Column: Let’s talk about ligamentous instability

Frank Grispino MOT, OTR/L, CHT

As a certified hand therapist/occupational therapist, I specialize in treating disorders from the hand to the shoulder. Over the years, I’ve had many people tell me they are “double jointed.” There is no anatomical or medical diagnosis known as “double jointed.” Ninety-nine percent of the time when a person says they are “double jointed,” they are really saying, “I have a joint instability caused by ligamentous laxity.” After initially explaining the concepts to patients, I usually quit saying “lax ligaments” and talk about being “loosey goosey.” It’s not very scientific, but it’s descriptive and more accurate than “double jointed.” Plus, it’s kind of fun to say.

Let’s see if we can land somewhere in the middle with our description and understanding of these concepts. First of all, we need to understand what the person is usually feeling when they arrive at the conclusion they are “double jointed.” It’s easier saying the former vs. the latter, isn’t it. It still makes me itch to say “double jointed,” so for my mental health, we will refer to this phenomenon as joint instability caused by lax ligaments from here on out.

An unstable joint can dislocate, meaning that the two bone ends are no longer congruent and the joint won’t move — dislocation. The bones of a joint are shaped to get a smooth and slick glide. An incongruent joint can feel like there are rocks impeding motion. It can be stuck and then suddenly snap into motion when the two bones move into their normal position. Pain is another common complaint.

Tendons attach muscles to bones. Ligaments attach bones to bones. Joints need to move. It’s how our muscles move us and let us interact with the environment. Joints also need to be stable, otherwise we dislocate the joint. The bones involved in the joint also work best when their parts fit together as designed. If the bones aren’t in the proper position when the joint moves, you can get wear and tear on the joint. This can cause arthritis, pain and injury.

Different joints get their stability from different structures. The main shoulder joint is a good example of a joint that gets most of its stability from muscles/muscle tension and to a lesser degree from ligaments and other structures. The carpal bones in the wrist get most of their stability from ligaments. The elbow is a joint that gets most of its stability from the way the bones fit with each other, as well as ligaments. The knee is a good example of a combination of muscle and ligament stabilizers — think quadriceps and anterior cruciate ligament (ACL) being big contributors to a stable knee.

A joint like the knee that is unstable can be made more stable with exercises to strengthen the muscles around the joint. This can help pain if the pain is caused by the knee bones not working as a team. A carpal instability can rarely be made stable with exercises only. This is because the carpals are stabilized by ligaments. You can’t strengthen ligaments with exercise. This is why a carpal instability is most receptive to surgical intervention to compensate for the loose or torn ligaments, strengthening with a scalpel and internal structures that may be placed to help out the damaged ligaments.

Are you loosey goosey? Here’s how you check. There’s a scale called the Beighton Scale. It checks for loosey gooseyness. There are five parts of the test. A quick check online found that a score of 0-3 = normal ligaments. A score of 4-9 = lax ligaments. You check both sides. Here’s how you do the test:

1. Lay your hand flat on a table. Bend your pinky back (with your other hand) at the first joint. If you go past the 90-degree mark, or past straight up and down, you get a point for each pinky that can do that.
2. Straighten your elbow. Flex your wrist, try to bend your thumb backwards (with your other hand) and make it touch your forearm. You get a point for each thumb that can do that.
3. Straighten your elbows. If they go 10 degrees or more past straight, you get a point for each elbow that can do that.
4. Stand up straight and lock your knees. Do they go 10 degrees past straight? If they do, you get a point for each knee that can.
5. Stand with your knees straight. Can you put your palms flat on the floor? Award yourself a point if you can.

Too much laxity can also be a symptom of Ehlors Danlos Syndrome. That’s outside the scope of this column and needs to be addressed by a medical specialist physician.

Laxity is not uncommon and usually just the way you were made. Thanks to Mom and Dad for your laxity. I do see young people with ligamentous laxity that are already starting to develop some joint hypermobility injuries and issues. Hopefully the lax joints are the ones that can be impacted by exercise, splinting or doing your everyday tasks a little differently to make them more stable when needed. It’s usually not a reason to worry, but it can have cumulative effects on musculoskeletal health over the years and some injuries like dislocations and arthritis are more common.

Are you loosey goosey? Take the test. Talk to your doctor if you have concerns. Request an order to come see me if you both think laxity may be causing you trouble.