IADMS Miami 2000   [back to the Category]

Hypermobility Syndrome: A Review of the Pathology, Symptoms and Implications   [read the french version]

Author :   Fara G. Desfor, P.T., M.Sc., M.A.C.P.

Author: Fara G. Desfor, P.T., M.Sc., M.A.C.P., University College of London, England, and Physio-Sports Center, New York, NY, USA

Many people who pursue a career in dance have inherent joint flexibility, which can be a great asset in the profession. Generalized joint laxity however, commonly known as hypermobility syndrome, combined with the extreme physical demands of dance, may put these dancers at high risk for instability and injury. It is in the best interest of the dancers, as well as the medical and dance professionals who care for and instruct them, to be aware of this common and frequently overlooked cause of local and widespread musculoskeletal symptoms.

The hypermobility syndrome (HMS) refers to a collection of musculoskeletal symptoms and clinical findings related to diffuse joint laxity, but can also include multi-system disorders that overlap with certain genetic connective tissue diseases. Although the specific gene defects found in the more serious heritable disorders of connective tissue are not present in HMS, this syndrome still exhibits similar, less severe, collagen defects that cause increased elasticity of ligaments, joint capsules, tendons, skin, and blood vessels. It has been suggested that the abnormalities in HMS may be due to a collagen processing defect or an irregularity in another part of the collagen connective tissue protein complex.

Regardless of the underlying pathophysiology involved in HMS, the mechanics of capsular, ligamentous, and tendinous laxity during dance training and performance can result in joint instability, poor movement technique or compensations, and increased vulnerability to injury. Joints affected by hypermobility do not appear to have the neuromuscular safeguards of ‘‘normal’’ joints. While dancers in general have less sensitivity to stretch, those with HMS will be even less sensitive to the signs of “painful stretch” or “over stretch.” These circumstances can result in muscle and tendon trauma, increased load on neural structures, and further lengthening of connective tissue structures.

Clinical findings frequently associated with HMS are joint and muscle pain, recurrent ankle sprains, joint subluxations and dislocations, chondromalacia patellae, scoliosis, hernia, rectal and uterine prolapse, varicose veins, spondylolysis/spondylolisthesis, temporomandibular joint dysfunction, skin bruising and papyraceous scars, pes planus (flat feet), tarsal tunnel syndrome, and backache. It is interesting to note that many of the injuries reported by dancers are also classically associated with HMS. These include stress fractures, ligament sprains (particularly ankle sprains), tendinitis, synovitis, and bursitis, as well as episodes of widespread arthralgia (joint pain, primarily back, knee, and foot/ankle) and myalgia (muscle pain).

There is still dispute in the research, however, whether there is a positive correlation between HMS and injury rates in dancers/athletes. It is possible that dance training has a positive effect on some signs of HMS, particularly in increasing proprioceptive awareness and neuromuscular control around the hypermobile joint. Initial research has suggested, though, that HMS is associated with an increased incidence of osteoarthritis (OA). It is believed that a predisposition to OA in hypermobile people may exist because of abnormal joint connective tissue and abnormal joint biomechanics of stress. This provides yet another reason to assess young dancers entering into dance schools or companies for hypermobility.

This is the abstract of a paper presented at the Tenth Annual Meeting of the International Association for Dance Medicine and Science, held 27-29 October 2000 in Miami, Florida, USA. All rights are reserved by the individual author(s).