The influence of joint hypermobility on functional movement control in an elite netball population: A preliminary cohort study

Masterclass: Hypermobility and hypermobility related disorders

INTRODUCTION

Hypermobile joints display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility may present in a single joint, a few joints or in multiple joints and may be congenital or acquired with training, disease or injury. Hypermobile joints may be asymptomatic or may be associated with pain, fatigue, multisystemic complaints and significant disability. Furthermore, joint hypermobility may be a sign of an underlying hereditary disorder of connective tissue.

PURPOSE

This masterclass aims to provides a state-of-the-art review of the aetiology, epidemiology, clinical presentation, assessment and management of joint hypermobility and hypermobility related disorders using an evidence based and biopsychosocial approach. The new framework for classifying the spectrum of joint hypermobility disorders along with new diagnostic criteria for the hypermobile Ehlers Danlos syndrome, published by an international consortium of clinical experts and researchers in 2017 is integrated into the paper.

IMPLICATIONS FOR PRACTICE

People with joint hypermobility related disorders present to healthcare professionals with a wide range of symptoms which extend beyond the musculoskeletal system. Early recognition and treatment are key to effective management. A biopsychosocial and patient empowerment approach to functional restoration is recommended.

Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders

BACKGROUND

Joint hypermobility (JH) is associated with autonomic nervous system dysregulation and functional abdominal pain disorders (FAPDs). Understanding the neurophysiological processes linking these conditions can inform clinical interventions. Autonomic activity regulates gastrointestinal (GI) sensorimotor function and may be a key mechanism. The aims of this study were to examine the relation of JH with dynamic autonomic activity and parasympathetic regulation in adolescents with FAPDs and identify optimal JH cutoff scores that best index autonomic regulation in FAPDs.

METHODS

A total of 92 adolescents with FAPDs and 27 healthy controls (age 8-18 years; 80% female) were prospectively enrolled. JH was assessed by Beighton scores. ECG recordings were conducted during supine, sitting, and standing posture challenges. ECG-derived variables-heart period (HP), respiratory sinus arrhythmia (RSA), and vagal efficiency (VE)-were analyzed using linear regression and mixed effects modeling.

KEY RESULTS

Beighton scores of ≥4 optimally distinguished autonomic function. Adolescents with FAPD and JH had reduced VE compared to adolescents with FAPDs without JH (B = 18.88, SE = 6.25, p = 0.003) and healthy controls (B = 17.56, SE = 8.63, p = 0.044). These subjects also had lower and less dynamic RSA and HP values during posture shifts, with strongest differences in supine position and using the VE metric.

CONCLUSIONS & INFERENCES

Suboptimal autonomic regulation indexed by reduced vagal efficiency may be a mechanism of symptoms in hypermobile FAPD patients with Beighton score ≥ 4. Autonomic disturbance may serve as potential intervention target for patients with JH and functional GI disorders.

The Applied Sports Science and Medicine of Netball: A Systematic Scoping Review

BACKGROUND

Netball is the one of the most popular women's sports in the world. Since gaining professional status in 2008 there has been a rapid growth in research in the applied sports science and medicine of the sport. A scoping review of the area would provide practitioners and researchers with an overview of the current scientific literature to support on-court performance, player welfare and reduce injury.

OBJECTIVE

The primary objective was to identify the current research on the applied sports science and medicine of netball. Additionally, the article provides a brief summary of the research in each topic of sports science and medicine in netball and identifies gaps in the current research.

METHODS

Systematic searches of PubMed, SPORTDiscus, MEDLINE and CINAHL were undertaken from earliest record to Dec 2020 and reference lists were manually searched. The PRISMA-ScR protocol was followed. Studies were eligible for inclusion if they investigated netball as a sport or the applied sport science and medicine of netball athletes.

RESULTS

962 studies were identified in the initial search, 150 of which met the inclusion criteria. Injury was the most highly investigated sport science and medicine topic (n = 45), followed by physical qualities (n = 37), match characteristics (n = 24), biomechanics (n = 15), psychology (n = 13), fatigue and recovery (n = 9), training load (n = 4) and nutrition (n = 3). A range of cohorts were used from school to elite and international standards. All cohorts were female netballers, except for one study. A rapid growth in studies over recent years was demonstrated with 65% of studies published in the last decade. There still remains gaps in the literature, with a low evidence base for nutrition, training load and fatigue and recovery.

CONCLUSION

This scoping review summarises the current evidence base and key findings that can be used in practice to enhance the applied sport science and medical support to netball athletes across a range of playing standards, and support the growth of the sport. It is evident that netball as a sport is still under-researched.

Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players

Netball is a predominantly female team court-sport which is played worldwide. Netball is becoming more popular in the United States following its countrywide introduction to schools and community centers. A unique characteristic of netball is the footwork rule which restricts players to a one-step landing after catching the ball. Most netball landings are single-leg landings resulting in high vertical ground reaction forces and high skeletal tissue forces. Thus, high-risk landing events that have the biomechanical potential for injury occur frequently. Noncontact knee ligament injuries are common following a knee abduction collapse when landing. Because the consequences of noncontact knee ligament injury are profound, strategies are needed to mitigate the burden of such injury for players, teams, and society. The purpose of this clinical commentary is to demonstrate how theoretical principles, different types of research, and different levels of evidence underpin a rational clinical reasoning process for developing noncontact knee ligament injury prevention screening procedures in netball. The theoretical principles that are discussed in this commentary include injury control, the sequence of prevention, principles of screening in injury prevention, the multifactorial model of injury etiology, complex systems theory, and systems science. The different types of research that are reviewed include descriptive and analytic-observational studies. The different levels of evidence that are discussed include prospective studies, cross-sectional studies, and clinicians' own kinesiological modelling. Subsequently, an integrated approach to the evidence-informed development of noncontact knee ligament injury prevention screening procedures is presented. Clinical practice suggestions include a selection of evidence-informed screening tests that are quickly and easily implemented with netball players in local communities. The need for repeated screening at strategic timepoints across a season/year is explained. Sports physical therapists will find this commentary useful as an example for how to undertake clinical reasoning processes that justify the content of screening procedures contributing to noncontact knee ligament injury prevention in community-level netball.

LEVEL OF EVIDENCE

5.

Classifying joint hypermobility: a comparison of three current classification systems

Background/Aims:

Joint hypermobility is an excessive range of motion in one joint and is related to increased risk of injury and performance adaptations within sports and dance. Joint hypermobility classification lacks consistency across the literature, which may hinder effective management. The aim of the study was to compare the prevalence of joint hypermobility across sex- and sport-specific participation using three different classification systems.

Methods:

Joint hypermobility was assessed in 286 participants consisting of rugby players, netballers, dancers and female and male controls. The Beighton score was used to measure joint hypermobility in the fifth metacarpophalangeal joints, thumbs, elbows, knees and lumbar spine. Scores were subsequently categorised using three different joint hypermobility classifications previously reported by Beighton et al (1973) , Boyle et al (2003) and Stewart and Burden (2004) .

Findings:

The prevalence of ‘not hypermobile’ varied considerably between classifications. This difference was greatest in female netball players and smallest in male rugby players. Within the ‘not hypermobile’ category, an additional 33 females and 5 males were ‘not hypermobile’ with the Beighton et al (1973) and Stewart and Burden (2004) criteria, which may highlight a sex consideration when assessing low Beighton scores. In the ‘distinctly hypermobile’ category, female subjects demonstrated sensitivity to classification system, most prominently dancers.

Conclusions:

There may be a need for separate sex categories. The female dancer classification may require further categorisation to identify extremes of joint hypermobility more effectively, which may aid injury prevention strategies.

The Beighton score as a predictor of Brighton criteria in sport and dance

OBJECTIVES

To determine the efficacy of using the Beighton joint hypermobility score as a predictor of Brighton criteria components, considering the influence of gender and sports participation.

DESIGN

Cross sectional study design.

SETTING

A University.

PARTICIPANTS

Sixty-five female rugby players, 38 male rugby players, 61 netball players, 42 female dancers, 40 male controls and 40 female controls.

MAIN OUTCOME MEASURES

The Beighton score was assessed using the Beighton and Horan Joint Mobility Index. The Brighton criteria was used to assess joint hypermobility syndrome. A binary logistic regression was performed for a pooled sample (n = 286), and subsequently for gender and sport to assess the Beighton score as a predictor of Brighton criteria.

RESULTS

Beighton scores were found to be a predictor of arthralgia (P = 0.002), dislocation and subluxation (P = 0.048) in the pooled analysis; a predictor of dislocation and subluxation (P = 0.047) in males and arthralgia (P = 0.001) in females. Beighton scores were a predictor of arthralgia in female rugby (P = 0.003) and in female controls (P = 0.012).

CONCLUSIONS

The potential of the Beighton score to predict joint arthralgia and dislocation/subluxation may allow clinicians to implement effective injury prevention strategies.