I was going to write this as part of the previous blog but I suspect it’s going to turn out too long so I’ve given it its own space.
One of the reasons suggested to me as to why both times the ACL has been reconstructed it appears to have failed, is the idea that I may have hypermobile knees.
I don’t know if this is the case or not but the concept of being overly flexible was fairly amusing given that:
Flexibility was certainly not my strong point when I was doing gymnastics (I was much more of a tumbler/vaulter with a decent sense of balance for beam than one of those gymnasts with great split leaps or a bendy back);
Since giving up gymnastics and trampolining, I’ve always joked that you only have so much flexibility to last a lifetime and I think I used mine up before the age of 16. A brick would probably be more flexible these days; and
While my legs do extend beyond 0 degrees, straight legs were also never my forte!
But I digress.
Having done some desk research, hypermobility does seem to be a factor blamed for failed ACL reconstructions but the definitions of hypermobility are relatively vague.
The NHS website describes Joint Hypermobility Syndrome as being when your joints are more flexible than other people’s (you may think of yourself as being double jointed). When this causes pain, it might be joint hypermobility syndrome.
It goes on to suggest that you see your GP if you:
Often get pain or stiffness in your joints or muscles
Keep getting sprains and strains
Keep dislocating your joints
Have poor balance or co-ordination
Have thin, stretchy skin
Have digestive problems like diarrhoea or constipation
Well, I’ve certainly never thought of myself as double jointed and I wouldn’t say it’s ever caused me any pain in and of itself. I do get pain or stiffness in my joints/muscles and sprains and strains never seem to fully heal but I’d say that’s more about getting older than anything else. The only joint that dislocates is this stupid knee, I’m only poorly balanced/co-ordinated if I’ve been drinking, I don’t think my skin’s particularly thin or stretchy, nor are digestive problems a particular issue. I did also see one article suggesting that mega fast labours are another sign of joint hypermobility syndrome and can safely say, following my experience with my little girl, that that isn’t the case here either.
So, for a diagnosis of joint hypermobility, does it just have to impact one joint or several? From what I’ve read, I think you can be diagnosed as having hypermobility in one or more joints but, for it to be classed as Joint Hypermobility Syndrome, it will likely affect more than one joint and also involve an array of other ‘minor’ symptoms. On that basis, I guess it’s possible that I do have hypermobile knees but, unless I’m going to be melodramatic about day-to-day things, I don’t think it goes any further than that.
Which brings me on to diagnosing Joint Hypermobilty Syndrome using the Beighton Score, particularly in current or former athletes.
The NHS website states that if a GP suspects Joint Hypermobility Syndrome, they are likely to carry out a series of tests to explore the extent of that hypermobility, scoring the results against a scale known as The Beighton Score to confirm or rule out the diagnosis.
The Beighton Score awards points for physical features as follows:
Bend a knee backwards – 1 point for each side
Bend an elbow backwards – 1 point for each side
Bend a thumb backwards onto your forearm – 1 point for each side
Bend a little finger back more than 90 degrees – 1 point for each side
Put hands flat on floor with knees straight – 1 point
A score of four or more is suggestive of Joint Hypermobility Syndrome.
The site also links to the Hypermobility Syndromes Association for a visual guide to these tests
Doctors can also use the more-detailed Brighton criteria to aid their diagnosis, while the scoring system seems to apply whether you display any of the features today or have done so in the past.
Now is it just me or do those tests seem fairly basic? For example, I wouldn’t have thought it is that unusual to be able to place your hands flat on the floor with your legs straight, particularly not if you’re a gymnast, other sportsperson, yoga practitioner or regular gym goer.
As children we’re also generally more flexible than we are as adults so it certainly wouldn’t surprise me if most people could score four or more pretty easily as a child. If you add to that the fact I actually remember playing with my friends at primary school and trying to bend our thumbs backwards onto our forearms and bend our little fingers back more than 90 degrees (okay, so we were weird kids!), some of us couldn’t do it at the start but after a few weeks practising, most of us could. Does that mean we were all have Joint Hypermobility Syndrome? Is hypermobility something that’s a genetic trait, a condition that is ‘trained’ or a bit of both? And if hypermobility is a risk factor for serious joint injuries, what does that mean for participation in sport – particularly those that require real flexibility – and / or the training regimes followed by young people pursuing sport at a competitive or elite level? Should we be screening for potential issues and developing 'preventative' training programmes to enable safe participation for those predisposed to hypermobility problems?
As I said earlier in this blog, there is a lot of musing but I’m particularly interested given my own history (how I got here, what that may or may not mean for finding a workable solution) and also as my three year old now does (and loves) gymnastics. How do I help her get the most out of the sport without setting her up for problems down the line?
I’d love to have time to research this (and many other aspects of ACL injury/factors/treatment options etc.) properly but life means that simply isn’t an option at the moment.
For any readers involved with gymnastics or similar sports though, I do want to flag the SHIFT movement science and gymnastics education sites with you, which are full of interesting articles and ideas.
And Facebook page:
The website homepage is a bit ‘inbound marketing’ but if you can get past that there’s lots of thought-provoking information – I just wish I had more time to read and critically evaluate the articles in more detail. One day….!
On which point, as expected, this blog is going on a bit and I need to head off. I’m sure it’s a theme I’ll come back to but, in the meantime, I’ll leave you with a selection of links to articles on Hypermobility and ACL which may also be useful.
Apologies again that I’ve not had chance to evaluate them properly before posting (hopefully I’ll get chance to do so in the not too distant future) but, in the meantime, they should at least provide further reading and a little food for thought.