When Bendy Becomes Too Bendy: Hypermobility in Children
There is nothing cuter than watching a baby discover their feet and happily suck their toes with pure delight. At around four months of age, this is a beautiful developmental milestone—reflecting flexibility, strength, coordination, and healthy neurological organisation.
Fast-forward a few years, however, and that same level of flexibility tells a very different story. When the twelve-year-old, can easily fold themselves into extreme positions, we are no longer looking at a milestone. We are looking at hypermobility.
And hypermobility in children is something many of us are seeing more frequently in practice—whether or not we consider ourselves “paediatric chiropractors.”
More Than Just Flexible Kids
Hypermobility in children remains under-recognised, misunderstood and often underestimated in its clinical significance. These are not simply flexible or sporty children. For many, joint hypermobility reflects an underlying connective tissue vulnerability that impacts stability, proprioception, neurological organisation and stress tolerance.
Children with hypermobility can look very different from one another. Some appear athletic and coordinated. Others struggle with posture, endurance, emotional regulation and/or fatigue. The common thread is that their nervous system is working much harder to stabilise a body with reduced passive joint support.
What Does Hypermobility Look Like?
Common physical features include:
Frequent joint pain or so-called “growing pains”
Fatigue with minimal exertion
Poor postural endurance, often with forward head posture
Recurrent sprains, strains or soft-tissue injuries
Delayed gross motor milestones or general clumsiness
Difficulty with prolonged sitting or writing tasks
Many children also present with neurological and autonomic features, such as:
Poor proprioception and body awareness
Sensory sensitivities
Headaches or neck pain
Dizziness or exercise intolerance
Sleep difficulties
Functional gastrointestinal complaints
Urinary incontinence
Anxiety or emotional lability
It is not uncommon for these children to be labelled as “unmotivated,” “anxious,” or “poorly coordinated,” when in reality their nervous system is expending significant energy simply trying to create stability.
Assessing Hypermobility: The Modified Beighton Scale
A simple and reliable screening tool for generalised joint hypermobility is the modified Beighton scale. It is quick to perform and easily incorporated into everyday clinical assessments.
The scale assesses:
Passive dorsiflexion of the fifth finger beyond 90° (right and left)
Passive apposition of the thumb to the forearm (right and left)
Elbow hyperextension beyond 10° (right and left)
Knee hyperextension beyond 10° (right and left)
Forward flexion of the trunk with palms flat on the floor
(interpreted cautiously in younger children)
Each positive finding scores one point, for a total of nine. In children, a score of 6 or more out of 9 is commonly used as a threshold for generalised hypermobility. Clinical judgement remains essential—this is a screening tool, not a diagnosis.
It is also important to note that hypermobile Ehlers–Danlos syndrome (hEDS) is generally not diagnosed until adolescence or adulthood.
What Does This Mean for Chiropractors?
Hypermobility fundamentally changes how we approach care—particularly in the cervical spine.
Children with connective tissue laxity tend to have:
Reduced passive joint stability
Greater reliance on muscular tone for control
Increased susceptibility to neurological irritation with excessive motion
In addition, these children have a significantly higher prevalence of congenital cervical variations, including:
Fusion anomalies
Posterior arch deficiencies
Transitional vertebrae
These findings are often asymptomatic and undetected, yet they strongly influence how a child responds to force, speed and direction of adjustment—especially in the upper cervical region.
Adjusting the Hypermobile Child: Less Is Often More
When caring for hypermobile children, restraint is a strength.
Key clinical principles include:
Prioritising stability over mobility
Using low-force, high-specificity techniques
Avoiding end-range loading or excessive rotational forces
Exercising particular caution with cervical adjustments, favouring gentle contacts and neurological input over mechanical leverage
Our goal is not to move what already moves well, but to support neurological organisation, proprioceptive input and adaptive tone, allowing the body to stabilise and function more efficiently.
A Broader Perspective
Hypermobility is not just a musculoskeletal finding. It is a whole-child pattern, involving connective tissue, neurology and adaptability. When recognised early and managed thoughtfully, these children often respond beautifully to chiropractic care.
As chiropractors, our true strength lies not in force, but in discernment—knowing when and how to adjust, and when our greatest contribution is supporting the nervous system’s capacity to organise, stabilise, and thrive.
Warmly,
Dorte