Hypermobility knee problems and trampolining for 10yr old

[PavlovtheCat01]

My dd is 10yrs old and has hypermobility issues with her ankles and recently her knees. She has been trampolining for about 8 months and her ankles are mostly ok. However over the last few months her knees have started to hurt, increasing in pain. a few weeks ago she landed badly on her left knee and hyper-extended it. She was seen in A&E on the advice of the GP who confirmed no breaks or dislocation, but bruising to the calf muscle and ligaments. I was told they didn't think she has Osgood Schlatters, as suggested her by trampoline coach, due to the location of the pain. It has healed well and she can walk ok, but by the end of the day she continues to complain of knee pain and it keeps 'going' on the left knee.

She hasn't been trampolining for 3 weeks due to this and holiday and is due to go back today. I am concerned about it because it's high impact on her knees and worried it might cause more damage. But she has had to stop so many activities because they increase her pain and she will be gutted if she cannot go. She misses it even after 3 weeks, and after some difficulties at school, enjoys seeing the friends she makes there, it increases her confidence.

Do you think trampolining will help strengthen her muscles around the knee or make the pain worse? Her knee cap is very wobbly and her lower leg has a lot of movement when twisting it around.

Should she have a break this week? How about in the future? She has a referral to orthopedic paediatrics (i think) to x-ray and hopefully refer to a hypermobility clinic (nothing local) but it's going to take ages for anything to come of that.

blimey this disappeared of active as soon as I posted. busy 20 mins before the school run eh?

I have hypermobility syndrome as part of s wider issue and used to trampoline a lot. As with your DD my knees were mostly affected so we purchased a knee brace for each leg which helped considerably. In fact i still use them (new ones though obviously) now for any high impact things I may do.

Argh. googling seems to indicate trampolining is a no no. but, my internet appears to be broken so I can read eveyrthing, it's not uploading everything. Argh. She will be devastated if it's really the case!

Forgot to say, knee pain can also be referred pain from the hip so if you are seeing pead ortho's soon make sure they check the hip rotation.

smokinggun oh really? that would be fab if possible! what kind of knee braces did you use? I have looked into them, for general use like when she walks distances her knees become more lax (not necessarily normal wear) but I am confused about what she needs/what is best.

She definitely has issues with her hip rotation. She has feet that turn inwards. It's been ignored for years despite us asking for some guidance, because also she always walked like she was about to trip over her feet, she had no pain. Then, since her ankle became floppy and she showed the doctor how she can turn it completely the other way around we've been given a bit of a runaround. they've only been treating the symptom (just the ankle prob) not the overall issues of hypermobile joints, pain and her hip rotation.

Thank you for reminding me to check though, as I often feel fobbed off or like I don't know what I am talking about, some have said her hips are fine, most recent person who fitted new orthotics said it was from her hips.

in fact, it seems entirely possible about the hip causing some of the pain, because her pain is around the knee but it also is concentrated in the thigh muscles coming from her knee upwards. Can they do something about it? I asked about her hips when she was 3, told she would grow out of her in-turned legs, then again when 7, told nothing problematic because no pain, then physio said not her hips, it was all because she was flat footed. orthotics said she had hypermobile ankle ligaments, last orthotics said flat footed was because of the hypermobility and also in her knees and hips. He said it like I knew! Like I should have known!

DD is hypermobile and were just at the start of waiting to see orthopaedics about her elbow partially coming out of joint regularly.

We did see a private paediatric physio team a while ago though about her walking in a crouched position and feet turned inwards. They gave us a number of strengthening exercises to help stabilise her ankles and legs. I mention this as they said to keep active but avoid trampolines as the impact is uncontrolled and over extension is easily done.

What do her coaches say?

Hyperflexible kids need masses of conditioning to stablises joints. Her programme should be conditioning heavy, with great care on stretching- nothing outside a normal range and definitely no increasing.

Has she thought about rythmic gymnastics, or acro if she's small enough for a flier? Less impact on joints, and most are very familiar with hypermobility so can work with it.

Apologies for terrible grammar there!

