Hypermobility in Kids and Teens: What Parents Need to Know (and How Physio Can Help)
By Kaitlin, Physiotherapist, Maylands Healthcare Hub
What Is Joint Hypermobility?
Hypermobility means a joint moves beyond what's considered a typical range of motion. It's common in children as their ligaments are naturally more elastic than adults' and most children will grow out of it without any issue. In some kids though, that extra range isn't matched by enough muscle strength and control around the joint, and that's when we start to see problems: fatigue, pain, frequent sprains, or a general "floppiness" that affects coordination.
When hypermobility is widespread (affecting multiple joints) and starts causing symptoms, we call it Hypermobility Spectrum Disorder (HSD) or, in some cases, Hypermobile Ehlers-Danlos Syndrome (hEDS). These aren't things to panic about. They're manageable, and physio plays a central role in that management.
How We Measure It: The Beighton Score
One of the first things we do in an objective assessment is the “Beighton score” which is a simple, well-established 9-point screening tool that checks how far specific joints move. It looks at:
Whether the little finger bends back past a 90° angle
Whether the thumb can be pulled back to touch the forearm
Whether the elbow bends backward past straight
Whether the knee bends backward past straight
Whether the palms can be placed flat on the floor with the knees straight.
Under the 2017 international criteria, a score of 6 or more out of 9 is generally considered generalised hypermobility in children and teens, though this criteria is not accurate when used alone as young joints are naturally quite flexible (Malfait et al., 2017). The Beighton score is just a starting point though; it tells us how bendy a child is, not whether they're struggling because of it. That's why I always pair it with a full functional assessment: how they move, how they fatigue, and where they're compensating. Ensuring I combine this with a thorough history and background of the individual child.
Signs to Look Out for in Children:
Parents often don't realise these are connected to hypermobility until we join the dots together in clinic:
Sitting in "W" position habitually
Complaining of sore legs at night (often dismissed as "growing pains")
Tiring quickly during sport or even standing for long periods
Frequent ankle rolls or "clumsiness"
Avoiding activities other kids their age enjoy, without an obvious reason
The ADHD Connection
This is quite surprising: there's a growing body of research linking joint hypermobility with neurodevelopmental conditions like ADHD. Dr James Kustow in the 2019 Ehlers Danlos Society Conference discussed the link that many children with ADHD are significantly more likely to score as hypermobile, and adults with ADHD have been shown in research to be several times more likely to have generalised joint hypermobility than those without it (Kustow, 2019).
The leading theory is that both may share an underlying connective tissue and dysautonomia or basically a nervous system link possibly related to how collagen is formed and how it affects both joints and brain development (Kustow, 2019). It's an active area of research so this evidence and then the guidelines supporting this still emerging, but it's useful context: if your child has ADHD and also seems accident-prone, fatigues quickly, or complains of joint or muscle pain, it's worth having them assessed for hypermobility alongside everything else.
How Paediatric Physio Helps
This is where we spend most of our time with hypermobile kids and teens. The goal isn't to "fix" flexibility. It's to build the strength, control, and body awareness (proprioception) around the joints so that extra range stops being a liability. A typical plan focuses on your child’s goals but can include some of the following::
Targeted strengthening for the muscles that stabilise lax joints
Proprioceptive and balance training to reduce clumsiness and injury risk
Movement education: teaching joints to move in safer, more controlled patterns
Pacing strategies for kids who fatigue quickly during sport or school days
Pain management techniques for those already experiencing discomfort
Where Clinical Pilates Fits In
Clinical Pilates is one of our favourite tools for hypermobile kids, and there's a good reason for that. It's low-impact, health professional led, and highly controllable. This matters a lot when you're working with joints that move too freely. Collections of various different studies (systematic review) looking at Pilates programs for children with generalised joint hypermobility has proven that improvement can be seen in muscle strength, reduction in fatigue, and better quality of life after in even a matter of weeks (Hornsby and Johnston, 2020).
In sessions, we use Pilates-based exercises to retrain the stabilising muscles around the shoulders, hips, knees, and spine. Building the kind of steady, controlled strength that supports a hypermobile joint rather than letting it move unchecked. For teens especially, it's also a great way to build confidence in their bodies again, particularly if pain or clumsiness has made them wary of sport or exercise.
What to Expect at Maylands
When you bring your child in, we start with a full assessment. This may include Beighton scoring, a look at how they move functionally, and a conversation about what's been happening day-to-day (pain, fatigue, sport, sleep, coordination). From there, we build a plan tailored to them, usually combining hands-on physiotherapy with a progressive clinical Pilates program as they build strength and confidence.
If any of this sounds familiar: the bendy joints, the sore legs after sport, the clumsiness that doesn't quite add up. It's worth getting it looked at properly rather than waiting for it to become a bigger problem.
Ready to get your child's movement checked? Book a paediatric physiotherapy assessment with Kaitlin at Maylands Healthcare Hub, and find out whether clinical Pilates could be the right next step for your child.
References:
Hornsby, E., & Johnston, L. M. (2020). Effect of Pilates intervention on physical function of children and youth: A systematic review. Archives of Physical Medicine and Rehabilitation, 101(2), 317–328.https://doi.org/10.1016/j.apmr.2019.05.023
Kustow, J. (2019, November 2). Linking ADHD and EDS/HSD [Conference presentation]. EDS Conference, Edinburgh, Scotland. https://www.ehlers-danlos.com/wp-content/uploads/2022/12/Kustow-ADHD-EDS-HSD-Edinburgh-2019.pdf
Malfait, F., Francomano, C., Byers, P., Belmont, J., Berglund, B., Black, J., Bloom, L., Bowen, J. M., Brady, A. F., Burrows, N. P., Castori, M., Cohen, H., Colombi, M., Demirdas, S., De Backer, J., De Paepe, A., Fournel-Gigleux, S., Frank, M., Ghali, N., … Tinkle, B. (2017). The 2017 international classification of the Ehlers–Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 8–26.https://doi.org/10.1002/ajmg.c.31552
