Joint Hypermobility and the Knee: When Flexible Knees Hurt

What is joint hypermobility?

Ligaments and joint capsules are made largely of collagen. In some people this tissue is naturally more stretchy, so joints move beyond the usual range. This is often inherited and is common in children, teenagers and women.

Hypermobility on its own is not a disease. Dancers, gymnasts and swimmers often benefit from it. It becomes a problem when it causes pain, instability or injuries. Doctors then speak of hypermobility spectrum disorder, and in a smaller group with wider features such as fragile skin, of hypermobile Ehlers–Danlos syndrome.

Symptoms in patients' own words

• "My knees bend backwards when I stand straight"
• "My kneecap feels like it slides out and back"
• "My knees ache after standing, walking or the gym"
• "I keep spraining my ankles and twisting my knees"
• "My joints click a lot"
• "I get tired easily and my muscles feel tight"

Pain is often felt around the front of the knee or behind it. Some people also notice easy bruising, stretchy skin, dizziness when standing up, or pain in many joints.

How it affects the knee

Looser ligaments mean the muscles have to work harder to keep the knee stable. When those muscles are not strong enough or not well coordinated, the joint is overloaded at the extremes of movement. Common knee problems in hypermobile people include knee hyperextension (genu recurvatum), pain at the front of the knee, the kneecap slipping or dislocating, and repeated sprains.

In Qatar we see it in teenage girls in dance and gymnastics, in yoga practitioners who push into deep end-range positions, and in young athletes in football and padel whose knees give way with twisting.

Diagnosis

Diagnosis is mainly clinical. Dr. Gelber asks about your symptoms, injuries and family history, and examines the knees along with other joints. A simple nine-point test called the Beighton score checks flexibility in the fingers, thumbs, elbows, spine and knees.

He then looks for specific knee problems: how the kneecap tracks, whether it can be pushed out of place, ligament stability and muscle strength. X-rays or MRI are used when there has been a dislocation, a significant injury or ongoing swelling. If features suggest a wider connective tissue condition, he may suggest review by a rheumatologist or geneticist.

Non-surgical treatment

Exercise is the main treatment and it works for most people. A physiotherapist experienced with hypermobility builds a gradual programme that focuses on:

• Strengthening the quadriceps, hamstrings, hip and core muscles
• Control and balance, so the knee stays stable during movement
• Learning to stand and exercise without locking the knee back into hyperextension
• Slow, steady progression to avoid flare-ups

Progress is often slower than in other people, so patience matters. A soft brace can help for a period after a kneecap dislocation. Pain medicines can help in flares, and general fitness, sleep and weight management also make a difference.

Surgical treatment

Surgery is approached cautiously. Tightening soft tissues in someone whose tissues stretch easily may not hold, and recovery can be slower.

That said, surgery has a clear role for recurrent kneecap dislocations that continue despite a good rehabilitation programme. MPFL reconstruction, which replaces the main stabilising ligament of the kneecap with a tendon graft, is often used, sometimes combined with realignment of the bone when the anatomy needs it. Torn ligaments or menisci are treated on their own merits. Decisions depend on careful examination and imaging.

Recovery and when to see a specialist in Doha

With a steady exercise programme, many people notice improvement over a few months and keep it by continuing their exercises. After kneecap stabilisation surgery, return to sport usually takes several months.

See a knee specialist if your kneecap has dislocated, your knee keeps giving way, pain stops you from working, training or praying comfortably, or the knee swells after an injury. Dr. Gelber assesses hypermobile knees at Aman Hospital in Doha.