She needs a good physio. Unfortunately you are unlikely to find that on the NHS. Took 16 years to get my hypermobility diagnosed despite seeing a whole host of doctors and physios. It was a private one who picked up on it immediately.
I wouldn't dare trampoline with my hypermobility. Very easy to hyper extend or subluxate.
My pain started with my feet and knees aged 11. I know now that it was caused by flat feet, caused by hypermobility. Hormones also play a key role which is probably why she is starting to suffer now.

really her coach initially said she wondered if it was Osgood Schlatters (disease?) which is when the muscles/ligaments stretch too far due to bones growing faster, particularly commonplace in high impact sports such as trampolining during puberty. She said she sees this a lot with those going through puberty. She advised DD to ensure she does her stretches every day, not just for the days she does trampolining.

She is not a competitive trampolinist yet, they are the ones who do hours of it and concentrate heavily on conditioning. She is recreational at the moment, but loves it and would like to do it more seriously in time. Her coach has commented on her very tight shoulders and I wondered if this was linked somehow? her upper body appears unaffected at the moment. Possible that she could do something similar but not quite so high impact. I can talk to her coach to see what else might be available, and also some more guidance on if she should continue.

delilah it's been a struggle and only seems that it's got this far now because we have pushed it. She had general physio, who worked on the principle similar to the Osgood Schlatters condition (Severs ?) but for her ankles, which was that she had a growth spurt and her muscles and ligaments had not stretched as much as her bones had grown. While there might be some truth in that, she could at the same time twist her ankle all the way the other way, and any exercise causes her ankles to become very floppy so I was never convinced it was just that. They then noticed her flat feet, eventually. She has exercises, and admittedly we are not as good as we could be with doing them, we do them, but not twice a day, and sometimes not at all when busy. We need to make this a proper daily routine.

I also worry about her hyper-extending again, as it was a hard landing, playfighting, but not super hard, just awkward and normal type landing for 10yr olds playing around.

I also agree that she needs to have good physio who have knowledge of hypermobility issues specifically. If necessary we will pay privately to get some advice while waiting for her referral. I was told there are clinics with specialist phsyios in, but not in Devon and a high waiting list. She has to be referred by paediatric orthopedics? (i never get it right way around!)

pragmatic we need to revisit the exercises more vigorously yes. DD's posture is wrong, another reason why i think her hips are involved - she stands with her stomach out, her back arched and her knees locked together. She can't sit with her legs together, and tends to kneel on chairs instead of sit on them. It's only been recently that i realised it was related to uncomfortableness/pain rather than just her goating around, because she never complained, she just adapted. She sits on the floor with her legs spread, normally crossed legged is ok but at the moment her knees hurt too much. She doesn't like sitting on the floor at all at the moment.

re becoming problematic during hormone increases, yup! she has those! Will it ease for her when her hormones settle into a routine, or will this be a problem from now on for her?

Maybe I will take her with me, as her DB also has trampolining before her session, and have a chat with her coach.

My DD2 has hypermobility (from CMT) and suffered from knee pain. We had excellent care from an NHS physio who gave her a course of exercises to build up the supporting muscles around her knees. They were effective very quickly and she has kept them up.

At 17, DD2 rides and swims regularly and runs occaisionally (doesn't really enjoy running). Seems to keep her symptoms in check.

We have always been told trampolining is not a good idea. But more than one kid on a trampoline playfighting? That's pretty bad. What was the coach thinking?

From your second post it sounds like she is hypermobile everywhere. She needs to be doing stuff for her core strength to avoid back issues in the future.

Because my DD has a recognised condition, I am quite aware of hypermobility and I see kids who seem more badly affected than my DD, where it hasn't been picked up on or treated. Actually we have friends who are very blasé about their kids' flat feet and poor posture and tone. Aches and pains and fatigue are written off as "whinging".

My daughter is a hypermobile dancer. She has to do a LOT of work on strengething & core & does daily excercises given to her by a dance physio.

I would reccomended taking her to a sports physio.

tinkly - they were not on a trampoline when she landed badly. that obviously came across wrong, I am sorry. she was out in the woods playing with her cousin during a family walk and landed badly during a play flight.

The coach only ever lets two on the trampoline to do 'seat wars' or whatever it's called, fully supervised!

I am surprised at how many people with knowledge of things like this dismiss it. I spoke to some school parents who are in the field (one is a podiatrist and the other works with prosthetics) and they both were very blase about a) hypermobility being nothing more than bendy and b) there not being that much that can be done. It made me feel like I was being over fussy as a parent. And I have had this at the GP, I am in there feeling that something quite major needs to be addressed and they look at me like I am an over anxious parent and that this is something she will just grow out of. I have tried to make it clear my concerns that she is at an age where she needs to learn about what is going on, learn how important it is to strengthen core muscles and also do the right exercises to condition, that we as a family need to do this, so it impacts on her growing up as little as possible. Luckily the last GP I saw (merged practices) took it seriously and said it was important that we get her proper diagnosis and treatment now and got the ball rolling. But it's been over two years since she first started getting serious pain in her ankles and it's just getting worse.

