Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Physiotherapy Management of Children with Hypermobility: A Review of an Out-Patient Self Management Exercise Programme.

Maillard1,  Susan M., Adkins2,  David, Haggart2,  Elaine, Bhagat2,  Swati

Great Ormond Street Hospital, London, Maidenhead, United Kingdom
Great Ormond Street Hospital, London, United Kingdom


The recognition of hypermobility in the paediatric population has increased and common complaints associated with this are pain and fatigue. Great Ormond Street Hospital, UK has implemented a self management exercise programme, which is specific and progressive to key muscle groups. It utilises open chain exercises with high repetitions (30) and low weights (0.5–2.5kg), in order to manage these patients from an outpatient-based clinic.


To establish whether this specific muscle training programme can be effectively used in the paediatric hypermobile population, to increase muscle strength, decrease pain and improve overall function.


A retrospective case note review of children who had attended the hypermobility out-patient service between Nov 2009 and March 2010 was completed (comparing initial assessment and follow up). Assessments of muscle strength, school attendance, Childhood Health Assessment Questionnaire (CHAQ), parental visual analogue scale (VAS) of general well being and pain VAS were collected on the children. All children were provided with an exercise programme at the initial assessment, based on 4–5 key exercises, focusing on increasing repetitions and weights. An excel database was used to compile findings.


Data from 20 children (10 males:10 females) who had already been diagnosed with hypermobility (Beighton score of >4/9), was collected. The mean age was 11 years (range 5–16 years). The primary complaints within the cohort were of pain and fatigue longer than 6 months in duration. School attendance for all but one patient was 100%.

On initial assessment the mean muscle strength score was 3.5/5 (oxford manual muscle score) in hip abductors, hip extensors and inner range quadriceps (range 2.5–5) and 7.25/10 repetitions for plantar flexors (range 2–10). At 8–12 week follow up, all children were completing 30 repetitions and using an average weight of 1.5kg (range 0.5–2.5kg). There was an average increase in muscle strength of hip abductors (60%), hip extensors (70%), inner range quadriceps (55%) and plantar flexors (40%).

The average score of the CHAQ on assessment was 1.15/3, pain VAS was 4.6/10cm and parental VAS of general well being 3.9/10cm (10=most unwell).There was a 60% decrease in the score of CHAQ between visits. Pain and parental VAS diminished by 55% and 45% respectively and all parents reported an improvement in fatigue.


The use of a specific progressive resisted muscle strengthening programme using open chain exercise, with high reps and low weights has been shown to increase muscle strength, improve overall function and decrease pain in children with hypermobility. This can therefore considered to be an effective method of managing hypermobile children within an outpatient clinic.

To cite this abstract, please use the following information:
Maillard, Susan M., Adkins, David, Haggart, Elaine, Bhagat, Swati; Physiotherapy Management of Children with Hypermobility: A Review of an Out-Patient Self Management Exercise Programme. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1342
DOI: 10.1002/art.29108

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