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Prevalence of hypermobility in primary school children: a Saudi experience

  • Abdullah M. Al-Shenqiti1,2,*,
  • Hatem A. Emara1,3
  • Fahad S. Algarni4
  • Osama A. Khaled1,5
  • Asma A. Altaiyar6
  • Tarek M El-gohary1,7

1Faculty of Medical Rehabilitation Sciences, Taibah University, 42353 Medina, Kingdom of Saudi Arabia

2Centre for Rehabilitation Science, University of Manchester, M13 9PL Manchester, UK

3Department of Growth and Developmental Disorders in Children and its surgery, Faculty of Physical therapy, Cairo University, 11432 Cairo, Egypt

4Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, 11543 Riyadh, Kingdom of Saudi Arabia

5Basic Science Department, Faculty of Physical therapy, Cairo University, 11432 Cairo, Egypt

6Medical Rehabilitation Hospital, Ministry of Health, 42316 Medina, Kingdom of Saudi Arabia

7Department of Biomechanics, Faculty of Physical therapy, Cairo University, 11432 Cairo, Egypt

DOI: 10.31083/j.jomh1804091 Vol.18,Issue 4,April 2022 pp.1-6

Submitted: 13 November 2021 Accepted: 09 December 2021

Published: 30 April 2022

*Corresponding Author(s): Abdullah M. Al-Shenqiti E-mail:


Background: This study aims to determine the prevalence of generalized joint hypermobility (GJH) in primary school children in relation to age (6–12 years) and gender. It also aims to ascertain whether musculoskeletal pain (MSP) is associated with GJH among these children. Methods: This cross-sectional study was conducted in five primary schools in Al-Madinah al-Munawarah city. The demographic profile recorded includes age, gender, ethnic group, height, weight, and body mass index. The existence of GJH was assessed by the Beighton score (≥4 was acknowledged as hypermobility). Prior to physical examinations, the Nordic Musculoskeletal Questionnaire was distributed to the students to assist in detecting symptoms in their neck, back, shoulders, and extremities. Results: The study included 563 students (392 boys, 171 girls; average 10.12 ± 1.588 years; range 6–12 years). GJH was found in 144 students (25.6%). Out of the total number of participants, the occurrence of GJH in male students was 30.87% versus 13.5% in female students, indicating a significant difference (p = 0.001) by gender. GJH was also more prevalent in the age group of 6–9 years (29.2%) compared to that of 10–12 years (23.7%), with a considerable significant difference of p < 0.05. With respect to MSP, 222 (39.4%) of the total number of students reported pain. Pain was found in 31 (21.5%) and 191 (45.6%) of hypermobile students and non-hypermobile students, respectively, with a significant difference of p = 0.029. MSP was also not associated with GJH among these children. Conclusions: The prevalence of GJH in the primary school children in this study was markedly higher than the range revealed in some countries in the region but somewhat within the range reported internationally.


Hypermobility; School-age children; Beighton score; Musculoskeletal pain

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Abdullah M. Al-Shenqiti,Hatem A. Emara,Fahad S. Algarni,Osama A. Khaled,Asma A. Altaiyar,Tarek M El-gohary. Prevalence of hypermobility in primary school children: a Saudi experience. Journal of Men's Health. 2022. 18(4);1-6.


[1] Kirk J, Ansell B, Bywaters E. The hypermobile syndrome. Mus-culoskeletal complaints associated with generalized joint hyper-mobility. Annals of the Rheumatic Diseases. 1967; 26: 419–425.

[2] Reuter PR, Fichthorn KR. Prevalence of generalized joint hyper-mobility, musculoskeletal injuries, and chronic musculoskele-tal pain among American university students. PeerJ. 2019; 7: e7625.

[3] Hakim A, Grahame R. Joint hypermobility. Best Practice and Amp; Research. Clinical Rheumatology. 2003; 17: 989–1004.

[4] Handa R. Benign Joint Hypermobility Syndrome. Clinical Rheumatology. 2021: 205–208.

[5] Russek LN. Hypermobility syndrome. Physical Therapy. 1999; 79: 591–599.

[6] CARTER C, WILKINSON J. PERSISTENT JOINT LAXITY and CONGENITAL DISLOCATION of the HIP. The Journal of Bone and Joint Surgery. 1964; 46: 40–45.

[7] Vougiouka O, Moustaki M, Tsanaktsi M. Benign hypermobility syndrome in Greek schoolchildren. European Journal of Pedi-atrics. 2000; 159: 628.

[8] Grahame R. Copeman’s textbook of Rheumatic diseases. 5th edn. Churchill Livingstone: Edinburgh. 1978.

[9] Al-Rawi ZS, Al-Aszawi AJ, Al-Chalabi T. Joint mobility among university students in Iraq. British Journal of Rheumatology. 1986; 24: 326–331.

[10] Jansson A, Saartok T, Werner S, Renström P. General joint lax-ity in 1845 Swedish school children of different ages: age- and gender-specific distributions. Acta Paediatrica. 2004; 93: 1202–1206.

[11] Lamari NM, Chueire AG, Cordeiro JA. Analysis of joint mobil-ity patterns among preschool children. Sao Paulo Medical Jour-nal. 2005; 123: 119–123.

[12] Czaprowski D, Kotwicki T, Pawłowska P, Stoliński L. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. Scoliosis. 2011; 6: 1–10.