She also suffers from acid reflux, stomach pains and constipation, which has simply been dismissed as a sluggish bowel. Thankfully for the most part we can control it with watching what she eats and minimising fatty foots like pizza and battered fish, but she still gets it. I asked about this when I saw the GP as I read it might be linked and again they shrugged it of.

I really don't want her to stop doing the things she loves, I would definitely prefer to pay for private physio until we get the referral we need, so that she can learn to improve her own core etc and be able to continue doing what she loves doing.

Hi I am a qualified rebound therapist - basically I take people on the trampoline who have various forms of disability.

I do take people onto the trampoline that have hypermobility. But it's not for bouncing in the traditional sense, but for therapy and fun excercise. The program that we use focuses on 5 effects - cardio-respiratory, muscle tone,
Postural mechanism, balance mechanism and kinaesthetic awareness.

The muscle tone part concetrates on increasing tone through a number of methods. Either low amplitude input or high amplitude bouncing.

Depending on the day and the person we will either stand and bounce on the trampoline together where I give the person some support and dampen the bed (absorb the energy). For these sessions supports have to be worn on the knees to reduce the risk of dislocation.

Depending on the day etc, it might be decided that the person uses the trampoline by sitting or laying down. Sometimes with a wedge to help relieve any discomfort.

However, I also work closely alongside physiotherapist and we create a program together.

Braces also vary between clients and to help get the best fit and support they see OT. Some of clients require support for
Most of the day, others for things like rebound therapy.

Acid reflux I also limit the time on trampoline depending on the client. I generally avoid taking anyone on for at 20 minutes after they've eaten/drink.

For constipation, depending on the
Type of excercise she so doing o the trampoline she could have a bowel movement afterwards.
Same with hydrotherapy which is also helpful for hypermobility.

theresnonamesleft thank you for that post. i really need to see physio/ot before giving her a brace then? i don't want to make it worse, but also really don't want her to stop doing what she loves. if a brace means she can do trampolining then we will try that, with proper advice. i am not sure she will be happy with just bouncing, she is just learning how to do tumble turns (i think that is what they are called!).

Do get some proper advice. With the right
Support and program it can be very beneficial. The rolls and stuff would depend entirely on her specific case. There's no one program fits all.

My grandaughter has hypermobility and the physio told us that she must not do trampolining or gymnastics.

Hey guys. I thought I would update.

We met with a specialist physio from the paediatric orthopedic team. She met with DD for total of 15 mins, max. She said she has tight hamstrings, calf and thigh muscles (can't remember the name of the thigh muscles!), and also around her hips/buttocks. She observed that DD walks with her feet turned inwards, asked if this was usual, I confirmed this is how she has always walked. She said that the rotation is the whole leg, not her feet. She did a quick physical exam and concluded:

She is not hypermobile, any more than any other child. Her pain is related to her growing, in particular hormones, and is why her muscles are tight, and that this means her hip muscles are pulling her feet inwards, hence the way she walks. She said that hypermobility is over-diagnosed, and mis-diagnosed and not understood very well (after asking who told me she was hypermobile, in a way that indicated I decided this myself). She also said that the GP was over-alarmed in her referral and that she has some movement in her knees but nothing concerning.

She didn't order any x-rays, and said her hips 'appeared fine'. She has referred her back to physio to learn exercises for stretching her muscles.

I am not convinced. I do accept that she will benefit from physio, which will help strengthen/stretch her muscles, but I am not convinced it is simply this, and I am bothered at the sudden 'no hypermobility issues' given the very strong assertion from previous HCP that this is the case.

Should I just accept this is correct? could it be wrong? Of course I would be happy if it is the case that she has no issues with hypermobile joints beyond that of any other child her age, but also I don't want anything to be missed that might affect her as she grows.

So, my knees turned inwards for years and my knee caps moved around, and it was entirely muscle problems (hips, buttocks, thighs, around knee) I am hypermobile too (diagnosed by multiple consultants, hypermobile everywhere) but my physios were correct in that hypermobility was not the cause of the knee alignment, and my knees are aligned near perfectly now. So hopefully it will all be resolved for your daughter