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Lunardi T.1, To M.2, Alexander C.M.2
1University of Birmingham, Birmingham, United Kingdom, 2Imperial College Healthcare NHS Trust, London, United Kingdom
Background: Joint Hypermobility Syndrome is characterised by unstable, overly flexible joints, multiple arthralgia and poor function. It differs to Generalised Joint Hypermobility, which is more common but generally asymptomatic. It is not fully understood why some flexible people have symptoms and some do not. However, people with Joint Hypermobility Syndrome are weak, therefore strengthening is often prescribed.
Purpose: This secondary analysis of a case control trial aimed to assess the relationships between strength and pain, medication consumption and activity in people with Joint Hypermobility Syndrome and to evaluate change in function to inform practice. Additionally, it aimed to help phenotype this condition by comparing these relationships to people who have Generalised Joint Hypermobility and average flexibility.
Methods: With ethical approval and informed consent, people with Joint Hypermobility Syndrome (n=47), Generalised Joint Hypermobility (n=26) and average flexibility (n=29) all with patellofemoral pain were recruited. They underwent a 16 week, goal directed strength programme. Outcomes included concentric and eccentric isokinetic torque (Cybex Leg Press), pain severity (Visual Analogue Scale), pain medication consumption each measured every two weeks, and activity measured every four weeks (Human Activity Profile). Knee function was assessed at the start and end of the programme (Lysholm score). Analysis was intention to treat and missing data were replaced with multiple imputed data to correlate torque with pain severity. Within group correlations were investigated using linear regression whereas between group analyses was performed comparing the validity of general and group specific regression models using none imputed data. Changes over time were analysed using Wilcoxon rank pairs and Friedmans tests.
Results: Eccentric and concentric isokinetic torque were inversely related to pain severity in the Joint Hypermobility Syndrome (B=-0.02, p 0.01 and B=-0.02, p 0.01 respectively) and Generalised Joint Hypermobility groups (B=-0.02, p 0.01 and B=-0.02, p 0.01 respectively). In the Control group a correlation was found for concentric but not for eccentric torque (B=-0.009, p 0.05 and B=-0.004, p>0.05 respectively). The sensitivity analysis on the raw data revealed inter-group differences in their relationships with pain (p 0.01).
Eccentric and concentric torque were inversely related to medication consumption in the Joint Hypermobility group (B=-0.28, p 0.01 and B=-0.30, p 0.05 respectively).
Eccentric but not concentric torque was related to an increase in activity (ρ=0.35, p 0.01 and ρ=0.05, p>0.05 respectively), which increased over time (p 0.05) in the Joint Hypermobility Group.
Torque could not be correlated with medication consumption or activity in the other two groups due to floor and ceiling effects respectively.
Knee function improved in all groups (p 0.05 for each group).
Conclusion(s): As eccentric torque increased, pain and medication consumption decreased and activity increased in the Joint Hypermobility Group. As concentric torque increased, pain and medication consumption decreased in the Joint Hypermobility Group. Correlations between torque and pain were not consistent across the three groups. Function improved in all groups.
Implications: Strengthening using a goal directed approach correlates with reduced pain, medication use and increased activity for people with Joint Hypermobility Syndrome supporting current practice. Studies to evaluate the effectiveness of physiotherapy are now required.
Funding acknowledgements: MT is supported by the Imperial College Healthcare Charity; CMA is supported by the National Institute of Health Research.
Topic: Musculoskeletal
Ethics approval: Harrow-London
All authors, affiliations and abstracts have been published as submitted.
