Physiotherapy Management of Hypermobility Disorders in Children

Physiotherapy Management of Hypermobility Disorders in Children
Treatment is usually a combination of the following areas. Symptoms at time of presentation will determine the focus of the program
Pain relief
hydrotherapy, taping, bracing, heat, massage, mobilisation, occassional use of electrotherapy devices
Proprioception
Body awareness of the position of a joint in space in relation to another joint. Facilitates body’s ability to synchronise limb and trunk movements. This reduces risk of dislocation, subluxation, “tripping over injuries”
Wobble board, Theradisc, minitramp, multi-stones. Progress difficulty by multi-tasking
Strengthening exercises
Strengthen the chain. Strengthen the painful area but also the rest of biomechanic chain.
Stretches
stretching of compensatory tight muscle groups. Compensatory mechanism to provide balance and stabilitycommonly hamstrings, gastroc-soleus
Stability exercises
Core stability exercise (transversus abdominus and multifidis)
pelvic stability exercises (gluteus medius and pelvic floor muscles)
Fit ball- Moving pelvis while keeping trunk still, move upper trunk while keeping pelvis still.
Increase complexity by adding in extremity movements.
“superman’s”,
Bridging with feet on ball.
Sit and watch TV on ball
Relaxation exercises- Muscles are fatigued and often prone to spasm by end of day. The muscles are working hard to control movement . When it is time to sleep muscles are still in a state of semi tension. By relaxing before bed, promote muscle relaxation, better sleep pattern. Reduce restless legs
Pacing- short frequent bursts of activity are always better than longer durations. The length of time dependent on child’s age. Avoid 2 sports on 1 afternoon (eg footy training followed by swimming squad). Avoid over-scheduling the child. Allow time for rest periods.
Timing of activities – younger children have more energy and less fatigue earlier in the day
Sport specific training,
Advice re position on field, suitable sports
Specific exercises for the area of body most at risk with particular sports
eg. Ankle- soccer, netball
Knee- football
Gymnastics- back
Position on field
Football- midfield is position where less body contact /impact occurs
Netball- Goal shooter/Goal attack less running
Avoid
High impact sports – rugby, touch rugby, ice hockey, football
Ideal Sports
Swimming, Non contact martial arts. kindy gym/toddler gym
Activities for younger children
kindy gym/toddler gym, Indoor climbing gyms in winter (Beach House/Fun Station), local park, baby swim or Aquatic Leisure centres, Circuit in own backyard
OT referral for hand management- hand exercises, pen grips, slope board, hand writing skills
Successful results with new spiral thigh garment in children with hip, knee pain and pelvic stability

Aim to provide as much information to parent to allow parent to manage symptoms effectively at home. Often 5-6 sessions in early stages to get symptoms under control. Then continue with the principles of management at home. Return to physio when new symptoms occurs eg tendinopathy, back pain, subluxations etc

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Subjective
myriad of symptoms – some or all of symptoms
tiredness , fatigue
toddler- wants to be in pram a lot
school age- too tired to walk home or walk to car from classroom
exhausted more than peers/siblings at end of day
Pain
night pain
more frequent “growing pains”
Strains, Sprains
Hx of recurrent sprains, dislocations or fractures, rolling the ankle. Pulled elbows
Coordination issues
Awkward running, difficulty putting clothes on in morning
Some are very coordinated and some poorly coordinated
Objective
Beighton Hypermobility Score – determination of hypermobility
Body posture in standing- flat feet, femoral anteversion and tibial torsion, incr or decr lordosis, winged scapula
Classic ‘C” trunk posture in sitting
Balance/coordination
Running style- often awkward gait, incr trunk flexion, rigid trunk, excessive movement lower legs or side to side trunk movement
Core stability , pelvic stability
Muscle strength- general lack of muscle tone and often more specific weakness in gluteals and trunk muscles
Muscle length- frequently tightness in hamstrings and gastrocnemius. Tightness in gastroc-soleus can contribute to idiopathic toe-walking
Bruising- multiple in varying stages of healing
poor scarring