The symptoms described are understood to be related to weaker muscles and as the joints may be less stable, muscles therefore must work harder to help support these flexible joints. The focus to help manage these symptoms is all about supporting your child to be generally healthy, strong and fit. The stronger and fitter your child is, the better it will be for their hypermobility and general well-being and the less likely they are to report any problems at all. (APCP 2012).

Ensuring your child does not get overweight is a really important part of the long-term management of joint hypermobility as this puts extra stress on muscles and joints causing more aches and pains.  If your child suffers from muscle aches and pains after exercise, please don’t stop them exercising as this results in weakening of their muscles and further pain.  It is therefore important instead to help your child to pace their exercise to help build their stamina, fitness and muscle strength gradually.

Regular participation in normal everyday activities, play and exercise is therefore the key to the most successful long-term management of joint hypermobility to prevent these problems.  Swimming and cycling in particular are really beneficial types of exercise to do regularly as these activities puts less stress on the joints whilst strengthening the muscles. 

  • Swimming
  • Ride on toys/trike/bike
  • Walks
  • Play parks
  • Soft play
  • Active toddler groups
  • Dance

  • Swimming
  • Cycling
  • Play parks
  • Soft play
  • P.E.
  • Sports clubs and teams with the exception of rugby
  • Martial arts
  • Ballet
  • Gymnastics (with care)
  • Walks

Joint protection 

  • Encourage your child to move each joint through its full range of motion once a day.  Keep movements slow and gentle
  • Encourage your child to understand and respect any pain, by noting and understanding the activity that stressed a joint you can help the child to learn to avoid repeating that movement
  • Encourage your child to be careful how they use their hands, stressful positions and techniques may increase the risk of putting extra stress on the joints
  • Avoid making a tight fist, try to use larger handled objects such as chunky pencils
  • Try not to pinch items between the thumb and fingers for too long such as when holding a book

Good body mechanics

  • Carry objects with the palms open distributing the weight evenly over the forearm
  • Avoid keeping joints in the same position for a long period of time
  • Balance periods of rest and activity during the day
  • Allow rest periods before the child becomes fatigued or sore
  • Alternate light and heavy work throughout the day
  • Take regular stretch breaks

Strengthen

  • Encourage regular low impact strengthening activities such as swimming and walking
  • Avoid inactivity
  • Regular gentle physical activity as being overweight can add extra stress on joints

Positioning – it is important that your child is correctly positioned when sat down to eat a meal. The chair and table should be at the correct height for them as they should feel stable and secure whilst they are sitting. Basic principles of good positioning will encourage cutlery skills and concentration when eating. 

  • Hips should be bent at a 90°angle
  • Feet flat on the floor hip width apart
  • Bottom and back supported
  • Chair tucked in under the table
  • Table is at the right height for child’s elbows to be supported on the table
  • Table clear of clutter to reduce distractions whilst eating

Facilitating feeding – if you are assisting your child to feed, ensure that you sit next to them on their preferred side; try hand over hand, so support their hand whilst they hold the cutlery; take your time as your child needs to learn the sequence and movements required for feeding.

Handling knives and forks – the following activities use some of the same skills which are involved in cutlery use (one hand holding object still whilst the other carries out the action). Encourage your child to carry out these activities in order to develop their skills:

  • Using a dustpan and brush – holding the dustpan still whilst using the brush
  • Using scissors
  • Using playdough – practice cutting using cutlery
  • Cooking/Baking – holding the bowl whilst mixing with a spoon
  • Colouring – hold the paper steady with one hand whilst colouring with the other
  • Opening screw top bottles and jars; Construction games. 
  • Practice cutting playdough with knife and fork

Cutting – Ensure the cutlery is held appropriately (placing first finger on top of the cutlery with rest of hand gripped around). Encourage your child to slow down and think about each stage of cutting separately (e.g. stab with the fork and then cut with the knife). Stand behind your child and help the hand with the fork in it to stay still whilst the knife moves back and forth across the food. Model cutting for your child so they can see how you do it. Children can find it difficult to monitor the appropriate amount of force to exert when cutting. Also when applying too much force, it may be difficult to cut and press at the same time. The combination of balancing movement and pressure can be difficult. To help, experiment with different food textures ranging from very hard to soft. This will increase awareness and hopefully encourage how to exert appropriate pressure and movement relevant to the food. Use a non-slip feeding mat to steady the plate if required. 

