Hypermobility in Children: How Physio Can Help

Some children seem naturally bendy. They may do the splits without trying, bend their fingers further than expected or sit comfortably in positions that make everyone else wince.

For many children, flexible joints cause no problems at all. They continue to run, play and develop without pain or difficulty. For others, hypermobility can make movement more tiring or contribute to joint pain, poor balance, frequent falls or difficulty keeping up with everyday activities.

The important question is not simply, “How flexible is my child?” It is, “Is their flexibility affecting how they move, play or participate?”

This is where an assessment with a paediatric physiotherapist can be helpful.

What Is Hypermobility?

Hypermobility means that one or more joints move beyond the range typically expected for a person’s age. You may have heard this described as being “double-jointed”, although the joints themselves are not actually doubled.

Children are generally more flexible than adults, and flexibility varies considerably from one child to another. Hypermobility can also run in families. A parent might recognise that they could perform the same party tricks or unusual stretches as a child.

It is also important to understand that hypermobility is not automatically a medical condition. A child who is flexible but has no pain, fatigue or difficulty participating may not need treatment.

However, some children need their muscles to work harder to control and support their flexible joints. Over time, this can contribute to discomfort, tiredness or reduced confidence in physical activities.

Hypermobility can also be associated with certain connective tissue conditions. This does not mean that every flexible child has an underlying disorder. If there are broader health concerns, frequent joint dislocations or significant symptoms, your child’s physiotherapist may recommend speaking with a GP or paediatrician.

What Can Hypermobility Look Like in a Child?

Hypermobility does not look the same in every child. Some signs are easy to spot, while others may initially be mistaken for clumsiness, poor posture or a dislike of sport.

You might notice that your child:

• Appears unusually flexible or can move their joints into extreme positions

• Frequently leans heavily against furniture

• Locks their knees backwards when standing

• Rolls their ankles regularly

• Trips or falls more often than expected

• Tires quickly during walking, sport or playground activities

• Complains of sore legs or joints, particularly after activity

• Has difficulty with balance, coordination or ball skills

• Finds handwriting or other tasks involving the hands tiring

• Avoids certain physical activities because they feel difficult or uncomfortable.

These signs do not confirm hypermobility on their own. They simply provide useful information about how your child’s body is managing movement.

How Hypermobility May Present at Different Ages

Babies and Toddlers

In babies and toddlers, hypermobility may be noticed alongside low muscle tone or delayed physical milestones. A child may take longer to develop the strength and stability needed for sitting, crawling, standing or walking.

Some toddlers may prefer sitting in positions that give them a wide base of support. Others may appear less steady on their feet or tire quickly when climbing and exploring.

Paediatric physiotherapy at this age is usually highly play-based. Support may focus on helping the child build strength through floor play, transitions between positions, climbing and other age-appropriate movement experiences.

Primary School-Aged Children

Once children begin school, the physical demands placed on their bodies increase. They are expected to sit at a desk, carry a school bag, navigate playground equipment and participate in sport and physical education.

At this age, hypermobility may show up as:

• Difficulty keeping up with classmates

• Frequent ankle rolling or minor injuries

• Poor balance or coordination

• Sore knees, ankles, feet or wrists

• Fatigue after school or sport

• Reluctance to participate in physical activities.

A child may say they “don’t like sport” when the real problem is that movement feels harder or more tiring for them. Understanding why they are struggling can help shift the focus away from what they cannot do and towards building the skills they need.

Teenagers

During adolescence, rapid growth, increased body weight and greater sporting demands can change how hypermobility affects a young person.

Teenagers may experience joint or muscle pain, recurring injuries, fatigue or difficulty recovering after exercise. Some may reduce their activity because they are worried about pain or reinjury. Unfortunately, becoming less active can lead to reduced strength and fitness, which may make the joints feel even less supported.

The goal is generally not to avoid movement. It is to find an appropriate level and type of activity that helps the young person become stronger without repeatedly aggravating their symptoms.

How Can Paediatric Physiotherapy Help?

A paediatric physiotherapist looks beyond how far a joint can move. They assess how the child uses their body during meaningful activities such as walking, running, jumping, climbing or playing sport.

An assessment may consider:

• Muscle strength and endurance

• Balance and coordination

• Posture and joint control

• Walking and running patterns

• Gross motor development

• Pain, fatigue or recurring injuries

• Activities the child finds difficult

• The child’s interests and family goals.

From there, the physiotherapist can create an individual plan to improve the areas affecting the child most.

Physiotherapy commonly focuses on building muscle strength and fitness so the muscles can provide better support around flexible joints. It may also help improve balance, posture and body awareness. The Sydney Children’s Hospitals Network recommends regular exercise, strength development and safe movement as important parts of managing symptomatic hypermobility.

What Exercises May Be Helpful?

There is no single exercise program for every child with hypermobility. The right activities depend on the child’s age, symptoms, strength, confidence and goals.

A physiotherapist may use activities such as:

• Stepping and balance games

• Obstacle courses

• Climbing activities

• Resistance exercises

• Bridges or modified squats for hip and leg strength

• Swimming, cycling or other lower-impact activities

• exercises that practise controlled movement rather than pushing joints to their end range.

For younger children, these may be disguised within games. A strengthening session might involve pretending to be different animals, climbing over cushions or balancing while collecting toys.

Exercises should be introduced and progressed carefully. More exercise is not always better, particularly if it causes a significant increase in pain or fatigue. Guidance from a paediatric physiotherapist can help families find the right starting point and build from there.

Helping Children Stay Active and Confident

Hypermobility does not have to stop a child from enjoying movement, sport or everyday play.

With the right support, children can learn how to control their movement, build strength and understand what their body needs. Progress may look different for every child. It could mean joining a sports lesson, walking further without becoming tired, experiencing fewer ankle rolls or simply feeling more confident on the playground.

At Brave Bodies, paediatric physiotherapy is designed to feel encouraging and achievable. Our physiotherapists work with babies, children and teens across South West WA using evidence-based, play-focused strategies that reflect each child’s individual needs.

If your child’s flexibility is accompanied by pain, fatigue, frequent injuries or difficulty participating, learn more about our paediatric physiotherapy services. You do not need to have all the answers, or a formal diagnosis, before reaching out.

Frequently Asked Questions

1. Does every child with hypermobility need physiotherapy?

No. Many children have flexible joints without pain or difficulty and do not need treatment. Physiotherapy may be helpful when hypermobility affects your child’s comfort, strength, balance, coordination, endurance or ability to participate in everyday activities.

2. How can I tell if my child’s flexibility is causing problems?

Look beyond how flexible your child appears. Signs that they may need support include recurring joint pain, frequent ankle rolling, fatigue, regular falls, difficulty keeping up with peers or avoiding activities because movement feels uncomfortable or challenging.

3. Can children with hypermobility still play sport?

Yes. Many children with hypermobility participate successfully in sport. Building strength, joint control and fitness can help them move more confidently. A paediatric physiotherapist can recommend appropriate activities and help your child gradually prepare for the physical demands of their chosen sport.

4. What exercises are best for a child with hypermobility?

The most suitable exercises depend on your child’s age, symptoms and individual movement patterns. Activities may focus on strength, balance, coordination and controlled movement. A physiotherapist can show your child how to exercise safely without repeatedly pushing their joints to the end of their range.

5. When should I seek professional advice about hypermobility?

Consider seeking advice if your child experiences persistent pain, fatigue, recurring injuries, frequent joint instability or difficulty with milestones, school activities, play or sport. A physiotherapist can assess their movement and recommend whether physiotherapy or further medical assessment is appropriate.