Hypermobility in Youth vs. Aging
In childhood and adolescence, hypermobility spectrum disorder (HSD) is often characterized by extreme flexibility and a susceptibility to joint sprains and subluxations. Many young people may perform impressive "party tricks" with their joints, and for some, these issues naturally decrease as their connective tissues stiffen with age. However, this natural decrease in flexibility is often misleading, as it does not mean the underlying condition improves.
The paradoxical effects of aging
For many, the stiffening of connective tissue masks the underlying joint instability rather than resolving it. This can lead to a deceptive reduction in obvious flexibility, while the deeper issues related to weakened collagen persist and even worsen. The change in the body’s mechanics over decades of compensating for loose ligaments can lead to new and more chronic problems.
The progression of symptoms with age
As individuals with HSD enter middle age and beyond, the challenges they face can shift dramatically from the more obvious joint laxity of their youth to more systemic, chronic issues. The cumulative stress on the body from years of compensating for joint instability takes its toll.
Musculoskeletal consequences
Over time, repeated microtrauma to the joints can lead to early-onset osteoarthritis. Muscles, working harder for decades to provide stability that ligaments can't, often develop tension and chronic strain. This manifests as widespread pain, stiffness, and fatigue. While the joints may appear less flexible on an exam, the pain and discomfort often intensify, leading to decreased mobility and function.
Systemic impacts on aging
Hypermobility spectrum disorder is not just a joint condition; it is a systemic disorder of connective tissue that can affect multiple body systems. As a person with HSD ages, these systemic symptoms can become more pronounced and debilitating.
- Cardiovascular issues: Autonomic nervous system dysfunction, such as postural orthostatic tachycardia syndrome (POTS), can worsen with age, leading to increased instances of dizziness, blood pressure instability, and fatigue.
- Gastrointestinal problems: Connective tissue weakness can affect the gut, leading to slower motility, gastroparesis, and chronic constipation.
- Pelvic health: Pelvic organ prolapse is a significant concern for women with HSD, with studies showing a high prevalence by midlife.
- Cognitive issues: Chronic pain and sleep disturbances can contribute to cognitive dysfunction, often referred to as “brain fog,” which can significantly impact quality of life.
Managing HSD symptoms in older adults
Effective management of HSD as one ages requires a multi-faceted and proactive approach. The goal shifts from accommodating flexibility to building stability and addressing chronic systemic issues. The key is to manage symptoms and prevent further damage rather than to try and "cure" the condition.
Conservative management strategies
Many strategies focus on non-invasive, therapeutic approaches to manage pain and improve function. Working with a multidisciplinary team of healthcare professionals is often crucial for the best outcomes.
- Physical therapy: A physiotherapist specializing in hypermobility can design a targeted strengthening program focusing on the stabilizing muscles around joints, without over-stretching already lax ligaments. This includes low-impact exercises like swimming and cycling.
- Pain management: Over-the-counter NSAIDs may help with mild pain, but more severe pain may require consultation with a pain management specialist.
- Proprioception training: Exercises to improve balance and coordination can help compensate for the body's diminished sense of joint position.
- Assistive devices: Braces, supportive footwear, and orthotics can provide external stability and reduce strain on vulnerable joints during daily activities.
HSD vs. normal aging: a comparison
| Feature | Normal Aging | Aging with HSD |
|---|---|---|
| Flexibility | Gradual, symmetrical decrease in overall flexibility. | Loss of extreme hypermobility, but often accompanied by increasing stiffness and chronic pain. |
| Joint Pain | May develop osteoarthritis, often linked to typical wear and tear. | Frequent joint pain often occurs earlier and is related to years of instability and microtrauma. |
| Energy Levels | General decrease in energy and stamina. | Chronic, debilitating fatigue is a hallmark symptom, often disproportionate to age. |
| Systemic Issues | Organ systems typically remain robust without specific genetic predisposition. | Increased risk and worsening of systemic conditions like dysautonomia, GI issues, and pelvic prolapse. |
| Injury Risk | Can increase due to decreased bone density and muscle mass. | Already elevated throughout life, risk continues with cumulative damage and less resilient connective tissue. |
Conclusion: a journey of management, not resolution
While the answer to does hypermobility spectrum disorder get better with age is complex, the reality for many is that symptoms don't disappear but rather evolve. The obvious joint flexibility of youth may diminish, but it is often replaced by chronic pain, fatigue, and other systemic issues caused by decades of strain on the body. Proactive management, focusing on stability, muscle strengthening, and addressing systemic complications with a knowledgeable healthcare team, is the key to maintaining a good quality of life. Educating oneself and working closely with specialists can help people with HSD navigate the unique challenges of aging with this condition, ensuring they manage their health effectively rather than simply reacting to new problems. For more information and support, the Ehlers-Danlos Society offers comprehensive resources on managing hypermobility as you age. Learn more at the Ehlers-Danlos Society.
The importance of specialist care
Given the complexity of HSD, particularly as it progresses, consulting with specialists is vital. A multidisciplinary team including a rheumatologist, physical therapist, and potentially a cardiologist or gastroenterologist can provide a comprehensive care plan. This approach ensures all aspects of the condition, from joint instability to systemic complications, are addressed effectively throughout the lifespan.
Exercise: the foundation of stability
Maintaining an appropriate exercise routine is critical for managing HSD at any age. While high-impact activities should be avoided, low-impact strength training is essential for building the muscular support needed to protect joints. Aquatic therapy can also be highly beneficial, providing resistance without the stress of gravity. The focus should be on controlled, safe movements that enhance stability rather than pushing the joints to their end ranges of motion.