Junior caring cutlery or OXO tot cutlery can be purchased from Amazon, www.nrs-uk.co.uk or www.completecareshop.co.uk (can help to develop the correct grip as they have indents to guide where the index fingers should go).

Hand strengthening ideas and games

  1. Paper crunching
  2. Spraying with bottles through water play
  3. Squeeze toys including sponges and stress balls
  4. Cutting with scissors using different gradients of paper
  5. Interlocking construction toys e.g. lego
  6. Clothes peg games

Playdough Activities or Therapy putty

  • Pinch opposition between tip of thumb and index finger. This exercise can also be performed with each individual finger. Place dough between finger and thumb tip, squeeze the dough until tips pass through the dough and meet
  • Roll a sausage and pinch between your thumb and index finger, be careful to not let the other fingers help
  • Roll small balls and pick them up between your fingers
  • Roll a sausage and join ends so that it makes a ring, put the ring over all your fingers and try to spread open your fingers

Preparation for writing

Good sitting forms the basis of good handwriting. Ensure the table and chair are the correct height. Ensure feet are flat on the floor and bottom is to the back of the chair.

Posture

  • Feet flat on the floor and hip width apart.  Use a step if required.
  • Hips flexed at 90°
  • Bottom and back supported
  • Chair tucked in under the table
  • Elbows supported on the table
  • If the chair has a deep seat, put a cushion behind the child’s back to give more support
  • Work out a simple physical reminder such as a tap on the shoulder when posture is poor
  • Try an angled writing surface using a lever arch file
  • A smooth work surface will provide less resistance to movement

Paper position This is important to allow a view of the writing and to help prevent the development of a hooked grasp. Left handers may need to position the paper at a different angle to right handers.

Pencil Grip 

The way the child holds a pencil/pen is important. The grip needs to be comfortable, not too tiring and allow movement of the pencil/pen in a controlled way to write neat letters. The best grip for many of us is:

  • Pencil balanced against hand
  • The wrist is slightly extended (bent upwards)
  • The tip of the thumb and index finger are on the pencil/pen with the index finger slightly flexed (bent)
  • The side of the middle finger has the pencil resting on it at the level of the fingernail
  • Pencil grips can reduce the finger/pencil pressure by changing the relative tension of the fingers and thumb involve.

Children should try and achieve a tripod pencil grasp as this is the most efficient and comfortable.  Practice with pincer grasp activities a pre-requisite for this.  However some children may need adapted pencils and grips.

How to decrease fatigue and pressure when writing

  • Have short breaks between longer periods of writing to relieve tension in hand muscles
  • Hand relaxation techniques and stretching and shaking of the hands and fingers
  • Investigate nib type and the flow of the pencil/pen on the paper as this may assist with fluency and control
  • Larger barrelled pencils/pens will reduce the strain on the finger joints
  • Try different textures of paper to encourage the child’s pressure awareness

Light Pressure 

  • Some children do not apply enough pressure through the pencil/pen, this affects their control over the pencil/pen and will make writing appear poorly formed
  • Provide an angled writing board (a lever arch file will work)
  • Try weighed wrist bands to provide additional sensory feedback to the wrist which will increase the child’s awareness of their hand, wrist and arm position
  • Use softer leaded pencils such as 2B so writing appears darker

Support at school

  • If your child is having difficulty writing longer pieces of script or you are worried how they will manage in their exams, please discuss further with the schools SENCo teacher.  

When should you seek medical advice for your child?

If your child is experiencing new pain or functional problems and you have already been assessed by a Physiotherapist, further advice can be sought from the service by making a self-referral via the link.  You will then receive a phone call from a physiotherapist to discuss these new concerns and a clinic appointment will be arranged as appropriate.

If your child has not been formally assessed by a doctor or Physiotherapist to confirm they have hypermobility it is recommended that you arrange an appointment with your GP to discuss this or you can self-refer your child into the physiotherapy service for this assessment and advice.

It is also recommended that you seek advice from your GP if you are concerned your child is experiencing frequent or severe pain as other medical tests may be required.

Symptomatic Hypermobility PDF

Please see the useful links below to help provide advice and further education around joint hypermobility.

Keeping active