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Cited by 145Connective tissue disorders researchMusculoskeletal pain and rehabilitationPediatric Pain Management Techniques

Joint hypermobility is a risk factor for musculoskeletal pain during adolescence: findings of a prospective cohort study

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Tobias, Jonathan H., Deere, Kevin, Palmer, Shea, Clark, Emma M., Clinch, Jacqui·2013·Arthritis & Rheumatism
DOI 10.1002/art.37836
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Abstract

Objective: To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. Methods: JH was determined according to the Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cutoff of ≥6 for the presence of hypermobility. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2,901 participants (1,267 boys and 1,634 girls) who had complete data. Results: A total of 4.6% of participants had JH at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 years was reported most commonly in the lower back (16.1%), shoulder (9.5%), upper back (8.9%), knee (8.8%), neck (8.6%), and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (odds ratio [OR] 1.68 [95% confidence interval (95% CI) 1.04, 2.72]), knee (OR 1.83 [95% CI 1.10, 3.02]), and ankle/foot (OR 1.82 [95% CI 1.05, 3.16]) (adjusted for sex, maternal education, and body mass index). An equivalent relationship was not observed at other sites, including the spine, elbows, hands, and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (OR 11.01) as compared with nonobese participants (OR 1.57) (P = 0.037 for the interaction of hypermobility and obesity). Conclusion: JH represents a risk factor for musculoskeletal pain during adolescence, comprising a specific distribution, namely, the shoulder, knee, and ankle/foot. These relationships were strongest in the presence of obesity, which is consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces.

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  • Participants at 17.8 years who had a Beighton score ≥ 6-9 at 13.8 years demonstrated a weak suggestion of a higher risk of chronic regional pain (OR 1.84, CI 0.97-3.50, p = 0.062).

    “In a general population cohort [19] participants at 17.8 years who had a Beighton score ≥ 6–9 at 13.8 years demonstrated a weak suggestion of a higher risk of chronic regional pain and chronic widespread pain (OR 1.84 (CI 0.97–3.50, p = 0.062) and 2.27 (CI 1.22–4.22, p = 0.01) respectively).”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [19]

  • Participants at 17.8 years who had a Beighton score ≥ 6-9 at 13.8 years demonstrated a higher risk of chronic widespread pain (OR 2.27, CI 1.22-4.22, p = 0.01).

    “In a general population cohort [19] participants at 17.8 years who had a Beighton score ≥ 6–9 at 13.8 years demonstrated a weak suggestion of a higher risk of chronic regional pain and chronic widespread pain (OR 1.84 (CI 0.97–3.50, p = 0.062) and 2.27 (CI 1.22–4.22, p = 0.01) respectively).”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [19]

  • The association between GJH and acute onset intermittent MSK pain has been found in several population studies of adolescents and one study in symptomatic children.

    “The association between GJH and acute onset intermittent MSK pain has been found in several population studies of adolescents [19, 20], and one study in symptomatic children [21].”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [19]

  • There are varying levels of evidence for a link between joint hypermobility and ASD, DCD and anxiety disorders in child cohorts.

    “Additionally, there are varying levels of evidence for a link with ASD, 20,22,23 DCD 24–28 and anxiety disorders. 29,30”

    From No association between joint hypermobility, musculoskeletal pain and neurodevelopmental problems in a school-based sample of 11-year-old children (2025) · cites this paper as [26]

  • While some longitudinal studies seem to support an association between GJH and MSP, they have not provided evidence for GJH being a causative factor for MSP.

    “While some longitudinal studies seem to support an association between GJH and MSP, they have not provided evidence for GJH being a causative factor for MSP (El-Metwally et al., 2004; Tobias et al., 2013; Sohrbeck-Nohr et al., 2014).”

    From Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students (2019) · cites this paper as Tobias et al., 2013

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Authors
Tobias, J. H., Deere, K., Palmer, S., Clark, E. M., & Clinch, J.
Affiliations
  • Southmead Hospital (GB)
  • University of Bristol (GB)
  • Bristol Royal Hospital for Children (GB)
ORCID
Venue
Arthritis & Rheumatism
Publisher
Wiley
Published
2013-03-28
Volume
65
Issue
4
Pages
1107-1115
ISSN
  • 0004-3591 (ISSN-L)
  • 1529-0131
DOI
10.1002/art.37836
OpenAlex
W1595181805
Cited by
145
References
26
Citations by year
2026: 7 · 2025: 7 · 2024: 5 · 2023: 15 · 2022: 10 · 2021: 19 · 2020: 14 · 2019: 11 · 2018: 13 · 2017: 8 · 2016: 9 · 2015: 11 · 2014: 15 · 2013: 1
FWCI
7.96
Type
journal article
Language
en
Open access
Licence
Locations
  • Arthritis & Rheumatism (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
Funders
  • Wellcome Trust (076467, 092731)
  • Versus Arthritis (18185)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
joint hypermobility, musculoskeletal pain, adolescence, Beighton score, shoulder pain, knee pain, obesity, risk factors, Avon Longitudinal Study of Parents and Children
MeSH terms
Adolescent, Ankle Joint, Back Pain, Female, Foot, Humans, Joint Instability, Knee Joint, Longitudinal Studies, Male, Obesity, Prospective Studies, Risk Factors, Cohort Studies, Logistic Models, Odds Ratio, Low Back Pain, Arthralgia, Neck Pain, Shoulder Pain, Musculoskeletal Pain

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