Joint Hypermobility and Lower Limb Injury – What Are The Risks

Joint hypermobility is often seen as an advantage or as a healthier status. How often have you heard someone say, “Oh, I can’t do that! I am stiff as!” while looking at someone else who can easily bend over and touch their toes. In this blog, we are going to take a look at the risk related to hypermobility and the lower-limb risk of injury.

What is Joint Hypermobility?

Joint hypermobility refers to the ability of a joint to move beyond the normal range of motion.

A joint is a structure made of ligaments that connect two or more bones, and when it is hypermobile, it is due to the connective tissue being looser or to variations in collagen.

It is hard to estimate the total number of people who are hypermobile, and there are also certain health conditions that are related to this presentation, but overall, the majority of people who are hypermobile do not suffer from any direct pain because of this presentation. On the other hand, if doing specific sports activities, the risk of injury may increase. We will see why later.

How Do We Test for Joint Hypermobility? – The Beighton Score

During a Myotherapy or Remedial Massage initial consultation, a hypermobility test is something that we commonly look at at the start of the session.

The Beighton Score allow us to determine the excessive hypermobility a patient may present with and helps us understand what range of motion we are expecting from specific movements.

The test consists of 9 passive movements that test the flexibility of the:

• Elbows;
• Knees;
• Fingers;
• Thumbs;
• Pelvis

Each side of the body is tested (for a total of 9 possible joints), and the higher the score, the more hypermobile the person is considered to be. The passive movement is delivered by the therapist, which moves the patient’s joint.

Beighton Score Tests:

• Bending the index or middle finger backward beyond 90° (one point each side)

• Bending the thumb back to touch the forearm (one point on each side)

• Hyperextension of the elbows beyond 10° (one point each side)

• Hyperextension of the knees beyond 10° (one point each side)

• Bending forward with straight knees and placing palms flat on the floor (one point)

Scores:

• 0 to 2 points – Hypomobile
• 3 to 4 points – Norms
• 5 to 9 points – Hypermobile

What the Research Says About Injury Risk

A systematic review from Pacey et al. (2010) found that:

• Knee injuries are significantly more common in hypermobile athletes, especially in contact sports such as football, rugby, and basketball.

• The risk of knee injury was up to 4.7 times higher in hypermobile individuals compared to their non-hypermobile peers.

• Interestingly, ankle injuries did not show the same increased risk.

This systematic review concluded that yes, hypermobility may increase the risk of injury, but only for specific joints.

Why Are Hypermobile Joints at Risk?

Now, let’s try to understand why hypermobile joints are at risk.

• Joint instability: Looser ligaments provide less support and lack stability.

• Muscle overcompensation: Muscles around the joint may have to work harder to stabilise movement.

• Delayed proprioception: Hypermobile individuals may have reduced awareness of joint positioning, making them more susceptible to awkward landings or twists.

These factors combine to place increased strain on the knees, particularly during high-impact and contact activities.

Managing Joint Hypermobility with Strength Training

Joints’ hypermobility is not something that can be changed to the extent of the ligament’s lack of stiffness, at least to any significant level (when looking at adults), but it can be managed via strengthening the muscles that cross the hypermobile joint.

Benefits of Strength Exercises for Joint Hypermobility:

• Improved joint stability: Stronger muscles support the joints and reduce reliance on ligaments.

• Better proprioception and control: Resistance training helps improve coordination and joint-position awareness.

• Injury prevention: By creating balanced strength around vulnerable joints (like the knee), you can reduce the likelihood of strains, sprains, and dislocations.

Practical Exercise Tips:

• Focus on controlled movements over heavy lifts – Lifting heavy helps you build hypertrophy in the muscle.

• Incorporate closed-chain functional exercises (like squats, lunges, and leg presses) that mimic real-life movements.

• Train the stabiliser muscle of the body:

  • Calf muscles for the ankles

  • Quads, hamstrings for the knee

  • Abdominal muscles for the lumbar area

  • Cuff rotator muscles for the shoulders

  • Biceps and triceps for the elbows

This is a breakdown and a simplification of what can be done. But when going for strength training, you can be sure that all those muscles would be included in any generic workout.

Final Thoughts

Hypermobility is not a limitation; it’s simply a characteristic of how your body moves. However, when combined with physical activity, especially in contact sports, it is associated with a higher risk of knee injuries.

The good news is that strength training and targeted rehabilitation can help protect hypermobile joints, improve performance, and keep athletes active for longer.

If you suspect you have hypermobility, book a Fitness Class here at Melbourne Massage and Treatment, Fitzroy North, and let’s start working on your presentation by choosing your goals and achieving them step by step.

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