Are People With Joint Hypermobility Syndrome Slow to Strengthen?

  • May To
    Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
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  • Caroline M. Alexander
    Corresponding author Caroline M. Alexander, PhD, Department of Therapies, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, United Kingdom.
    Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom

    Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Published:December 29, 2018DOI:



      To investigate whether the rate of change of muscle strength in people with joint hypermobility syndrome (JHS) who have anterior knee pain (AKP) differs when compared to 2 control groups who have AKP and to evaluate the relationship between strength and pain as well as the effect of strength upon activity and knee function.


      A cohort study, with 3 groups: JHS with AKP, generalized joint hypermobility with AKP (GJH), and normal flexibility with AKP (control group [CG]). Follow-up appointments were performed every 2 weeks for 16 weeks.


      The physiotherapy outpatient department within a London (United Kingdom) hospital.


      A total of 102 people, aged between 18 and 55 years, were recruited between July 2014 and March 2016; 47 JHS, 29 GJH, and 26 CG (N=102). After 16 weeks, 31, 20, and 21 participants completed the study, respectively. Participants were recruited from support groups, a London hospital group and university, local sports centers, and clubs.


      Individualized leg exercises for 16 weeks.

      Main Outcome Measure

      Muscle torque generated from the lower limb, every 2 weeks for 16 weeks.


      There was no difference in the rate of change of concentric muscle strength between the JHS group and the CG or GJH group (P>.88 and P>.97). There was no difference in the rate of change of eccentric muscle strength between the JHS group and the CG or GJH group (P>.60 and P>.94). However, people with JHS were significantly weaker than the other 2 groups, taking 3 to 4 months to reach the baseline strength of the GJH group.


      People with JHS can strengthen at the same rate as other people in pain.


      List of abbreviations:

      AAS (adjusted activity score), AKP (anterior knee pain), ANOVA (analysis of variance), CG (control group), GJH (generalized joint hypermobility), HAP (human activity profile), EDS – H (Ehlers-Danlos Syndrome – hypermobility type), IQR (interquartile range), JHS (joint hypermobility syndrome), MDC (minimal detectable change), VAS (visual analog scale)
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