In this solo lecture, Dr. Aaron Hartman, MD, critiques the commonly used Beighton score for assessing hypermobility, explaining its origins as a research screening tool, its age‑adjusted thresholds, and its blind spots (e.g., lack of spine, neck, shoulder, and pregnancy considerations). He then outlines a comprehensive clinical examination approach, describing facial and skeletal ratios, skin texture, stretch‑mark patterns, scoliosis, foot papules, and other physical markers that can reveal hypermobility beyond the Beighton score. Dr. Hartman highlights pediatric clues such as W‑sitting, clumsiness, and double‑jointedness. He connects hypermobility to systemic effects of altered fascia, including mast cell activation, neurological pressure, gut dysmotility, organ prolapse, and related conditions like POTS, dysautonomia, SIBO, and autoimmune issues. Finally, he advocates a holistic, individualized treatment plan—nutritional support, neurological retraining, gut health, and environmental modifications—to mitigate these downstream effects and improve health trajectories, especially in children, emphasizing the potential to shift generational outcomes.
Chapters
Welcome back. Once again, we're going to keep on taking a deep dive into hypermobility and actually how you can tell if someone's hypermobile, some of the nuances of it, and some of the things that it can be related with. Super interesting stuff. If you're listening to this right now, odds are you're not following us or following along. If you can do that below, click the link, that'd be super helpful. It helps get the word out there. And now back to the episode. So the primary thing we use right now to gauge hypermobility is the Beighton score. Is a standardized tool used to actually help make the diagnosis of hypermobility. You have to realize it's a research-based tool. It was actually put together by the EDS Society for physicians, practitioners who aren't familiar with it to track along categories 1, 2, and 3, as well as for patients to actually self-diagnose and take it to the provider with the goal of finding people in an easy way that doesn't miss anybody. I'm thinking about screening tools. If you make them so you don't miss anybody, they're not overly sensitive, which means they'll overlook a lot of people that can get missed. So that's— so as I'm walking through things, I want you to realize this screening tool will miss a lot of people, has blind spots, and once you know what they are, you can fix those. So what is the Beighton score? It's a 9-point assessment that looks at different joints, 5 maneuvers. Looks at some flexibility, you know, can you bend it down and touch this? Pinky flexibility, elbows, knees, and then can you lean forward and touch the ground? A score in adults of typically 4 or above means you're positive for this. And the thing about the— and then 5 for kids. The interesting thing is that the UK uses a more strict guideline that picks up more people than we use here in the United States, which I think is interesting as well. And if you're over 50, the score, like the number to you get to be hypermobile also drops. Well, that drops. If you're a kid, you have to be a little higher. So instead of, you know, 4, it goes up to 5. And as you get older and stuff, you know, 5, it drops down to 4. It kind of goes up and down a little bit based on your age, et cetera. But the idea is that this is what we use, flexibility. The problem with it, it only looks at mainly upper extremity, hands, some hand stuff, knees. It doesn't look at spine. It doesn't look at neck. It actually doesn't look at your fingers. It only looks at pinky and thumb. It doesn't look at the other ones. It doesn't look at wrist per se. It looks at the thumb going through. It doesn't look at shoulders, spine, sacrum. I've had patients dislocate their hip rolling in bed. I'm like, well, that's kind of hypermobile. It doesn't take into account pregnancy. I've had some patients who, as they get pregnant, all of a sudden their joints start getting loose because the progesterone makes them more loose. So there's a lot of blind spots related to this, the score. The score was ultimately made for epidemiologists for survey, not a clinical diagnosis. You get a higher score in women than certain ethnicities. That doesn't correlate well all the time with clinical symptoms. And for my gymnast dancers, people trained with hypermobility don't always correlate one-to-one as well. That's where you have to look at other fascia, other things. So the point is that it's a general screening tool. We use it, but it misses a lot of stuff. And that's what I think people need to keep in mind. So then the question is, well, what the— how else do I figure out if people are hypermobile? And that's when you do a physical exam and you look at people. So starting at the face, you know, do you have a longer face, facial structure, like elongated face? Do you have a high-arch palate? Do you have tori, which is your bones in your mouth associated with Tall tongue, jaw clenching, a longer neck. If you— it's really interesting, you look at people's body habitus and see if they have really long neck related to their head size or torso, or even long legs related to their torso. That can go along with hypermobility. And what— there is a category, a criteria by itself, this alone increases your risk for mold-related illness. Are your arms longer than you are tall by greater than, I think it's 1.0 5, I believe, is the ratio. So all of a sudden, just looking at someone's body, looking at their body ratios can give you a feel like, is someone hypermobile or not? Also, if you're looking at, you're feeling their neck, what's the skin feel like? How stretchy is it? Where are the arms? Like typically on the forearms, they'll have a very silky kind of velvety kind of feel to their skin. And you notice people having stretch marks in places where they shouldn't. Like, should a guy have stretch marks on his thighs? Probably not. On his chest? I mean, probably not. You know, women, When I went through my growth spurt and I got stretch marks. Most people don't do that. And