Generalized joint hypermobility in professional dancers: a sign of talent or vulnerability?

Scheper, Mark; Vries, Janneke E. de; Vos, Rien de; Verbunt, Jeanine; Nollet, Frans; Engelbert, Raoul

doi:10.1093/rheumatology/kes220

Cited by 64 publications

(73 citation statements)

References 40 publications

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“…As connective tissue stiffness cannot be influenced, the effect of muscle strength training may be limited. However, these findings were reported [18] in adolescents and young adults which were more flexible compared to the currently included population. The only influence on tissue stiffness is aging.…”

Section: Discussionmentioning

confidence: 74%

“…Previous research has shown that the presence of GJH is an independent factor associated with muscle weakness, not only in subjects with symptomatic forms of GJH but also in healthy professional dancers. [18] It can be hypothesized that muscle weakness is not only the result of deconditioning, but is partially caused by the inefficient force transfer through muscle fibers due to altered structural integrity of connective tissue. [39] If this hypothesis is true, it could have consequences for the trainability of muscle strength in EDS-HT patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, 24 female healthy volunteers participated. Exclusion criteria for the control subjects were: (1) a Beighton score <4/9, [18] (2) any musculoskeletal pain at present, and (3) the use of analgesics or antidepressants. Written informed consent was obtained from all the participants according to the Helsinki Declaration.…”

Section: Participantsmentioning

confidence: 99%

“…Muscle strength might be an important determinant of activity limitations, however, a direct relationship between muscle strength and activity limitations in EDS-HT has never been demonstrated. Muscle weakness and atrophy have frequently been observed in both non-symptomatic [18] (e.g. dancers) and symptomatic forms of GJH (e.g.…”

Section: Introductionmentioning

confidence: 99%

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The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Scheper

Rombaut

Vries

et al. 2016

Disability and Rehabilitation

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Purpose: The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. Methods: Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. Results: Muscle strength was associated with 30CRT (r ¼ 0.67, p ¼ <0.001), 6MWT (r ¼ 0.58, p ¼ <0.001) and HAQ (r ¼ 0.63, p¼ <0.001). Proprioception was associated with 30CRT (r ¼ 0.55, p < 0.001), 6MWT (r ¼ 0.40, p ¼ <0.05) and HAQ (r ¼ 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. Conclusions: Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. ä IMPLICATIONS FOR REHABILITATIONReducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Scheper

Rombaut

Vries

et al. 2016

Disability and Rehabilitation

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“…12 Furthermore, a recent study reported that elite-level adolescent and adult dancers with GJH aged 17 to 27 years have more musculoskeletal complaints, more fatigue, and reduced physical fitness level compared to dancers and nondancers without GJH. 39 Adult elite-level athletes perceive injuries more often than nonelite athletes, and GJH is suggested to lead to an increased injury frequency. 33 Reasons for an increase in injury frequency in those with GJH may include ligamentous laxity and reduced knee joint proprioception, as found previously in a study of children aged 8 to 15 years with HMS.…”

mentioning

confidence: 99%

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

Schmidt¹,

Pedersen²,

Junge

et al. 2017

J Orthop Sports Phys Ther

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U t STUDY DESIGN:Cross-sectional. U t BACKGROUND:Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. U t OBJECTIVE:To assess the prevalence of GJH in elite-level adolescent athletes, and to study the association of GJH with pain, function, HRQoL, and musculoskeletal injuries. U t METHODS:A total of 132 elite-level adolescent athletes (36 adolescent boys, 96 adolescent girls; mean ± SD age, 14.0 ± 0.9 years), including ballet dancers (n = 22), TeamGym gymnasts (n = 57), and team handball players (n = 53), participated in the study. Generalized joint hypermobility was classified by Beighton score as GJH4 (4/9 or greater), GJH5 (5/9 or greater), and GJH6 (6/9 or greater). Function of the lower extremity, musculoskeletal injuries, and HRQoL were assessed with self-reported questionnaires, and part of physical performance was assessed by 4 postural-sway tests and 2 single-legged hop-for-distance tests. U t RESULTS:Overall prevalence rates for GJH4, GJH5, and GJH6 were 27.3%, 15.9%, and 6.8%,

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Hypermobile Ehlers–Danlos syndrome (a.k.a. Ehlers–Danlos syndrome Type III and Ehlers–Danlos syndrome hypermobility type): Clinical description and natural history

Tinkle

Castori²,

Berglund

et al. 2017

American J of Med Genetics Pt C

331

345

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The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder.

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Generalized joint hypermobility in professional dancers: a sign of talent or vulnerability?

Cited by 64 publications

References 40 publications

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

Hypermobile Ehlers–Danlos syndrome (a.k.a. Ehlers–Danlos syndrome Type III and Ehlers–Danlos syndrome hypermobility type): Clinical description and natural history

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