Hypermobility, coordination and spinal pain: an inherent association
Journal: Manipulative Assocition of Chartered Physiotherapists Study Day
INTRODUCTION Joint hypermobility syndrome (JHS) is a multisystem connective tissue disorder. Pain enhancement, chronic pain, dislocations, and soft tissue rheumatism are some of the symptoms associated with this common but largely unrecognised condition (Grahame and Hakim 2006). It has also been suggested that some patients with JHS show poor coordination and movement patterns which contribute to biomechanical dysfunction and chronic pain (Clark et al 2009). Pain and coordination difficulties have been observed in children with JHS (Adib et al 2005) and there are similarities in the functional difficulties reported by children with either a diagnosis of JHS or developmental coordination disorder (DCD) (Kirby and Davies 2006). DCD is the preferred term for children with motor skill impairments in the absence of a neuromuscular disorder. Symptoms include poor proprioception, motor planning, visual spatial awareness and the retention of primitive reflexes which impact on activities of daily living. Motor impairments associated with DCD persist into adulthood (Cousin and Smyth 2003).
PURPOSE OF STUDY To investigate the association of JHS and DCD in adults and compare the reporting of spinal pain in those with JHS and DCD.
METHODS Subjects comprised 90 participants with JHS recruited from a hypermobility clinic compared with 113 healthy volunteers recruited from a university. The data was examined by regression. Odds ratios for JHS and DCD were calculated.
RESULTS The percentage of subjects who reported DCD in the JHS and healthy volunteer groups were (55.6%) and (18.6%) respectively. A significant association between group membership and the reporting of DCD was noted, chi square = 30.11, p < .001. Participants with JHS were 6 [95% CI 2.9 – 10.3] times more likely to report DCD than healthy volunteers. The percentage of participants with JHS who reported neck, upper and lower back pain were 67%, 57% and 83% respectively. There was a significant association between those with JHS and neck pain who reported DCD, chi square = 4.40, p < .05. Participants with JHS and neck pain were 3 [95% CI 1.1 – 6.4] times more likely to report DCD than no DCD.
CONCLUSIONS Participants with JHS are more likely to report DCD than healthy volunteers. A high percentage of participants with JHS report spinal pain. Participants with JHS and neck pain are more likely to report DCD.
IMPLICATIONS/RELEVANCE FOR PHYSIOTHERAPY PRACTICE For those presenting with JHS and DCD early recognition and a multidisciplinary approach are required in which physiotherapy plays a leading role.
ETHICS APPROVAL: National Hospital for Neurosurgery and Neurology and the Joint Institute of Neurology Research Ethics Committee (ref 09/H0716/5)