Primary topic:

MUSCULOSKELETAL: Spine

2nd topic:

Author(s):

Clark C.¹, Carr E.², Breen A.³

Text:

Purpose: 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 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). Symptoms of DCD 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 are known to persist into adulthood, and may continue to significantly affect the lives of adults with the condition (Cousin and Smyth 2003). The purpose of the study was to investigate the association of JHS and DCD and report on the prevalence of spinal pain.
Relevance: Adults with JHS frequently report accessing a range of health professionals throughout their lives. Multiple joint instabilities, soft tissue injuries and chronic spinal pain are thought to contribute to de-conditioning and the continuing cycle of pain and poor biomechanics. It is suggested that impaired motor control may not be just as a result of pain, but related to inherent coordination difficulties linked to DCD.
Participants: Participants (aged 18-65 years) included 90 with JHS recruited from a hypermobility clinic and 113 healthy volunteers with no pain recruited from a university setting.
Methods: Case comparison study in which the two study groups were compared using responses from questionnaires.
Analysis: Regression analysis to ascertain the association between age, gender, education and DCD. Pearson's chi square to investigate the correlation between JHS and DCD, odds ratios were calculated.
Results: There was no significant association between age, gender or education between the groups and their corresponding DCD scores. The percentage of participants 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 spinal pain at one site was 93%; the distribution of pain was; neck (67%), upper back (57%) and lower back (83%).
Conclusions: Participants with JHS were six times more likely to report DCD than healthy volunteers. Spinal pain is a major symptom for adults presenting with JHS.
Implications: There is a significant association between JHS and DCD in adults many of whom report spinal pain. It is suggested that interventions should address the integration of all sensory components contributing to motor control. JHS and DCD are genetic conditions which present at an early age. Early recognition and appropriate intervention may prevent long term pain, motor and functional impairments.

Key-Words:

1. Hypermobility
2. Coordination
3. Spinal pain

Funding acknowledgements:

Acknowledgements: Professor R. Grahame and Dr. H. Kazkaz, Hypermobility Clinic , University College London Hospitals, UK

Ethics approval:

National Hospital for Neurosurgery and Neurology and the Joint Institute of Neurology Research Ethics Committee, UK. (ref 09/H0716/5)