# Can you really be double-jointed?

The freight cars with the hand-painted advertisements splashed across their sides have rolled to a stop and their occupants have disembarked: elephants, clowns, a strong man, trapeze artists, a bearded lady and other self-styled oddballs. The carnival has arrived in small-town America.

As people enter the gates, various barkers compete for their attention and their dollars. As a family with young children decides what to see first, some of their neighbors emerge wide-eyed from a small tent. Above the entrance, in small red cursive letters, is the word "contortionist."

Inside, a performance commences that seems to defy logic and reality. The contortionist begins slowly by lifting one leg and placing her foot behind her head. As she does, she seems to pivot 180 degrees on the leg that supports her. Now bending down and looking back at the audience, she lowers her suspended leg, clasps her hands behind her back and brings them over her head so that her unseparated hands are now in front of her.

As the show continues, it seems as if the performer is made of rubber, and not bone. Her movements and motions don't seem humanly possible to the family or the rest of the audience who almost protectively touch their own elbows, wrists and knees as the astounding show continues.

­As spectacularly strange as the show is, it's not entirely unique. Out of every 100 random audience members, about three people in it will have features that we commonly call double-jointed [source: Elliott]. So what does it mean to be double-jointed? Does it mean you have two joints instead of the normal allotment of one? Is there one joint that allows for normal motion, and another that allows for extra motion, or does one joint just not work right? Come on in, folks -- you won't see anything like it. For the amazing double-jointed discussion, step right in to the next section.

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## Double-what-ted? Hypermobility

Before we discuss what it means to be "double-jointed" (a term we'll analyze closer in a moment), we should learn a little about how a "normal" joint works.

A joint is basically where two bones meet, allowing one to move against the other. The ends of the bones are tipped with cartilage where contact is made to prevent damage. Ligaments and other connective tissue hold the bones together. The motion is caused by muscle contraction or extension, and the muscles are attached to the bones by tendons.

Most joints allow for a standard range of motion. For instance, your elbow allows you to bend your arm and straighten it. If your arm was extended past the point where it essentially formed a straight line, it would likely cause a dislocation of the joint -- a painful separation of the bones and the ligaments that hold them in place.

However, some people do have a larger range of motion in their joints than others. The term double-jointed is commonly used, but it's not accurate. Try joint hypermobility or joint hyperlaxity instead. A person with hypermobility in the elbow may be able to extend his or her arm 10 degrees or so beyond what most of us consider to be a full extension.

How is this possible? Genetics play a large role, because the shape of the ligaments and the bone structure in large part determines the amount of motion a joint will have. Your hips and shoulders both have ball-and-socket joints: The end of one bone has a bulb that fits into a cuplike space on the other bone. If the ball is deep in the socket, the range of motion will be quite good, but not as good as when the ball rests shallowly in the socket. In fact, some people can roll the ball out of the socket and then roll it back in.

## Many Degrees of Separation: Pros and Cons of Being Hypermobile

There are some benefits and drawbacks to joint hypermobility. The upside includes possible advantages for musicians or athletes. Think of a pianist with hypermobile fingers and thumbs, or a gymnast with hypermobile hips or vertebrae. Other advantages include freaking out your family members at the dinner table and winning bets in bars. This ability must be honed in order to maintain it, though, whether you're a concert pianist or just a hypermobile hobbyist. If you have extra range of motion, you must keep your joints limber through regular stretching, or some of that ability may be lost as you age.

On the other hand (the extra-bendy one), hypermobility often comes with a steep price. There is an increased risk of arthritis in hypermobile joints, especially fingers. There may be extreme pain felt in many different joints, especially in younger people who are going through rapid growth spurts. Although some athletes may benefit from hypermobility, other people with hypermobile joints are more vulnerable to injuries. Several different but related conditions that cause pain or discomfort are grouped under the umbrella term hypermobility syndrome (HMS). To be clear, having joints with hypermobility doesn't mean you have HMS -- only if it's the source of chronic ­pain, which occurs in a minority of people with hypermobile joints. However, if you do suffer from HMS, there is a 1-in-2 chance your offspring will as well [source: Grahame].

Interestingly, if you can do things like put both feet behind your head and walk around on hyperextended arms while swinging your upper body between your elbows, local anesthetics may not be as effective on you as your less flexible compatriots. Research has indicated that local anesthetics seem to have little or no effect on many hypermobile people, something you may want to mention to your doctor if you have a medical procedure or pregnancy approaching.

So, you can't be double-jointed, but only because the term doesn't really mean anything. You can, however, be hypermobile, meaning you put just a little extra in everything you do.

For lots more information on hypermobility, bones and joints, see the next page.

### Sources

• Elliott, Jane. "Double jointed: Curse or blessing?" BBC News. Sept. 22, 2008.http://news.bbc.co.uk/1/hi/health/7523248.stm
• Grahame, R., M.D. "Pain, distress and joint hyperlaxity." Joint, bone, spine: revue du rhumatisme. 2000. (Feb. 6, 2009) http://www.ncbi.nlm.nih.gov/pubmed/10875311
• Grahame, R., M.D. "Pregnancy and JHS/EDSHM." Sept. 10, 2005. (Feb. 6, 2009)http://www.hypermobility.org/pregnancy.php
• Gray, Henry. "Anatomy of the Human Body." 1918. http://www.bartleby.com/107/pages/page286.html
• Hakim AJ; Graham R. "A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain." International Journal of Clinical Practice 2003; volume 57: p163-166.http://www.hypermobility.org/research.php
• Hakim AJ, Grahame R. Symptoms of autonomic nervous system dysfunction in the benign joint hypermobility syndrome. Rheumatology (Oxford) 2003; Volume 42 supplement: Abstract number 47. http://www.hypermobility.org/research.php
• Laskowski, Edward, M.D. "Joint hypermobility: What causes 'loose joints'?" July 20, 2007. (Feb. 5, 2009) http://www.mayoclinic.com/health/hypermobility/AN01646
• Mayo Clinic. "Bursitis." Sept. 27, 2007. (Feb. 6, 2009) http://www.mayoclinic.com/health/bursitis/DS00032