[13] Kumar B, Lenert P. Joint Hypermobility Syndrome: Recogniz-ing a Commonly Overlooked Cause of Chronic Pain. The Amer-ican Journal of Medicine. 2017; 130: 640–647.

[14] Murray KJ, Woo P. Benign joint hypermobility in childhood. Rheumatology. 2001; 40: 489–491.

[15] Tobias JH, Deere K, Palmer S, Clark EM, Clinch J. Joint hy-permobility is a risk factor for musculoskeletal pain during ado-lescence: findings of a prospective cohort study. Arthritis and Rheumatism. 2013; 65: 1107–1115.

[16] Bridges AJ, Smith E, Reid J. Joint hypermobility in adults re-ferred to rheumatology clinics. Annals of the Rheumatic Dis-eases. 1992; 51: 793–796.

[17] Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint hyper-mobility syndrome in childhood. a not so benign multisystem disorder? Rheumatology. 2005; 44: 744–750.

[18] K. Humane R, A. Deshmukh A. Correlation of generalized joint hypermobility and selective joint hypermobility with physical activity in school going children of age 6 to 12 years. Panacea Journal of Medical Sciences. 2018; 8: 59–65.

[19] Gedalia A, Press J, Klein M, Buskila D. Joint hypermobility and fibromyalgia in schoolchildren. Annals of the Rheumatic Dis-eases. 1993; 52: 494–496.

[20] Birrell FN, Adebajo AO, Hazleman BL, Silman AJ. High preva-lence of joint laxity in West Africans. British Journal of Rheumatology. 1994; 33: 56–59.

[21] Mikkelsson M, Salminen JJ, Kautiainen H. Joint hypermobil-ity is not a contributing factor to musculoskeletal pain in pre-adolescents. The Journal of Rheumatology. 1996; 23: 1963–1967.

[22] Grahame R, Bird HA, Child A. The revised (Brighton 1998) cri-teria for the diagnosis of benign joint hypermobility syndrome (BJHS). The Journal of Rheumatology. 2000; 27: 1777–1779.

[23] Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th edn. FA Davis: Philadelphia. 1985.

[24] Boyle KL, Witt P, Riegger-Krugh C. Intrarater and Interrater Re-liability of the Beighton and Horan Joint Mobility Index. Journal of Athletic Training. 2003; 38: 281–285.

[25] Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. The Journal of Pediatrics. 2011; 158: 119–123.

[26] Sirajudeen M S, Waly M, Alqahtani M, et al. Generalized joint hypermobility among school-aged children in Majmaah region, Saudi Arabia. PeerJ. 2020; 8: e9682.

[27] de Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. International Nursing Review. 2003; 50: 101–108.

[28] Silva AG, Sa-Couto P, Queirós A, Neto M, Rocha NP. Pain, pain intensity and pain disability in high school students are dif-ferently associated with physical activity, screening hours and sleep. BMC Musculoskeletal Disorders. 2017; 18: 1–11.

[29] El-Garf AK, Mahmoud GA, Mahgoub EH. Hypermobility among Egyptian children: prevalence and features. The Journal of Rheumatology. 1998; 25: 1003–1005.

[30] Seçkin U, Tur BS, Yilmaz O, Yağci I, Bodur H, Arasil T. The prevalence of joint hypermobility among high school students. Rheumatology International. 2005; 25: 260–263.

[31] Rikken-Bultman DG, Wellink L, van Dongen PW. Hypermobility in two Dutch school populations. European Journal of Obstet-rics, Gynecology, and Reproductive Biology. 1997; 73: 189–192.

[32] Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, Tobias JH, et al. Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation. Arthritis and Rheumatism. 2011; 63: 2819–2827.

[33] Gocentas A, Jascaniniene N, Pasek M, Przybylski W, Matulyte E, Mieliauskaite D, et al. Prevalence of generalised joint hyper-mobility in school-aged children from east-central European re-gion. Folia Morphologica. 2016; 75: 48–52.

[34] Lamari NM, Chueire AG, Cordeiro JA. Analysis of joint mobil-ity patterns among preschool children. Sao Paulo Medical Jour-nal. 2005; 123: 119–123.

[35] Hasija RP, Khubchandani RP, Shenoi S. Joint hypermobility in Indian children. Clinical and Experimental Rheumatology. 2008; 26: 146–150.

[36] Qureshi AU, Maalik A, Ahmad TM. Relationship of joint hyper-mobility and musculoskeletal problems and frequency of benign joint hypermobility syndrome in children. Journal of Ayub Med-ical College Abbottabad. 2010; 22: 150–154.

[37] Bozkurt S. Hypermobility Frequency in School Children: Rela-tionship with Idiopathic Scoliosis, Age, Sex and Musculoskele-tal Problems. Archives of Rheumatology. 2018; 34: 268–273.

[38] Leone V, Tornese G, Zerial M, Locatelli C, Ciambra R, Bensa M, et al. Joint hypermobility and its relationship to musculoskele-tal pain in schoolchildren: a cross-sectional study. Archives of Disease in Childhood. 2009; 94: 627–632.

[39] Al-Jarallah K, Shehab D, Al-Jaser MT, Al-Azemi KM, Wais FF, Al-Saleh AM, et al. Prevalence of joint hypermobility in Kuwait. International Journal of Rheumatic Diseases. 2017; 20: 935–940.

[40] Mikkelsson M. One year outcome of preadolescents with fi-bromyalgia. The Journal of rheumatology. 1999; 26: 674–682.

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