Hypermobility is what we call a spectrum condition, meaning that it can present in many different ways. The core problem is that ligaments, tendons and other tissues are more elastic than normal. This relates to the ratio between the elastic and stiff tissues in the body—an area in which the level of collagen plays a key role. When this ratio is not correct, we tend to see hyper-extension in two broad forms.

The first presents as multiple musculoskeletal problems, such as repeated joint dislocations and temporomandibular joint dysfunction, which can cause things like jaw pain and limited mouth opening, or lead to pelvic floor dysfunction: a source of severe pelvic pain.

Twenty years ago, people were not being diagnosed with hypermobility; now they are.

The second form, which is less obvious, has an effect on various internal organs. In the bowel, for example, hypermobility can present as irritable bowel syndrome or other problems such as sluggish transit of contents. It can also affect the blood vessels, whereby sufferers develop dilated blood vessels which can lead to aneurysms.
 In the most extreme cases, hypermobility is behind classified conditions like Ehlers-Danlos syndrome, which is defined as a family and genetic trait and causes a whole variety of problems, including loose and unstable joints, extreme tiredness, heartburn, constipation, dizziness and incontinence.

What next?
For me the next big step is not clinical, but educational. Twenty years ago, people were not being diagnosed with hypermobility; now they are. 

We now have the Beighton and Brighton scoring systems in place, which are based on physical clinical examination tests and go some way towards picking up hypermobility issues. The problem is that there are still consultants who refuse to treat hypermobility as a specific condition and so won’t use Beighton or Brighton as diagnostic tools in the first place.

In five years’ time, it would be great if hypermobility was being routinely taught in undergraduate and postgraduate training schemes. This would be a big step towards identifying and managing patients’ conditions earlier—as with many conditions, the sooner you pick it up, the better chance