Abstract
BackgroundJoint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. The study objective was to investigate whether impairments in JHS are due to hypermobility or another factor of JHS by identifying impairments in gait and stair-climbing tasks; an activity that is demanding and so may better show differences between the cohorts.MethodsSixty-eight adults participated; 23 JHS, 23 Generalised Joint Hypermobility (GJH), and 22 Normal Flexibility (NF). Inclusion criteria for JHS participants were a positive classification using the Brighton Criteria, for GJH a Beighton Score ≥ 4, and for NF a Beighton Score < 4 with no hypermobile knees. Participants were recorded with a 10-camera Vicon system whilst they performed gait and stair-climbing. Temporal-spatial, and sagittal plane kinematic and kinetic outcome measures were calculated and input to statistical analyses by statistical parametric mapping (SPM).ResultsDuring the gait activity JHS had significantly greater stride time and significantly lower velocity than NF, and significantly greater stride time, lower velocity, and lower stride length than GJH. SPM analysis showed no significant differences between groups in gait kinematics. There were significant differences between groups for gait moments and powers; people with JHS tended to have lower moments and generate less power at the ankle, and favour power generation at the knee. A similar strategy was present in stair ascent. During stair descent people with JHS showed significantly more hip flexion than people with NF.ConclusionsAs there was only one significant difference between GJH and NF we conclude that impairments cannot be attributed to hypermobility alone, but rather other factor(s) of JHS. The results show that both gait and stair-climbing is impaired in JHS. Stair-climbing results indicate that JHS are using a knee-strategy and avoiding use of the ankle, which may be a factor for clinicians to consider during treatment.
Highlights
Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia
We included stair-climbing in this study as it is an activity that places greater demands on the body than level walking and might highlight functional impairments. In both stair ascent and descent, stride time was significantly slower in JHS than Generalised Joint Hypermobility (GJH) and Normal Flexibility (NF) groups, whereas there was no significant difference between GJH and NF groups
Even though the GJH group were as hypermobile as the JHS group, only one significant difference was observed between GJH and NF groups
Summary
Joint Hypermobility Syndrome (JHS) presents with a range of symptoms including widespread joint hypermobility and chronic arthralgia. Symptomatic hypermobility, here called Joint Hypermobility Syndrome (JHS), is a Heritable Disorder of Connective Tissue (HDCT) characterised by multiple hypermobile joints associated with chronic pain [1]. Whilst the main symptom is long-term and widespread pain [1], JHS is a multi-factorial condition that presents with a wide range of articular and extra-articular symptoms, including joint instability such as recurring and traumatic joint dislocations, and proprioceptive differences [2, 3]. A new classification system was proposed where the most severely symptomatic individuals are classified as Hypermobile Ehlers Danlos Syndrome (hEDS) and patients exhibiting fewer and/or less severe symptoms classified as Hypermobility Spectrum Disorder (HSD) [7, 8]. In this paper we use the legacy terms of JHS and GJH as this research was conducted prior to the proposal of the new classification system
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