This article is part of our comprehensive guide to exercise and rehabilitation for hypermobility.
Hypermobility and children
In recent years the medical world has begun to realise that the prevalence of hypermobility is far greater than it was once thought to be. Therefore, it has never been a better time to focus on specific hypermobility exercises for children. This helps them to increase their joint stability, motor skills, and to help them traverse the many hormonal changes that puberty brings that can often make hypermobility worse. There are lots to cover when it comes to exercises and hypermobile children, let us cover each area
Why we should be focusing on exercises for Hypermobile children
Joint hypermobility can cause many issues for our children, this is why it’s important that we address these issues when they are young, as their brains are more plastic. This means that by focusing on addressing areas that may cause issues in the future, we can help to mitigate a lot of potential future distress for our children. In the following section let us take a look at some of the issues that children with hypermobility may face.
Motor development in hypermobility
It is thought that delayed motor development is present in approximately one-third of children with generalised joint hypermobility. However, there is no association between the degree of hypermobility and delay in motor development. From various studies looking at physical therapy and exercises for children with hypermobility, It does appear that consistent, monthly, physiotherapy, combined with a home treatment protocol implemented by primary caregivers, is sufficient to achieve motor catch-up(1). It is important that we focus on coordination and motor skills with our children, as it can reduce the risk of trips and falls that may cause joints to subluxate/dislocate.
Anxiety and Hypermobility
In recent years, a strong correlation between hypermobility and anxiety has been established. Whilst the exact mechanisms remain unknown, one thing is for sure, children with hypermobility have a higher frequency of anxiety disorders(2) and a higher intensity of physiological anxiety. Exercise can be a powerful tool for children with anxiety, as exercise activates frontal regions of the brain (3) responsible for executive function, which helps control the amygdala, our innate reacting system to real or imagined threats to our survival. As well as benefits to executive functions, exercise also helps to get the heart rate up. This changes brain chemistry, increasing the availability of important anti-anxiety neurochemicals, including serotonin, gamma-aminobutyric acid (GABA), brain-derived neurotrophic factor (BDNF), and endocannabinoids(4).
Joint subluxations/dislocations in children
As mentioned previously, children with connective tissue laxity are susceptible to joint subluxations and dislocation. Whilst joint dislocations can be very distressing to anyone, no matter their age, they can be a lot more distressing for children. Adults with hypermobility tend to develop certain coping skills that help to aid them with joint dislocations, whereas children have not had time to do the same. This means that dislocations can be incredibly distressing for children with hypermobility.
What is the best exercise for hypermobile children?
Exercises that promote unilateral loading, proprioception, and of course strengthening and stability will be the best exercises for children with hypermobility. Depending on the age of your child, different forms of exercise may be better than others.
Hypermobility exercises for small children
For children up to the age of 10 years old, you may experience difficulties in following a solid exercise programme. Especially, if young children do not fully grasp the importance of doing their hypermobility exercises. Setting aside time for specific exercises can often be a challenge in itself, never mind the actual exercises! And given the prevalence of technology in hypermobile children’s lives these days, children get bored far quicker than they used to.
Children often have a hard time with hypermobility, with a lot of their complaints getting pushed aside and put down to “growing pains” by doctors not educated around hypermobility. They may even have had negative experiences around exercises in the past from various people, and there may be a lot of anxiety around exercises. With the odds stacked against us, where can we start with exercises to make them more accessible for small children?
Well, there are 3 main points we can focus on:
- We can modify exercises to make them into fun and engaging games that focus on strength, stability, and motor skills.
- We can use the time for bonding by doing the exercises with them.
- We can help to reframe the narrative around exercises.
Not all exercises need to be rigorous, boring, and a downright chore to do. Children love games, we all know this, and there is no reason why you can’t use games to implement your hypermobility exercises. One of our favourite lower-body stability games can be found in the video below. It’s a great game in general, but also with a little bit of competition thrown in, combined with a good closed chain stability exercise that targets the hips, knees, and ankles.
We can also use this time to bond with our children, making the experience far less daunting. “How do I do this?” I hear you ask. Simply by doing them with the child. If you can make the exercises into a game, then all the better. Remember, pain is a biopsychosocial experience, and its mediated and created by those three factors. Never underestimate the power of the social bubble when it comes to pain or hypermobility. A good exercise game not only strengthens social connections, and breaks down fears around exercises, but it also releases pain-killing chemicals within the body.
Lastly, get used to reframing the surrounding narrative during exercises. No child wants to feel pressured into their hypermobility exercises. So, make sure your child associates doing their exercises as a good, fun, family, activity, rather than a boring chore.
References:
- Mintz-Itkin, R., Lerman-Sagie, T., Zuk, L., Itkin-Webman, T. and Davidovitch, M. (2009). Does physical therapy improve outcome in infants with joint hypermobility and benign hypotonia? Journal of Child Neurology, [online] 24(6), pp.714–719. doi:https://doi.org/10.1177/0883073808329526.
- Bulbena-Cabre, A., Duñó, L., Almeda, S., Batlle, S., Camprodon-Rosanas, E., Martín-Lopez, L.M. and Bulbena, A. (2019). Joint hypermobility is a marker for anxiety in children. Revista de Psiquiatría y Salud Mental (English Edition), 12(2), pp.68–76. doi:https://doi.org/10.1016/j.rpsmen.2019.05.001.
- Schoenfeld, T.J., Rada, P., Pieruzzini, P.R., Hsueh, B. and Gould, E. (2013). Physical Exercise Prevents Stress-Induced Activation of Granule Neurons and Enhances Local Inhibitory Mechanisms in the Dentate Gyrus. Journal of Neuroscience, [online] 33(18), pp.7770–7777. doi:https://doi.org/10.1523/jneurosci.5352-12.2013.
- BRELLENTHIN, A.G., CROMBIE, K.M., HILLARD, C.J. and KOLTYN, K.F. (2017). Endocannabinoid and Mood Responses to Exercise in Adults with Varying Activity Levels. Medicine & Science in Sports & Exercise, 49(8), pp.1688–1696. doi:https://doi.org/10.1249/mss.0000000000001276.
- Schuch, F.B., Stubbs, B., Meyer, J., Heissel, A., Zech, P., Vancampfort, D., Rosenbaum, S., Deenik, J., Firth, J., Ward, P.B., Carvalho, A.F. and Hiles, S.A. (2019). Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies. Depression and Anxiety, 36(9), pp.846–858. doi:https://doi.org/10.1002/da.22915.
