Are chronic musculoskeletal pain and generalized joint hypermobility disabling contributors to physical functioning?
Open accessAbstract
BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents. AIM: to evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear. DESIGN: The design of this study was observational and cross-sectional. SETTING: The adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). POPULATION: Four subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH. METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH. RESULTS: Adolescents with CMP had decreased muscle strength (P=0.01), endurance (P=0.02), and lower motor performance (P<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (P=0.01), endurance (P<0.01), and motor performance (P<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found. CONCLUSIONS: Adolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP. CLINICAL REHABILITATION IMPACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to non-hypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.
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The level of catastrophizing and pain intensity does not differ between adolescents with or without hypermobility and chronic musculoskeletal pain.
“Also, the level of catastrophizing and pain intensity did not differ between adolescents with or without hypermobility and CMP.25,57”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [57]
The retrieved material contains the paper’s title and bibliographic details but no results comparing catastrophizing or pain intensity between adolescents with and without hypermobility and chronic musculoskeletal pain. Searches for those terms and for group comparisons found no relevant passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredElevated scores of perceived harmfulness in activities, as a construct of pain-related fear, are experienced in adolescents with chronic musculoskeletal pain compared to healthy peers, but these scores are independent of the presence of GJH.
“Elevated scores of perceived harmfulness in activities, as construct of pain-related fear, were experienced in adolescents with CMP compared to healthy peers; however, these scores were independent of the presence of GJH.57”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [57]
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Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review
van Die-de Vries, J. E., Rameckers, E., Calders, P., Engelbert, R. H., Ramaekers, S. P., Goossens, M. E., & Verbunt, J. A. (2025) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2025.100467 · Cited by 1 · see citing works
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- Authors
- VAN MEULENBROEK, T., HUIJNEN, I. P., ENGELBERT, R. H., & VERBUNT, J. A.
- Affiliations
- Maastricht University (NL)
- Amsterdam University Medical Centers (NL)
- Venue
- European Journal of Physical and Rehabilitation Medicine
- Publisher
- Edizioni Minerva Medica
- Published
- 2021-11
- Volume
- 57
- Issue
- 5
- Pages
- 747-757
- ISSN
- 1973-9087 (ISSN-L)
- 1973-9095
- OpenAlex
- W3138079462
- Cited by
- 7
- References
- 13
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- European Journal of Physical and Rehabilitation Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic musculoskeletal pain, generalized joint hypermobility, physical function, fear of pain, adolescents, muscle strength, muscular endurance, motor performance, physical activity level
- MeSH terms
- Adolescent, Cross-Sectional Studies, Humans, Joint Instability, Muscle Strength, Chronic Pain, Musculoskeletal Pain
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