What role do physiotherapy and exercise play in the management of joint hypermobility, and how can I effectively implement these 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 joint instability, referral to physiotherapy with paediatric expertise is appropriate to provide tailored exercise programmes and support.

Exercise interventions focus on strengthening periarticular muscles, improving proprioception, and enhancing general physical activity levels to maintain joint function and reduce the risk of subluxation or dislocation. Advice on normal healthy physical activity should be given to asymptomatic individuals with hypermobility to encourage safe participation in exercise and to monitor for symptom development.

Effective Implementation in Clinical Practice:

• Identify children with symptomatic hypermobility who require physiotherapy referral, ensuring no red flag features or underlying conditions are missed.
• Refer to physiotherapists with paediatric musculoskeletal expertise for assessment and development of individualized exercise programmes focusing on muscle strengthening, proprioceptive training, and functional improvement.
• Provide education and information to patients and families about hypermobility and the importance of maintaining physical activity safely.
• Encourage regular review and monitoring of symptoms and functional status to adjust therapy as needed.
• Incorporate self-care strategies such as warm-up and cool-down routines, appropriate equipment use, and pacing of activities to prevent injury.

Overall, physiotherapy and exercise should be integrated as part of a multidisciplinary approach to manage joint hypermobility effectively, aiming to improve quality of life and functional outcomes.

References: This approach is supported by UK guidelines on musculoskeletal presentations in children, which recommend physiotherapy referral for symptomatic hypermobility and emphasize exercise and education as key management strategies ¹.