-2016

https://www.backinaction.co.uk/forchildren

https://www.bbc.co.uk/bitesize/articles/z3c6tfr#zn9s3qt

https://www.sensoryeducation.co.uk/collections/pencil-grips-handwriting-resources

https://www.essentialaids.com/children-with-disabilities/children-s-cutlery.html

Contact Numbers tel: 01482 674539 or tel: 01482 674532 (Monday to Friday, 8am to 4pm)

This leaflet was produced by the Children’s Physiotherapy & Occupational Therapy Department, Humber Health Partnership, and will be reviewed in June 2028.