Hypermobility Tests – Conduct your own Beighton Score.

by | Jan 3, 2022 | Chronic Conditions

Are you worried you are Hypermobile?

Hypermobility is estimated to affect between 10-20% of the total population. It occurs on a sliding scale from mild hypermobility to advanced, clinical hypermobility. It is measured with the Beighton Score.

The Beighton Score is a simple scale of 0-9 based on 5 different tests. A point is given for each joint that is hypermobile. The joints and movements tested are:

  1. Little finger extension x 2
  2. Thumb extension x2
  3. Elbow elbow extension x2
  4. Knee extension x2
  5. Hamstrings x1

 

 

Studies on the prevalence of generalised Hypermobility

A large study conducted in the UK on 6000 children in 2011 found that 27% of girls and 10% of boys aged 13 had some form of hypermobility (a score of >3 on the Beighton Score).

Another study, this time on American College students in 2019, found 12.5% of the student population scored >4.

Clinical Hypermobility (a score >7) is rare and commonly only occurs in those with Ehlers Danlos syndrome which affects about 1 in every 5000. You can find out more about Ehlers Danlos here.

 

What can I do if I am Hypermobile?

Fortunately, there has not been any evidence to date that those with hypermobility are more likely to suffer an injury. There is, however, evidence that when those with hypermobility do suffer an injury, the severity can be worse.

It therefore makes sense to choose sports where severe injury, such a joint dislocations and fractures, are less common, which might involve avoiding contact sports.

There is emerging evidence that heavy strength training may play a protective role for joint hypermobility, so a well-programmed weight training program may be of benefit.

 

 

 

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!

    About the author: Jasen Winny

    About the author: Jasen Winny

    Level 1 Physiotherapist

    Jasen joined the Clinical Physiotherapy, St Ives team in June 2024. He first graduated from Macquarie University in 2021 with a Bachelor of Human Sciences majoring in Human Movement. He then completed the Doctor of Physiotherapy at Bond University, graduating with Distinction and was placed on the Deans list for Academic excellence in 2024.

    He grew up swimming competitively, competing in several national championships. He understands how the high physical demands associated with training and competition can influence injury and impact performance.

    Jasen has an interest in sports injuries, Orthopaedic Prehab & Post-op Rehabilitation.

    Outside of the clinic, Jasen enjoys staying active and spending time outdoors. You’ll find him at the beach either surfing or walking his dogs. He also enjoys boxing, mountain biking and skiing in winter

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