Understanding the Complexities of Hypermobility and Aging
Joint hypermobility, or joint laxity, is a condition where joints can move beyond the typical range of motion. It's most commonly observed in childhood and often lessens over time as a person matures. This natural stiffening of collagen, the primary protein in connective tissues, leads many to believe that hypermobility is a temporary condition that will resolve with age. However, for individuals with hypermobility spectrum disorders (HSD) or heritable connective tissue disorders like Ehlers-Danlos Syndrome (hEDS), the story is far more complex.
The Decline in Flexibility Doesn't Mean Symptoms Disappear
The idea that hypermobility 'goes away' with age is misleading for those with symptomatic conditions. While the physical measure of joint flexibility may decrease, this is often a trade-off for new, and often more painful, issues. The underlying connective tissue defect doesn't resolve; it simply manifests differently over a person's lifespan. As the body stiffens, hypermobile individuals may lose their youthful flexibility but gain increased muscle stiffness, chronic pain, and a higher risk of early-onset osteoarthritis. This occurs because the joints have been under repeated stress for years, accumulating microtrauma that leads to degenerative changes.
Why Pain Often Increases with Age
Several factors contribute to the increase in pain and other symptoms as a hypermobile individual ages:
- Cumulative Joint Damage: Years of excessive joint movement, subluxations, and minor injuries place continuous stress on joints, leading to premature wear and tear on cartilage.
- Decreased Muscle Strength and Proprioception: Muscle weakness and poor proprioception (the body's sense of its position in space) are common in hypermobile individuals. As a person ages, natural muscle strength declines, further compromising joint stability and increasing the risk of injury.
- Compensatory Movement Patterns: To stabilize loose joints, the body develops compensatory muscle tension and movement patterns. Over time, these patterns can cause chronic muscle pain and imbalances throughout the body.
- Hormonal Changes: Significant hormonal shifts, such as those during menopause, can disrupt collagen production and exacerbate symptoms in individuals with hEDS.
The Impact of Hypermobility on Different Body Systems
Hypermobility and related conditions like hEDS are systemic, affecting more than just the joints. As a person with hEDS ages, systemic issues can become more pronounced. These can include:
- Cardiovascular Issues: Increased risk of mitral valve prolapse and dysautonomia, including Postural Orthostatic Tachycardia Syndrome (POTS), where blood vessels don't restrict properly.
- Gastrointestinal Problems: Slower gastric emptying, chronic constipation, and reflux due to connective tissue dysfunction in the gut.
- Neurological and Cognitive Effects: Increased brain fog, fatigue, and difficulties with executive function, often linked to chronic pain and sleep disturbances.
- Pelvic Floor Dysfunction: Higher rates of pelvic organ prolapse, particularly for women, which can be exacerbated by menopause.
Managing Hypermobility Across the Lifespan
Effective management is crucial to mitigating the long-term effects of hypermobility. A proactive approach can help maintain a good quality of life and slow the progression of symptoms.
| Hypermobility vs. Ehlers-Danlos Syndrome: A Comparison of Management | Feature | Benign Joint Hypermobility (BJH) | Hypermobile Ehlers-Danlos Syndrome (hEDS) |
|---|---|---|---|
| Severity | Often less severe; may cause occasional pain. | Can lead to widespread, multi-system issues. | |
| Symptom Progression | Symptoms often decrease with age, though pain can develop. | Pain and systemic issues may worsen with age, despite joint stiffening. | |
| Management | Focuses on strengthening muscles, posture, and joint protection. | Requires a comprehensive, multidisciplinary approach addressing systemic issues. | |
| Associated Conditions | Usually no other significant health issues. | Often associated with POTS, MCAS, and chronic fatigue. | |
| Prognosis | Generally good, with symptoms often manageable. | Varies widely; proactive management is key to slowing progression. |
Practical Strategies for Living with Hypermobility
- Strengthening Exercises: Work with a physical therapist knowledgeable about hypermobility to focus on joint stability. Low-impact activities like swimming, Pilates, and resistance training build muscle support without overstretching ligaments.
- Activity Modification: Learn to pace yourself to avoid fatigue and pain flare-ups. Modify movements to reduce joint stress, such as keeping a slight bend in your knees and elbows instead of locking them.
- Physical and Movement Therapy: A physical therapist can create a personalized plan to improve proprioception, stability, and movement patterns. In some cases, occupational therapy or rehabilitative chiropractic care may be beneficial.
- Joint Protection: Use braces, compression sleeves, or supportive footwear when needed to provide extra support and awareness. Avoid activities that cause pain or overextend joints, like contact sports.
- Holistic Management: Address systemic symptoms with the help of a multidisciplinary healthcare team. This may include a cardiologist for POTS, a gastroenterologist for digestive issues, and a counselor for managing stress and mental health.
- Nutrition and Hydration: A balanced diet and good hydration are important for overall tissue health. Some individuals may benefit from dietary changes, especially if they have associated conditions like Mast Cell Activation Syndrome (MCAS).
Conclusion
While the overt flexibility of hypermobility may lessen with age due to the natural stiffening of connective tissue, the underlying condition does not simply disappear. For those with symptomatic hypermobility or a connective tissue disorder, the decrease in flexibility is often accompanied by new and challenging symptoms, including increased pain, fatigue, and joint instability. Proactive management, guided by a knowledgeable healthcare team, is essential for improving long-term outcomes and maintaining quality of life. By focusing on joint stability, managing systemic issues, and listening to your body, individuals with hypermobility can navigate the complexities of aging and continue to lead active lives. For more information, visit The Hypermobility Syndromes Association.
