Joint hypermobility (JH) means that you are able to move joints beyond their normal range of movement. For example, a hypermobile person may be able to put their leg behind their head or bend their thumbs back to their wrists.
Joint hypermobility can affect just one or two joints, or all of the joints can be unusually bendy. It is common and most hypermobile people live normal lives. Some use their hypermobility to their advantage (for example, in dance or gymnastics).
Hypermobile people can be more likely to injure themselves, for example, twisting an ankle. They may be more susceptible to dislocations of joints because their joints are already lax owing to the looser and more stretchy connective tissues (ligaments, tendons and soft tissues) supporting them.
A woman with JH may be more likely to experience PGP owing to the already lax connective tissue supporting the pelvic joints. However, not every woman who has hypermobile joints will experience PGP. Hypermobility may increase the likelihood that one of the pelvic joints will move or get stuck in the wrong position, resulting in the asymmetrical movement which is central to PGP problems.
Find out more about managing hypermobility in pregnancy, from a midwife’s perspective
Treatment for PGP follows the same principles, with or without JH.
If you are hypermobile and have PGP you are likely to respond well to manual therapy of the pelvic joints, but will often need an additional specific exercise programme when your pain has reduced. You may take longer to recover than women without hypermobility.
There has been a recent medical review of JH as a whole. JH is now recognised to be part of a spectrum of conditions called hypermobility spectrum disorders (HSD). This spectrum ranges between people with no symptoms apart from the joints’ ability to move beyond normal limits (asymptomatic joint hypermobility), through to hypermobile Ehlers-Danlos Syndrome (hEDS) – a disorder of connective tissue which may be inherited from a parent.
Some people with JH may experience:
People with JH who experience these types of symptoms, along with many others, may go on to be diagnosed with HSD or hEDS, usually by a rheumatologist or geneticist.
People diagnosed with HSD or hEDS may also experience a variety of other symptoms including:
A diagnosis of HSD is given when all other heritable disorders of connective tissue including hEDS have been excluded.
Symptoms of HSD and hEDS can vary between each individual, ranging from mild, with few symptoms, to more severe, affecting many systems of the body. It is common for physiotherapists, occupational therapists, pain consultants, psychologists and rheumatologists, among many others, to be involved in the management of these conditions.
Many people with HSD and hEDS can lead a normal life and can manage their symptoms well if they receive the right diagnosis and healthcare support. Those who are more severely affected often require treatment from a team of healthcare professionals and are likely to have to make significant adaptations to their daily lives.
There are also 13 rarer types of Ehlers-Danlos syndrome which may increase your chances of experiencing PGP symptoms.
If you have been diagnosed with HSD, hEDS or another connective tissue disorder and are also experiencing PGP, you may respond well to manual therapy in conjunction with any other treatments already in place for managing your condition.
t is important to manage your pain if it is not already being managed. This can allow your treatment, including manual therapy, to be more effective.
You may be seeing a physiotherapist for the management of your HSD or hEDS and a different manual therapist (physiotherapist, osteopath or chiropractor) for PGP symptoms. If this is the case, it is helpful for both practitioners to liaise regarding your care and treatment plans.
Symptoms will differ between women with these conditions prior to experiencing PGP. Women will experience differing levels of pain and functional ability depending on how severely they are affected. The severity of how you are already affected is likely to impact on how quickly you recover from PGP.
If symptoms persist despite receiving good manual therapy from a practitioner with experience in treating PGP and hypermobility, you may have a pelvic floor problem as well. There is more information on our Pelvic floor and PGP page which explores why many women with PGP either do not respond to treatment or find that their progress is slower.
There are other causes of pelvic pain including:
These can also be more common in HSD and hEDS (read more about chronic pelvic pain and other pelvic pain conditions here). Talk to your GP or one of the other healthcare professionals involved in your care for further advice, assessment and treatment options.
For more information about the symptoms, diagnosis, treatment and management of hypermobility disorders, please visit:
