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. It can affect one or two joints or all of the joints can be unusually bendy. Joint hypermobility is common and most hypermobile people live normal lives and some use their hypermobility to their advantage (e.g. in dance or gymnastics).
Hypermobile people can be more likely to injure themselves, e.g. twist an ankle, or 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.
Most hypermobile people respond well to treatment, although they may take longer to heal, and most will not go on to experience further problems. Others, however, may only partially recover and go on to re-injure the same joint and/or other joints in the body.
A woman with JH may be more likely to experience PGP owing to the already lax connective tissue supporting the pelvic joints but not every woman who has hypermobile joints will experience PGP. The 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.
To find out more about managing hypermobility in your pregnancy, please click on the below link to hear a midwife’s perspective:
However, the treatment follows the same principles with or without JH. Please see our ‘Treatment’ section for more information.
If you are hypermobile and have PGP you are likely to respond well to manual therapy of the pelvic joints followed by a specific exercise programme when pain has reduced, though you may take longer to recover. If this is the case you may find information on our ‘What to do if treatment is not helping’, ‘Emotional impact of PGP’and ‘Practical suggestions’ pages helpful.
There has been a recent medical review of JH as a whole and JH is now recognised to be part of a spectrum called Hypermobility Spectrum Disorder (HSD). This spectrum ranges between, at one end, asymptomatic JH (someone who has no symptoms apart from their joints’ capacity to move beyond normal limits) through to hypermobile Ehlers-Danlos Syndrome (hEDS – a heritable disorder of connective tissue) at the other end.
Some people with JH may experience long-term pain, fatigue, frequent dislocations or subluxations (partial dislocation) of one or more joints, and recurring ligament, tendon or soft tissue injuries. People with JH who experience these types of symptoms, along with many others, may go on to being 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 gastrointestinal (stomach and digestive system) symptoms, symptoms of the autonomic nervous system and problems with bladder and pelvic floor function. 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 interventions from a team of healthcare professionals and are likely to have to make considerable adaptations to their daily lives.
There are also 13 rarer types of Ehlers-Danlos syndrome, including classic or vascular variations with symptoms relating to severe skin and cardiac problems, and Marfan syndrome which is linked to problems with the heart, lungs and eyes.
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. If you are seeing a physiotherapist for the management of your HSD or hEDS as well as a manual therapist (physiotherapist, osteopath or chiropractor) for PGP symptoms, it is helpful for both practitioners to liaise regarding your care and treatment plans. It is also important to manage your pain, if it is not already being managed; this can allow manual therapy treatment to be more effective. Please see our ‘Pain in PGP’ section for more information.
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 the rate at which you may recover from PGP.
If symptoms persist despite receiving good manual therapy from a practitioner experienced in treating PGP, and ideally hypermobility, then you may find it helpful to read our ‘Pelvic floor and PGP’ page to explore this common reason why many women with PGP either do not respond to treatment or find that their progress is slower. If these options fail then you may wish to explore other causes of pelvic pain including hip dysplasia, lower back/disc problems and bowel or bladder disorders, as these can also be common in HSD and hEDS (you can read more about chronic pelvic pain and other pelvic pain conditionshere). Please consult 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: