What role do physiotherapy and exercise play in the management of joint hypermobility, and how can I implement this in my practice?

Role of Physiotherapy and Exercise in Joint Hypermobility Management

Physiotherapy and exercise play a central role in managing symptomatic joint hypermobility by improving muscle strength, joint stability, and function, thereby reducing pain and preventing injury. For children and young people with hypermobility who have symptoms such as pain, functional impairment, or recurrent joint subluxations/dislocations, referral to physiotherapy with paediatric expertise is appropriate to provide tailored exercise programmes and support.

Exercise interventions should focus on strengthening periarticular muscles, improving proprioception, and enhancing general physical activity levels to maintain joint function and reduce symptoms. Advice on normal healthy physical activity should be given to those with asymptomatic hypermobility, with education about the condition and guidance to return for review if symptoms develop.

Effective Implementation in Clinical Practice

In clinical practice, physiotherapy should be considered when symptomatic hypermobility affects daily activities or mobility. The physiotherapist can design individualized exercise programmes that include muscle strengthening, proprioceptive training, and functional activities. Early referral is important if there are red flags, severe pain, or significant functional impairment.

Self-care strategies should be advised alongside physiotherapy, including warming up before exercise, cooling down afterwards, using appropriate equipment and footwear, and pacing activities to avoid overuse injuries. Regular review and adjustment of the exercise programme based on clinical response and goals are essential.

Referral pathways should be used judiciously, with specialist assessment (e.g., paediatric rheumatology) reserved for cases with diagnostic uncertainty, severe or symmetrical joint involvement, or associated connective tissue disorder features.

Overall, physiotherapy and exercise form a cornerstone of conservative management for joint hypermobility, aiming to maintain function, reduce symptoms, and prevent complications through tailored, supervised, and progressive interventions.

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