they'll have like stretch marks in the wrong direction. I've noticed stretch marks can also be a clinical marker for Bartonella. So I'm not going to talk about that here, but that's something to think about. And then scoliosis, you actually will see more scoliosis in people with hypermobility. So I'm doing a physical exam, for example, like someone's back. I usually run my finger down the back and you'll feel like stuff turn. When you're looking at someone, you might see them— I mean, a lot of you all probably notice my one shoulder's off compared to my other one because I have some mild scoliosis in my neck. So all of a sudden you can see people's shoulders being off, their back, their hips. If someone stands up, you notice the hip tilt. And then when you're doing physical exam, you might notice like their collarbones being off a little bit. These are all markers of scoliosis, which you will see more in people that are hypermobile. And then like looking at their feet, they have these little things called pesiogenic papules, these little herniations on their feet that pop out. Collapsing arches. These are all things that can set someone up for— let me rephrase this— they're all things that, that are associated with hypermobility. So all of a sudden, having a clinical eye, knowing how to look at people, helps me delineate. Is that Beighton score of 2 or 3 in a 50-year-old, is it really insignificant, or are they hypermobile? Or is that Beighton score of 5 in a child, is it significant or is it not, right? So all of a sudden, knowing these other nuances can help you when when you're looking at someone to figure out, are they hypermobile? As far as kids are concerned, you know, W— I don't know how many of y'all know what W-sitting is. That's something my wife taught me early on. She's a pediatric occupational therapist. When kids sit, their legs will splay out and make a W. Those kids are maybe hypermobile. You know, history of ankle sprains, a clumsy child. That's one of the things about hypermobility is the cerebellum is bigger. So if you train it, you can become an elite athlete. If you don't train it, you might have a clumsy, wonky kid who bounces off off walls and seems kind of clumsy and clunky. And then the whole kid double jointed, the kids who do the party tricks, right? Double jointed, popping shoulders out, like taking your hands and like being able to do it all the way around. Those are markers of, huh, is this kid hypermobile? Is this adult hypermobile? And then basic things like subluxing and my ribs kind of pop out of place and they go back in place. I feel my vertebrae in my back move. Sometimes my shoulder or my hip will pop out of place. One time I was riding a bike with my son. I remember we were doing a turn really hard, he was pushing out, his shoulder popped in and out. Well, I already knew he was hypermobile, but it was one of those things where he felt it clunk and that's like, ooh. And then we kind of talked about how he's hypermobile and he needs to eat more protein. And that was a fun conversation to have with a 12-year-old boy. He's still not, he's getting a little better at 15 with it, but you know, boys will be boys. But the ultimate thing is this is a fascial disease. So having hypermobility connective tissue Affects every structure in the body. It affects your heart, kidney, liver, affects your brain. If your brain sinks too much, you can actually get back pressure on your brainstem and cause neurological issues. Fascia also contains nerves, immune cells, mast cells. There's a reason why a lot of people with fascia issues have mast cell activation syndrome. You can also, with the altered fascia that being loosened, loosey-goosey, you can get altered nerve signaling, more pain, more sensitivity, more likely to get pain syndromes. Um, more mast cell stuff we talked about, which leads down to a whole host of other issues. Um, leaky gut. If your gut is kind of hanging more, you can actually get proptosis of organs, which are sagging organs, slowing of bowel function, leading to SIBO and bacterial overgrowth. And then finally, you know, the cranial structures I mentioned before. All of a sudden, hypermobility can lead to all these different pathways. And I've been seeing this for years, and I'm putting this out there because there's so many people I see with mold and Lyme concussion, gut issues, autoimmune problems, you know, all these unrelated, related things. And we realize if you have hypermobility, you have to have a nutritional plan, a neurological brain retraining plan, a gut plan, an environmental plan that takes your hypermobility into account. So that's my basic 1,000-foot view of hypermobility and the fascia. Next, I'm going to talk about what we actually do nutritionally, what what I do with patients to help the body heal better, what I've done, some cool things I've done in the past. And if you're a parent out there listening to this and you're hypermobile, look at your kids because you can literally change their health. This is what I'm really passionate about. You can literally change their health trajectory to be the super athletic, super smart person who's doing really cool things from being that person with POTS, dysautonomia, or whatnot. So that's where I feel like getting this information out there can literally change a whole generation. And this is— and I'll stop with this. This is very similar to diabetes. Hear me out here. And a lot of other things we're seeing where it used to see diabetes when you're 16, 17, then 30 and 40. Now we're seeing at 15 to 20. We're seeing things like Ehlers-Danlos, chronic fatigue, a lot of these health issues younger and younger and younger because this fascia is being ignored. The same time point, if we nutritionally support people's connective things that connect, connective tissue. We can start pushing that back up. And that's what I'm really excited about, is changing the course of the next generation of people as well as those that I'm working with right now. So hopefully that information was helpful. That's what we're gonna talk about next time. Take care. We'll talk to you soon.
