![]() ![]() Children with JHS and pain have reduced physical activity and participation in functional childhood tasks such as helping round the home or riding a bike. In the presence of chronic joint pain, or in conjunction with multi-system involvement of the skin, eyes, or cardiovascular system, hypermobile individuals meet the diagnosis of Joint Hypermobility Syndrome (JHS) using the Brighton criteria. Knee pain is the most common musculoskeletal complaint in these children. While children with GJH can be asymptomatic, reports of musculoskeletal symptoms in hypermobile individuals are increasing and children with GJH are at greater risk of developing chronic pain. The prevalence of GJH in children varies across populations, due to differing methodologies and ethnicities, with rates varying from 12% of Turkish adolescents, 16% of Egyptian children, 28% of Chinese adolescents, 35% of Italian school-aged children and 59% of Indian children. Generalised joint hypermobility (GJH) is prevalent in 27.5% of girls and 10.6% of boys of mixed races in the United Kingdom and is diagnosed when greater than normal physiological range of motion is evident in multiple joints. Trial registrationĪustralia & New Zealand Clinical Trials Registry ACTRN12606000109505. A physiotherapist prescribed, supervised, individualised and progressed exercise programme effectively reduces knee pain in children with JHS. Parents perceive improved child psychosocial health when children exercise into the hypermobile range, while exercising to neutral only is perceived to favour the child’s physical health. No other differences were found between groups and no adverse events occurred. Conversely, parent-reported overall physical health significantly favoured exercising only to neutral (p=0.037). Significant differences between treatment groups were noted for parent-reported overall psychosocial health (p=0.009), specifically self-esteem (p=0.034), mental health (p=0.001) and behaviour (p=0.019), in favour of exercising into the hypermobile range (n=11) compared to neutral only (n=14). Significant improvements in child-reported maximal knee pain were found following treatment, regardless of group allocation with a mean 14.5 mm reduction on the visual analogue scale (95% CI 5.2 – 23.8 mm, p=0.003). ResultsĬhildren with JHS and knee pain (n=26) aged 7-16 years were randomly assigned to the hypermobile (n=12) or neutral (n=14) treatment group. Assessors were blinded to the participants’ treatment allocation and participants blinded to the difference in the treatments. Quality of life, thigh muscle strength, and function were also measured at (i) initial assessment, (ii) following the baseline period and (iii) post treatment. Randomisation was computer-generated, with allocation concealed by sequentially numbered opaque sealed envelopes. ![]() MethodsĪ prospective, parallel-group, randomised controlled trial conducted in a tertiary hospital in Sydney, Australia compared an 8 week exercise programme performed into either the full hypermobile range or only to neutral knee extension, following a minimum 2 week baseline period without treatment. This study aimed to (i) determine if a physiotherapist-prescribed exercise programme focused on knee joint strength and control is effective in reducing knee pain in children with JHS compared to no treatment, and (ii) whether the range in which these exercises are performed affects outcomes. No trial has previously examined whether exercising to neutral or into the hypermobile range affects outcomes. Knee pain in children with Joint Hypermobility Syndrome (JHS) is traditionally managed with exercise, however the supporting evidence for this is scarce. ![]()
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