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  • Silas Logan(they/them)

Deep Dive: Hypermobility Spectrum Disorder (HSD)

[Image Description: Cover image is of a person with white skin having one leg bent (the one closest to the camera), with the knee pointing upwards. Near the kneecap are the hands of the physical therapist grasping it. The person has their other leg straight out on a physical therapy table. End of Image Description.]

What is Hypermobility Spectrum Disorder (HSD)?

Commonly thought of as being “double-jointed” or uncommonly flexible, Hypermobility Spectrum Disorder is a spectrum of connective tissue disorders that result in varying degrees of disability. There are four main disorders under the umbrella: asymptomatic HSD, symptomatic HSD, historical HSD, and hEDS.

1: Asymptomatic HSD

This person may be hypermobile in one or more joints with little to no associated pain or musculoskeletal symptoms (such as dislocations, subluxations, atypical proprioception, or the incorrect sense of where body parts are and how much effort needs to be put in to move them).

Can be:

  • Generalized (across the body)

  • Peripheral (hands & feet)

  • Localized (single joints or groups of joints)

2: Symptomatic HSD

This person may be hypermobile in one or more joints with one or more musculoskeletal symptoms.

Can be:

  • Generalized (across the body)

  • Peripheral (hands & feet)

  • Localized (single joints or groups of joints)

3: Historical HSD

This person may have once met the diagnostic criteria* for HSD but now lacks the same flexibility. They may still have musculoskeletal symptoms.

4: Hypermobile Ehlers Danlos Syndrome (hEDS)

hEDS is a symptomatic condition that falls under the HSD umbrella, and diagnostic criteria involve “joint hypermobility, signs of faulty connective tissue throughout the body (e.g. skin features, hernias, prolapses), a family history of the condition, and musculoskeletal problems (e.g. long-term pain, dislocations) … There are many associated symptoms and disorders [such as] orthostatic tachycardia, digestive disorders, pelvic and bladder dysfunction, and anxiety disorders” (Ehlers Danlos Support UK). This disorder has the strictest criteria and the most effect on connective tissues outside of joints.

*A small note on diagnostic criteria: a Beighton score is used to evaluate flexibility, which looks at the range of motion of various joints and assesses flexibility. A positive score is required for generalized HSD, peripheral HSD, and hEDS.

How can this be disabling?

For me personally, I have generalized HSD and have dealt with injuries associated with it since I was a child. I used to sprain my ankles constantly during elementary school, and I have also, ironically, always been flexible enough to put my legs behind my head but too inflexible to touch my toes. My g-HSD is comorbid with the uneven alignment of my legs (miserable malalignment), and I have had symptoms such as widespread joint pain and subluxations (partial dislocations) of the hip and shoulder since I was a preteen. The subluxations stopped once I entered high school, but the constant trauma my joints have dealt with from such a young age has destroyed a lot of the soft tissue and cartilage in them. I have to be especially cautious when exercising and moving strenuously, and physical therapy is something I need to do daily in order to keep the joint pain away. As little as a week without those specific exercises can be disabling, and even then, my knee pain or shoulder pain will flare up irregularly.

What are common treatments?

While no specific treatment can “cure” this chronic condition, physical therapy aimed at strengthening the supportive muscles for affected joints is often utilized to manage symptoms and pain. Along with physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs) and mobility aids such as braces and canes are also used to manage pain.

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