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"But I'm Hypermobile": Understanding the Beighton Score

The claim “But I’m hypermobile!” is a common refrain among many athletes who perform dizzying feats of flexibility yet exhibit poor stability and/or motor control.  Though often used as a general descriptive term, “hypermobility” actually has a specific clinical definition.  Identifying clinical hypermobility is especially important in acrobatic sports, not only to screen for injury risk but also to identify potential talent.

The Beighton Score is one accepted clinical means to assess hypermobility, and something anyone can find themselves in a few minutes. 

Beighton Criteria

·         One point if while standing forward bending you can place palms on the ground with legs straight

·         One point for each knee that bends backwards

·         One point for each elbow that bends backwards

·         One point for each little finger that bends backwards beyond 90 degrees.

·         One point for each thumb that touches the forearm when bent backwards

 

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Any score above 4 meets the “Major” criteria for hypermobility.  “Minor” criteria includes any score 1-3, or greater than or equal to zero if aged 50+; and any of the criteria below. (from The Hypermobility Syndrome Association)

·        Arthralgia (> 3 months) in one to three joints or back pain (> 3 months), spondylosis, spondylolysis/spondylolisthesis.

·        Dislocation/subluxation in more than one joint, or in one joint on more than one occasion.

·        Soft tissue rheumatism. > 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).

·        Marfanoid habitus (tall, slim, span/height ratio >1.03, upper: lower segment ratio less than 0.89, arachnodactyly [positive Steinberg/wrist signs].

·        Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring.

·        Eye signs: drooping eyelids or myopia or antimongoloid slant.

·        Varicose veins or hernia or uterine/rectal prolapse   

Clinical hypermobility is indicative of more serious problems outside the musculoskeletal realm and may require separate treatment regimens.   Psychiatric conditions such as panic disorders are commonly linked to clinical hypermobility.   Additionally, cardiac disorders and yes, chocolate cravings are other commonly linked conditions!

Some people call themselves hypermobile if they have above average flexibility, but it’s often a case of misplaced mobility or mobility that exceeds stability.  For example, the low back is commonly mobile among individuals with poor thoracic spine and/or hip mobility.  Some people can perform epic backbends yet have no mobility in the thoracic spine and hips, getting nearly all their range of motion through the lumbar spine (Ouch!).   

It’s important to not confuse instability or extreme mobility with hypermobility.  Yes, those with hypermobility may be unstable, but it does not follow that instability means hypermobility.  Vast joint excursions are not bad in themselves if they are met with a corresponding level of stability and coordination.    

Is there a CAUSAL connection between emotional instability and movement instability?   Does unstable collagen throughout the body trigger some emotional response in the brain to incite psychological unrest?  The literature is not clear, but it is sure an interesting theory!

References

Martín-Santos R, Bulbena A, Porta M, Gago J, Molina L, Duró JC.  Association between joint hypermobility syndrome and panic disorder.  Am J Psychiatry. 1998 Nov;155(11):1578-83.

Pailhez G, Rosado S, Bulbena Cabré A, Bulbena A.  Joint hypermobility, fears, and chocolate consumption.  J Nerv Ment Dis. 2011 Nov;199(11):903-6.

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