Hypermobility & Joint Pain

Our hypermobility research is led by Dr Emma Clark and Prof Jon Tobias in collaboration with Prof Shea Palmer at the University of the West of England. We have conducted research into the impact of hypermobile (lax or bendy) joints on pain as part of project grant awarded by Arthritis Research UK. This research has used the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, based on assessment of hypermobility performed at age 14 in around 6000 participants. We found that the prevalence of hypermobile joints is considerably higher in girls compared to boys, and is also greater in those who do a lot of exercise[1,2]. In a further study we identified obesity as a major risk factor for joint pain in those who are hypermobile[3]. We are planning further work with ALSPAC to look at how hypermobility changes as people age, and to carefully investigate the association between joint hypermobility and symptoms such as pain, fatigue, urinary symptoms, gastrointestinal symptoms, gynaecological symptoms, anxiety and depression.

We have also looked at symptoms adults with joint hypermobility experience, and from this have developed a patient-reported outcome measure called the Bristol Impact of Hypermobility (BIoH) questionnaire [4,5]. This is important because we now have a valid measure that we can use to objectively measure if people’s symptoms associated with hypermobility are getting worse or better. It also allows us to carefully look at the effect of interventions such as physiotherapy.

We have carried out a feasibility study looking at the role of physiotherapy for adults with joint hypermobility, funded by a grant from the NIHR HTA programme (ISRCTN 29874209)[6]. This study, led by Dr Shea Palmer, was a collaboration between the University of the West of England, the University of Bristol and North Bristol NHS Trust. It developed and tested a comprehensive physiotherapy treatment package for adults with joint hypermobility and our results suggested a future definitive randomised controlled trial of physiotherapy for adults with hypermobility is feasible. We are currently planning this definitive study.

[1] Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, Tobias JH, Clark EM (2011) Epidemiology of generalised joint laxity (hypermobility) in 14 year old children from the UK: A population-based evaluation. Arthritis Rheum. Arthritis & Rheumatism 63(9):2819-2827. http://doi.org/10.1002/art.30435.

[2] Tobias JH, Deere K, Palmer S, Clark EM, Clinch J (2013) Joint hypermobility is a risk factor for musculoskeletal pain during adolescence. Arthritis & Rheumatism 65(4):1107-1115. https://doi.org/10.1002/art.37836.

[3] Deere KC, Jacqui J, Holliday J, et al. (2016) Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort. Pain 153(9):1932-1938. https://doi.org/10.1016/j.pain.2012.06.006.

[4] Palmer S, Cramp F, Lewis R, Gould G, Clark EM (2017) Development and initial validation of the Bristol Impact of Hypermobility (BIoH) questionnaire. Physiotherapy 103:186-192. https://doi.org/10.1016/j.physio.2016.04.002.

[5] Palmer S, Manns S, Cramp F, Lewis R, Clark EM (2017) Test-retest reliability and smallest detectable change of the Bristol Impact of Hypermobility (BIoH) questionnaire. Musculoskeletal Science & Practice 32:64-69. https://doi.org/10.1016/j.msksp.2017.08.007.

[6] Palmer S, Cramp F, Clark EM, Lewis R, Brookes S, Hollingworth W, Welton N, Thom H, Terry R, Rimes KA, Horwood J (2016) The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technol Assess. 20(47):1-264. https://doi.org/10.3310/hta20470.

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