Physician practices in evaluation and treatment of patients with generalized joint hypermobility and bleeding

The purpose of this study was to study the association between the presence of generalized joint hypermobility (GJH) and anxiety within a non-clinical high performing group of adolescents and young adults. Second, to study the impact of GJH and/or anxiety on physical and psychosocial functioning, 168 adolescents and young adults (mean (SD) age 20 (2.9)) were screened. Joint (hyper)mobility, anxiety, and physical and psychosocial functioning were measured. In 48.8% of all high performing adolescents and young adults, GJH was present, whereas 60% had symptoms of anxiety. Linear models controlled for confounders showed that adolescents and young adults with GJH and anxiety had decreased workload (ß (95%CI) −0.43 (−0.8 to −0.08), p-value 0.02), increased fatigue (ß (95%CI) 12.97 (6.3–19.5), p-value < 0.01), and a higher level of pain catastrophizing (ß (95%CI) 4.5 (0.5–8.6), p-value 0.03). Adolescents and young adults with only anxiety had increased fatigue (ß (95%CI) 11 (4.9–19.5). In adolescents and young adults with GJH alone, no impact on physical and psychosocial functioning was found. Adolescents and young adults with the combination of GJH and anxiety were significantly more impaired, showing decreased physical and psychosocial functioning with decreased workload, increased fatigue, and pain catastrophizing. Presence of GJH alone had no negative impact on physical and psychosocial functioning. This study confirms the association between GJH and anxiety, but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in adolescents and young adults with GJH and might influence tailored interventions.

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Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04023-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nili Steinberg ◽

Shay Tenenbaum ◽

Aviva Zeev ◽

Michal Pantanowitz ◽

Gordon Waddington ◽

...

Keyword(s):

Muscle Strength ◽

Postural Balance ◽

Patellofemoral Pain ◽

Joint Hypermobility ◽

Knee Extensors ◽

Young Girls ◽

Generalized Joint Hypermobility ◽

Increased Risk ◽

High Prevalence ◽

Physical Abilities

Abstract Background Many young girls with generalized joint hypermobility (GJH) choose to participate in dance because their bodies are suited for this activity. Scoliosis tends to occur often in thin girls, who also are more likely to choose dance. Both anomalies (GJH and scoliosis) may be related to reduced abilities such as diminished strength and insufficient postural balance, with increased risk for musculoskeletal conditions. The main objectives of the present study were to determine the prevalence of dancers with GJH, the prevalence of dancers with scoliosis, and the prevalence of dancers with these two anomalies; and, to determine differences in physical abilities and the presence of patellofemoral pain (PFP) between young female dancers with and without such anomalies. Methods One hundred thirty-two female dancers, aged 12–14 years, were assessed for anthropometric parameters, GJH, scoliosis, knee muscle strength, postural balance, proprioception ability, and PFP. Results GJH was identified in 54 dancers (40.9%) and scoliosis in 38 dancers (28.8%). Significant differences were found in the proportion of dancers with no anomalies (74 dancers, 56.1%) and dancers with both anomalies (34 dancers, 25.8%) (p < .001). Dancers with both anomalies had reduced dynamic postural balance in the anterior direction (p = .023), reduced proprioception ability (p < .001), and weaker knee extensors (p = .036) and flexors (p = .040) compared with dancers with no anomalies. Among dancers with both anomalies, 73.5% suffered bilateral PFP, 17.6% suffered unilateral PFP, and 8.8% had no PFP (p < .001). Conclusions A high prevalence of young girls participating in dance classes had GJH, as the increased joint flexibility probably provides them with some esthetic advantages. The high prevalence of scoliosis found in these young dancers might be attributed to their relatively low body mass, their delayed maturation, and the selection process of dancers. Dancers with both GJH and scoliosis had decreased muscle strength, reduced postural balance, reduced proprioception, with higher risk of PFP. The main clinical implications are the need to reduce the risk of PFP among dancers by developing appropriate strength and stabilizing exercises combined with proprioceptive and postural balance training, to improve the correct alignment of the hyperextended and hypermobile joints, and to improve their supporting muscle strength.

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Medium-term Results of Body Balance Trainings in Primary School-Aged Children with Generalized Joint Hypermobility and Symptomatic Mobile Flat Foot: Cohort Study

Педиатрическая фармакология ◽

10.15690/pf.v18i5.2326 ◽

2021 ◽

pp. 373-384

Author(s):

Alena Yu. Dimitrieva ◽

Vladimir M. Kenis

Keyword(s):

Primary School ◽

Balance Training ◽

Joint Hypermobility ◽

Control Group ◽

Flat Foot ◽

Body Balance ◽

School Aged Children ◽

Generalized Joint Hypermobility ◽

Longitudinal Arch ◽

Unstable Platform

Background. Mobile flat foot etiology and its correlations with postural imbalance remain topical issues for now, especially in children with generalized joint hypermobility. Additionally, it is poorly known that complaints prevail in children with mobile flat foot and joint hypermobility, and whether existing complaints are associated with foot deformation.Objective. The aim of the study is to estimate medium-term effects of body balance trainings on the height of longitudinal arch of the foot and on the complaints structure in primary school-aged children with generalized joint hypermobility.Methods. The study included 114 primary school-aged children (7–11 years old) with mobile symptomatic flat foot who were divided into four groups: I — control group of children who did not perform training; II — children who performed standard complex of rehabilitation exercises recommended for flat foot; III — children who performed a specially designed complex of exercises for body balance training; IV — children exercised on unstable platform. The foot examination included: clinical assessment of feet shape and position (FPI-6 scale), visual and manual mobility tests, computer scanning with calculation of anthropometric indices (basic anthropometric parameters were calculated from scanned foot images). Clinical evaluation of balance was carried out according to the BESS (Balance Error Scoring System) scale and computer pedobarometry. Assessment of complaints structure was carried out according to the Oxford Child Foot Condition Questionnaire.Results. Children of control group significantly increased the number of errors in performing tests compared to the baseline data (p = 0.034) according to the BESS scale. No statistically significant changes were obtained in children of the second group (p = 0.08). Total number of errors committed by children of third and fourth groups on unstable platform decreased by 2.9 times and 3.4 times, respectively (p = 0.022 and p = 0.044). Decrease in partial load on medial longitudinal arch of foot in step cycle in average by 2.0–3.5 times compared to baseline parameters was revealed in children of third and fourth groups. Moreover, children of third and fourth groups have shown improvement in parameters regarding the shape and position of the feet by average of 1.3–1.7 times higher compared to the parameters of the feet of children performing standard complex of rehabilitation exercises (p = 0.036).Conclusion. This study has shown the efficacy of body balance training in increasing the height of longitudinal arch of the foot and good dynamics in the structure of complaints in primary school-aged children with generalized joint hypermobility and symptomatic mobile flat foot.

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