Lower Limb Biomechanical Observations in Hypermobile Children: An Exploratory Case-Control Study

Generalised joint hypermobility (GJH) describes an excessive range of joint movement and is associated with increased musculoskeletal injury risk, joint pain, and instability. This study compares lower limb biomechanical characteristics between children with and without GJH. Children aged 5-18 years with GJH (Beighton score ≥ 6/9 pre-puberty, ≥5/9 post-puberty) were age- and sex-matched with controls (Beighton score ≤ 2/9). Biomechanical measures included internal hip rotation, quadriceps (Q) angle, tibial torsion, ankle range of motion (ROM), and foot posture index (FPI). Wilcoxon rank sum test and chi-square were used to assess group differences. Fifty-two participants (median age 11 years, 69% females) included 27 children with GJH and 25 healthy children. Internal hip rotation, Q-angle, ankle ROM and FPI were significantly higher for children with GJH (p < 0.001) than healthy peers. While tibial torsion showed no difference in males, females had greater internal tibial torsion [median difference: right -4° (95%CI:-7,-2), p = 0.002; left -5° (95%CI:-7,-1), p = 0.010]. The largest differences were in ankle ROM [median difference: right 9° (95%CI:7,12); left 9° (95%CI:6,12)]. Children with GJH present different biomechanical measures than non-GJH peers. Further research into the clinical relevance of ROM at the hip, ankle and foot for children with GJH which are movement planes not assessed in Beighton score is warranted.