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Paediatric hypermobility - what can help?

Exercise

Physical activity should be actively encouraged for all children with hypermobility. However, it is important that the child is fit enough to participate in the sport they wish to do. If this is not the case, the child may need to focus on building suitable strength and stamina before engaging in the new activity. Please also refer to section on pacing.

  • Encourage regular low impact strengthening exercises, such as swimming, walking and or/cycling.
  • Ensure that children avoid overstretching their joints.
  • Long periods of inactivity can make symptoms worse.
  • Avoid joints being in the same position for long periods of time; don’t give them a chance to get stiff! Move around regularly.
  • Encourage gentle exercise and movement throughout the day.

Footwear/orthotics

All children benefit from good supportive footwear. When purchasing shoes, ensure shoes are stiff around the heel, have a sturdy sole, soft uppers and preferably with laces to support the whole foot. If the ankle is unstable, then the child may find benefit from an ankle boot style, preferably lace up.

Orthotics are special insoles to be worn inside shoes to help hold the foot in a better functional position. They can be used for people with flat feet or where the foot turns in too much. They may also help with foot, ankle, and knee symptoms by reducing the amount of extra work that muscles have to do relating to hypermobility. You may require advice from GP/podiatrist or physiotherapist with this.

Diet

It is recommended that children eat a healthy balanced diet as excess weight can add stress to the joints and muscles which may increase symptoms of hypermobility.

Pacing/energy conservation

  • Balance periods of rest and activity during the day. Allow periods of rest before children become fatigued and/or sore.
  • Be mindful of how many activities need/want to be done during a day, managing the workload throughout the day can help overworking joints, alternating light/heavier work throughout the day.
  • Children who avoid activity due to their symptoms may benefit from pacing to get back to normal activities again. Pacing involves a gradual increase in activity. Not doing too much activity in one day but spreading it across a week. You should focus on building strength and slowly increase time spent doing an activity.
  • Avoid the “boom bust” style of pacing. Often people use pain and energy levels as a guide to their activities and pacing them. This means they risk doing too much activity on good days, which makes their pain worse. They are then forced to rest while the pain settles down. Activity little and often is better than lots of activity all in one go.

Pain management

  • Aches and pains associated with hypermobility are usually a result of muscle fatigue, not damage or injury.
  • Pain killers and NSAID’s are not usually effective.
  • Pacing/energy conservation strategies (above) can help children self-manage their pain.
  • Heat or ice: warm baths, hot water bottles or heat packs can help relax your child’s muscles. Ice can reduce swelling.
  • Distraction techniques: focusing on pain will make it feel worse. Keep children’s minds busy with activities to distract them.
  • You should take your child to their GP if their pain isn’t manageable.

Sleep

Sleep is very important for children with (and without) hypermobility. Encourage a good sleeping routine, including relaxation before bedtime. A warm room with soft lighting before bed is often helpful, with no screen time an hour before bed. Sometimes a warm bath or shower helps prepare the body for sleep.

School

  • Pen/pencil grips may provide comfort and easier grip to reduce the pressure needed for children to secure the pen/pencil in their hands.
  • When completing exams/ long pieces of work, children may benefit from using a computer, or changing between a computer and written work, as repetitive activities may increase symptoms. Children may require movement breaks during lengthy exams. An exam access arrangements assessment may be beneficial. You can discuss this with your child class teacher or additional learning needs co-ordinator (ALNCO).
  • Ensure children have a good posture in a seat, at the table (feet flat on floor, 90° angle at hips and knees, with bottom back in chair). A good sitting position aims to reduce the strain put on the joints.
  • Use of a writing slope may improve wrist position for writing.
  • Children with hypermobility may appear “fidgety” but they just need to move their joints and often fidget to gain stability. Prolonged floor sitting may be difficult. Encourage regular movement breaks, these are recommended to prevent joints from getting stiff.
  • Discourage “W sitting” (sitting with bottom between your feet).
  • Discourage carrying a bag over one shoulder; avoid carrying heavy items in the schoolbag. A rucksack using both shoulders is often best.
  • Using locker at School is recommended to reduce the strain put on joints in carrying items all at once in the school bag.
  • Children may need to be allowed more time to get between classes.
  • Unless told otherwise, children should participate as much as they can in P.E (the curriculum may need to be differentiated).
  • Avoid unnecessary high impact sports if the child is experiencing pain.
  • Have a plan to allow children to rest at school if they get overtired or in pain.

Self-care

  • Children may benefit from wide handled cutlery that widens the grasp and helps to reduce pain, fatigue and improve co-ordination. Cutlery may be widened using elastic bands, or pipe lagging. The same can be done for toothbrushes and smaller/thin items.
  • If children are struggling with buttons, zips and/or laces, choose bigger buttons/zips or trial different styles of clothing (i.e. Velcro, elastic lacing).

Kitchen

  • Keep everyday items such as cutlery, plate, (took ‘&’ out) bowl and glass at a level that is within easy reach (for example; at waist height to avoid over bending and overstretching).
  • Keep items used regularly in the same place, close to kettle, cooker etc.
  • Slide heavy items across worktop (e.g. milk) to avoid lifting them.
  • Consider using online shopping for groceries or do lots of small shopping trips per week.
  • Think about how much water is needed in a kettle. Do not fill the kettle full if you only require one cup. Travel kettles are often lighter in weight.
  • Minimise the weight of pots and pans by using a steamer, or cooking items in a wired chip basket or colander over saucepans that can be lifted out, so hot water does not need to be drained from the saucepan.
  • Dycem sheeting may be useful to open tight jars.

Hypermobility is a lifelong condition and ongoing self-management is fundamental. Self-management if one of the keys to living well with hypermobility. When people self-manage their difficulties, their quality of life usually improves.

You don’t have to make all these changes at once. By gradually incorporating these methods into day-to-day activities it will be easier to stick with them. If your child continues to experience significant pain and have functional difficulties despite using the strategies above consistently please contact our service on the contact details below.

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