Joint Hypermobility in Children: What Parents Need to Know

“Stop being dramatic.” “It’s just growing pains.” “She’s just flexible.” These are some of the most common things parents are told when they raise concerns about a child who seems to tire easily, complains of leg or knee pain after sport, or rolls their ankles repeatedly on flat ground.

In many cases, the underlying explanation is joint hypermobility — and it is more common in children than most people realise. This article is for parents who want to understand what hypermobility in children looks like, when it is worth investigating, and what physiotherapy may be able to offer.

Part 1: Is Hypermobility Normal in Children?

To a degree, yes. Children are generally more flexible than adults. Connective tissue naturally becomes less lax as the body matures, which is why many children who appear hypermobile in early childhood become less so by their late teens.

This is sometimes called “benign joint hypermobility” — flexible joints with no associated symptoms. It requires no intervention and is not a cause for concern.

However, some children experience symptoms alongside their hypermobility. When joint laxity is accompanied by pain, fatigue, recurring injury, or difficulty keeping up with peers in physical activity, it warrants further attention.

Part 2: Signs That May Suggest Symptomatic Hypermobility

Hypermobility in children does not always look the way parents expect. Below are some signs that may indicate symptomatic joint hypermobility, though these should always be assessed by a qualified health practitioner:

Physical signs

• Recurring ankle sprains, knee pain, or wrist pain — particularly in the absence of a clear mechanism of injury

• Flat feet or feet that roll inward significantly (over-pronation)

• Difficulty holding a pencil or tiring quickly with handwriting tasks

• Poor balance or a tendency to trip and fall more than peers

• Joints that click, pop, or “go out” during everyday activity

Behavioural and activity-related signs

• Reluctance to participate in sport or physical activity, or complaints of pain during or after it

• Preferring to sit in a W-sit position on the floor (legs splayed out behind, forming a W shape)

• Complaining of leg or growing pains in the evenings, particularly after active days

• Tiring more quickly than peers in physical activities

• Difficulty sitting upright at a desk without leaning or slumping

Part 3: Why Children With Hypermobility Struggle

In a child with hypermobile joints, the ligaments that are meant to provide passive joint stability are more lax than typical. This means the muscles have to work harder to compensate — even during ordinary activities like sitting, standing, and walking.

For most children, this is manageable. But when demands increase — a full school day, after-school sport, a growth spurt — the muscles may fatigue more quickly, leading to pain, injury, or avoidance of activity.

Growth spurts in particular can be a time when hypermobility symptoms become more noticeable, as bones grow faster than the soft tissue structures around them, temporarily increasing laxity and load demands.

Part 4: What About Growing Pains?

“Growing pains” is a term that is used loosely, and it is worth understanding the distinction. True growing pains are typically:

• Bilateral (affecting both legs)

• Located in the muscles of the thighs, calves, or behind the knees — not in the joints themselves

• Occurring in the evenings or at night, often after active days

• Relieved by massage or heat

If your child’s pain is in the joints rather than the muscles, is present during activity rather than only in the evenings, or is associated with swelling, warmth, or redness, these are signs that should be assessed by a health practitioner. They may or may not be related to hypermobility, but they warrant proper evaluation.

Part 5: What Physiotherapy for a Hypermobile Child May Involve

Physiotherapy for children with symptomatic joint hypermobility is not about restricting activity — quite the opposite. The aim is to support children to remain active by building the strength and joint awareness they need to do so comfortably.

An assessment at Velca would typically include:

• A hypermobility screen appropriate for the child’s age

• Assessment of muscle strength around the key symptomatic joints

• Balance and proprioception testing

• Review of footwear and any relevant biomechanical factors

• A discussion with parents about activity levels, school demands, and the child’s goals

A physiotherapy programme for a hypermobile child may include:

• Strengthening exercises targeted to the joints that are most symptomatic — often hips, knees, and ankles

• Balance and coordination work to improve proprioception

• Activity and load guidance to help the child and family understand how to manage activity levels without causing flare-ups

• School and sport advice including seating posture, bag weight, and participation in PE

• Education for parents and children about what hypermobility is, why it causes symptoms, and what to expect as the child grows

Part 6: A Note on Growing Out of It

Many children with hypermobility do see their symptoms improve as they grow, particularly if they build good muscle strength during childhood. However, this is not universal — some children go on to receive an hEDS or HSD diagnosis in adolescence or adulthood, particularly if symptoms persist or worsen.

Getting an assessment now does not commit a child to a lifelong diagnosis. It simply means they get the right support at the right time, rather than being told to push through pain that has a clear and manageable cause.

This article is for general information purposes only. It is not a substitute for advice from a registered health practitioner. If you have concerns about your health, please consult a qualified professional.

Velca Health Centre | 3/10 Wellington St, Howick, Auckland 2014 | velca.co.nz | 022 639 2705