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Are People With Joint Hypermobility Syndrome Slow to Strengthen?

  • May To
    Affiliations
    Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom
    Search for articles by this author
  • Caroline M. Alexander
    Correspondence
    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.
    Affiliations
    Department of Therapies, Imperial College Healthcare NHS Trust, London, United Kingdom

    Department of Surgery and Cancer, Imperial College London, London, United Kingdom
    Search for articles by this author
Published:December 29, 2018DOI:https://doi.org/10.1016/j.apmr.2018.11.021

      Abstract

      Objectives

      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.

      Design

      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.

      Setting

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

      Participants

      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.

      Interventions

      Individualized leg exercises for 16 weeks.

      Main Outcome Measure

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

      Results

      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.

      Conclusion

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

      Keywords

      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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      References

        • Tinkle B.T.
        • Bird H.A.
        • Grahame R.
        • Lavallee M.
        • Levy H.P.
        • Sillence D.
        The lack of clinical distinction between the hypermobility type of Ehlers-Danlos syndrome and the joint hypermobility syndrome (a.k.a. hypermobility syndrome).
        Am J Med Genet A. 2009; 149A: 2368-2370
        • Grahame R.
        • Bird H.A.
        • Child A.
        The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS).
        J Rheumatol. 2000; 27: 1777-1779
        • Beighton P.
        • Horan F.
        Orthopaedic aspects of the Ehlers-Danlos syndrome.
        J Bone Joint Surg Br. 1969; 51: 444-453
        • Grahame R.
        Hypermobility: an important but often neglected area within rheumatology.
        Nat Clin Pract Rheumatol. 2008; 4: 522-524
        • Castori M.
        • Tinkle B.
        • Levy H.
        • Grahame R.
        • Malfait F.
        • Hakim A.
        A framework for the classification of joint hypermobility and related conditions.
        Am J Med Genet C Semin Med Genet. 2017; 175: 148-157
        • To M.
        • Simmonds J.
        • Alexander C.
        Where do people with joint hypermobility syndrome present in secondary care? The prevalence in a general hospital and the challenges of classification.
        Musculoskeletal Care. 2017; 15: 3-9
        • Rombaut L.
        • Malfait F.
        • De Wandele I.
        • et al.
        Muscle mass, muscle strength, functional performance, and physical impairment in women with the hypermobility type of Ehlers-Danlos syndrome.
        Arthritis Care Res (Hoboken). 2012; 64: 1584-1592
        • Sahin N.
        • Baskent A.
        • Ugurlu H.
        • Berker E.
        Isokinetic evaluation of knee extensor/flexor muscle strength in patients with hypermobility syndrome.
        Rheumatol Int. 2008; 28: 643-648
        • Engelbert R.H.
        • Juul-Kristensen B.
        • Pacey V.
        • et al.
        The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome.
        Am J Med Genet C Semin Med Genet. 2017; 175: 158-167
        • Hills R.
        • Kitchen S.
        Development of a model of patient satisfaction with physiotherapy.
        Physiother Theory Pract. 2007; 23: 255-271
        • Chartered Society of Physiotherapy
        Quality assurance standards for physiotherapy service delivery. Code of members' professional values and behaviours.
        Chartered Society of Physiotherapy, London2012: 1-37
        • Crossley K.M.
        • Stefanik J.J.
        • Selfe J.
        • et al.
        2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures.
        Br J Sports Med. 2016; 50: 839-843
        • Witvrouw E.
        • Werner S.
        • Mikkelsen C.
        • Van T.D.
        • Vanden Berghe L.
        • Cerulli G.
        Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment.
        Knee Surg Sports Traumatol Arthrosc. 2005; 13: 122-130
        • Booshanam D.S.
        • Cherian B.
        • Joseph C.P.
        • Mathew J.
        • Thomas R.
        Evaluation of posture and pain in persons with benign joint hypermobility syndrome.
        Rheumatol Int. 2011; 31: 1561-1565
        • Leone V.
        • Tornese G.
        • Zerial M.
        • et al.
        Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study.
        Arch Dis Child. 2009; 94: 627-632
        • Harvie D.
        • O'Leary T.
        • Kumar S.
        A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works?.
        J Multidiscip Healthc. 2011; 4: 383-392
        • Bolgla L.A.
        • Boling M.C.
        An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010.
        Int J Sports Phys Ther. 2011; 6: 112-125
        • Keays S.L.
        • Mason M.
        • Newcombe P.A.
        Individualized physiotherapy in the treatment of patellofemoral pain.
        Physiother Res Int. 2015; 20: 22-36
        • Beighton P.
        • Grahame R.
        • Bird H.
        Hypermobility of joints.
        4th ed. Springer, London2012
        • Heintjes E.M.
        • Bierma-Zeinstra S.M.
        • Berger M.Y.
        • Koes B.W.
        Lysholm scale and WOMAC index were responsive in prospective cohort of young general practice patients.
        J Clin Epidemiol. 2008; 61: 481-488
        • Davidson M.
        • de Morton N.
        A systematic review of the Human Activity Profile.
        Clin Rehabil. 2007; 21: 151-162
        • Esco M.R.
        Resistance training for health and fitness.
        American College of Sports Medicine, Indianapolis2017
        • Clark D.I.
        • Downing N.
        • Mitchell J.
        • Coulson L.
        • Syzpryt E.P.
        • Doherty M.
        Physiotherapy for anterior knee pain: a randomised controlled trial.
        Ann Rheum Dis. 2000; 59: 700-704
        • Laird N.M.
        • Ware J.H.
        Random-effects models for longitudinal data.
        Biometrics. 1982; 38: 963-974
        • Kelly A.M.
        The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain.
        Emerg Med J. 2001; 18: 205-207
        • Collins N.J.
        • Misra D.
        • Felson D.T.
        • Crossley K.M.
        • Roos E.M.
        Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS).
        Arthritis Care Res (Hoboken). 2011; 63: S208-S228
        • Scheper M.
        • Rombaut L.
        • de Vries J.
        • et al.
        The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception.
        Disabil Rehabil. 2017; 39: 1391-1397
        • Jindal P.
        • Narayan A.
        • Ganesan S.
        • MacDermid J.C.
        Muscle strength differences in healthy young adults with and without generalized joint hypermobility: a cross-sectional study.
        BMC Sports Sci Med Rehabil. 2016; 8: 12
        • Scheper M.C.
        • de Vries J.E.
        • Juul-Kristensen B.
        • Nollet F.
        • Engelbert R.H.
        The functional consequences of generalized joint hypermobility: a cross-sectional study.
        BMC Musculoskelet Disord. 2014; 15: 243
        • Jones D.A.
        • Rutherford O.M.
        Human muscle strength training: the effects of three different regimens and the nature of the resultant changes.
        J Physiol. 1987; 391: 1-11
        • Bathen T.
        • Hangmann A.B.
        • Hoff M.
        • Andersen L.O.
        • Rand-Hendriksen S.
        Multidisciplinary treatment of disability in Ehlers-Danlos syndrome hypermobility type/hypermobility syndrome: a pilot study using a combination of physical and cognitive-behavioral therapy on 12 women.
        Am J Med Genet A. 2013; 161A: 3005-3011
        • Palmer S.
        • Cramp F.
        • Clark E.
        • et al.
        The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome.
        Health Technol Assess. 2016; 20: 1-264