Objectives:
The aim of this study was to determine the prevalence of hypermobility among all new patients attending Outpatient Paediatric Physiotherapy in Tallaght Hospital. We also aimed to review the relationship between hypermobility, core strength and functional abilities.
Hypermobility involves proprioception impairment, increased frequency of pain and tendency to injure soft tissues while performing physical activities (Czaprowski et al 2011). Prevalence of hypermobility in school children has previously been reported as 30-34% (Remvig 2011). The Beighton Scale is recommended to screen for hypermobility in the paediatric population. (Cincinnati Children’s Hospital, 2014).
Methods:
All newly referred patients to Outpatient Paediatric Physiotherapy were assessed prospectively using the Beighton Scale over a 3 month period along with demographic information, age of walking, crawling, history of pain, falls, dislocations, reason for referral and core strength (measured by 4-point to 2-point kneel duration). Parental consent was obtained.
Results of 50 completed audit forms were analysed. The sample was sub divided into those scoring ≥4/9 as ‘hypermobile’ and those scoring <4/9 as ‘normal’. Excel was used for descriptive statistics and SPSS to identify significance between sub groups.
Results:
Overall a high prevalence of hypermobility was identified (46% of all attendees). A higher proportion of females presented with hypermobility (61%). Significant difference in core strength was identified between groups (p= ≤ 0.05 (0.037); Mean hypermobile: 18.7 seconds; mean Normal 31.1 seconds). Significant difference in crawling type was identified between groups (significantly more bum shufflers in hypermobile sample P≤ 0.05 (0.037)). No significant differences in walking age, reported pain, reported falls were identified between groups.
Conclusion:
A higher prevalence of hypermobility was identified in this sample compared to normal school aged children. Previous research indicates a relationship between hypermobility and increased tendency to injure (Czaprowski et al 2011). Our study agrees and confirms this finding.
Studies have identified reduced peripheral muscle strength in the hypermobile population (Scheper et al, 2014) however no studies were identified specifically focusing on core strength. We were unable to ascertain from this study whether this finding was a cause of effect from hypermobility. The significantly greater proportion of bum shufflers in the hypermobile sub group may also be related to reduced core strength. The impact of hypermobility on developmental milestones and core strength would warrant further review.
Whether symptomatic or incidental, appropriate screening, advice and guidance may prevent symptoms or behaviour modification. In order to reduce the impact of hypermobility, we would advocate for development of core strength through generalised gross motor exercise.
Ethics:
Exempt from requiring ethical review.
References:
Remvig, L., Kümmel, C., Kristensen, J.H., Boas, G. and Juul-Kristensen, B., 2011. Prevalence of generalized joint hypermobility, arthralgia and motor competence in 10-year-old school children. International Musculoskeletal Medicine, 33(4), pp.137-145.
Czaprowski, D., Kotwicki, T., Pawłowska, P. and Stoliński, L., 2011. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. Scoliosis, 6(1), p.22.
Cincinnati Children's Hospital Medical Center Joint Hypermobility Team 2014. “Evidence-based clinical care guideline for Identification and Management of Pediatric Joint Hypermobility” CCHMC EBDM Website Guideline 43 pages 1-22
Scheper, M., de Vries, J., Beelen, A., de Vos, R., Nollet, F. and Engelbert, R., 2014. Generalized joint hypermobility, muscle strength and physical function in healthy adolescents and young adults. Current rheumatology reviews, 10(2), pp.117-125.
