IADMS Madrid 2001   [back to the Category]

Is joint hypermobility in performing artists an asset or a liability?   [read the french version]

Author :   Rodney Grahame, CBE, MD, FRCP, FACP

Is joint hypermobility in performing artists an asset or a liability?

Rodney Grahame, CBE, MD, FRCP, FACP, Hypermobility Clinic, University College London Hospitals, British Performing Arts Medicine Trust, London, England

A debate has raged since the days of antiquity as to whether increased inherent joint flexibility constitutes a natural advantage or disadvantage.

Hypermobility favors the selection of female students into ballet school, but may also threaten future careers because of susceptibility to injury. In musicians there is compelling evidence that lax fingers and wrists favor the flautist and string player, but lax knees and spines penalize the timpanist and others who stand while they play. Similar divergence was seen in an industrial setting.

Since, in an individual, Hypermobility does not necessarily affect all joints, where asset becomes liability depends on firstly which joints are hypermobile and secondly the nature of the activity performed.

When hypermobility gives to symptoms the benign hypermobility syndrome (BJHS) may be present. This is now regarded as a multi-system heritable disorder of connective tissue, which shares overlap features with Marfan and Ehlers-Danlos syndromes. New validated diagnostic criteria have been recently published. Musculoskeletal symptoms, in particular pain, predominate and these may dominate the lives of many affected patients seen in a Hypermobility Clinic.

On the other hand many (perhaps most) hypermobile individuals have little complaint and lead active and pain-free lives (many as dancers). Evidence is emerging that elderly hypermobile subjects in the community are subject to less osteoarthritis of the knee and have a higher bone mineral density than their less mobile peers.

Hypermobility in this age group at least may therefore be considered to be a “fitness factor.”