The effect of generalized joint hypermobility on functional capacity, pulmonary function, respiratory muscle strength, and chest expansion in healthy young adults

Yıl 2023, Cilt: 6 Sayı: 2, 300 - 306, 27.03.2023

Büşra Kepenek Varol , Ukbe Şırayder , Metehan Sandal , Deniz Tuncer

https://doi.org/10.32322/jhsm.1221090

Öz

Aim: Genetic involvement of connective tissue containing elastin, collagen, and fibrils in joint hypermobility determines the tightness and laxity of the ligaments, thereby increasing the possibility of injuries by affecting the stability of joint capsules and the extensibility of tendons. The aim of this study was to investigate the effects of generalized joint hypermobility (GJH) on respiratory function, respiratory muscle strength, chest expansion, and functional capacity in healthy young adults.
Material and Method: Thirty subjects aged between 18-25 years with a four or higher Beighton Score were included as the GJH group, and 30 healthy age-gender volunteers with three or lower scores were included as the control group. Functional capacity was measured with the 6-Minute Walk Test (6MWT), the quadriceps muscle strength with a digital dynamometer, pulmonary function and respiratory muscle strength with a spirometry, and chest expansion with a tapeline.
Results: There were significant differences in the 6MWT distance (p=0.017), FVC (p=0.001), FEV1 (p=0.001), and MEP (p<0.001) while no significant differences were observed in quadriceps muscle strength, FEV1/FVC, PEF, and MIP (p>0.05). There is a significant difference in the xiphoid (p<0.001) and subcostal (p<0.001) measurement in the chest expansion value, and no difference in the axillary measurement (p=0.071).
Conclusion: The results of this study demonstrated that functional capacity, pulmonary functions, respiratory muscle strength, and chest expansion may be affected in young adults with GJH. In this study, it was found that the values that required a forced expiratory maneuver were affected. This suggests that the abdominal muscles, which play an important role in forced expiration, may also be affected by changes in the muscles due to deterioration in the connective tissue.

Anahtar Kelimeler

generalized joint hypermobility, functional capacity, pulmonary function, respiratory muscle strength, chest expansion

Kaynakça

• Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int 2021; 41: 1707-16.
• Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility andrelated conditions. Am J Med Genet Part C Semin Med Genet 2017; 175: 148-57.
• Hakim A, Grahame R. Joint hypermobility. Best Pract Res ClinRheumatol 2003; 17: 989-1004.
• Bates AV, Mcgregor AH, Alexander CM. Prolonged standing behaviour in people with joint hypermobility syndrome. BMC Musculoskelet Disord 2021; 22: 1-8.
• Russek LN, Errico DM. Prevalence, injury rate and symptom frequency in generalized joint laxity and joint hypermobility syndrome in a “healthy” college population. Clin Rheumatol 2016; 35: 1029-39.
• Oddy C, Johnson MI, Jones G. The effect of generalised joint hypermobility on rate, risk and frequency of injury in male university-level rugby league players: a prospective cohort study. BMJ Open Sport Exerc Med 2016; 2: e000177.
• Van Meulenbroek T, Huijnen I, Stappers N, Engelbert R, Verbunt J. Generalized joint hypermobility and perceived harmfulness in healthy adolescents; impact on muscle strength, motor performance and physical activity level. Physiother Theory Pract 2020; 37: 1438-47.
• Murray KJ. Hypermobility disorders in children and adolescents. Best Pract Res Clin Rheumatol 2006; 20: 329-351.
• Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: Review of theliterature. J Rheumatol 2007; 34: 804-9.
• Tinkle BT. Symptomatic joint hypermobility. Best Pract Res Clin Rheumatol 2020; 34: 101508.
• Nicholson LL, Simmonds J, Pacey V, et al. International perspectives on joint hypermobility: A synthesis of current science to guide clinical and research directions. JCR J. Clin. Rheumatol 2022; 28: 314-20.
• Nash MN, Liu CA, Maestas B, et al. Chest pain from hypermobility responding to physical therapy in an adolescent. Am J Phys Med Rehabil 2017; 96: 219-22.
• Arena R, Myers J, Williams MA, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007; 116: 329-343.
• Engelbert RH, van Bergen M, Henneken T, Helders PJ, Takken T. Exercise tolerance in children and adolescents with musculoskeletal pain in joint hypermobility and joint hypomobility syndrome. Pediatrics 2006; 118: 690-6.
• Scheper MC, de Vries JE, Juul-Kristensen B, Nollet F, Engelbert RH. The functional consequences of generalized joint hypermobility: a cross-sectional study. BMC Musculoskelet Disord 2014; 15: 243.
• Fatoye F, Palmer S, Macmillan F, Rowe P, van der Linden M. Proprioception and muscle torque deficits in children with hypermobil-ity syndrome. Rheumatology (Oxford) 2009; 48: 152-7.
• Jindal P, Narayan A, Ganesan S, MacDermid JC. Muscle strength differences in healthy young adults with and without generalized joint hypermobility: A cross-sectional study. BMC Sports Sci Med Rehabil 2016; 8: 12.
• Lanza FC, de Camargo AA, Archija LR, Selman JP, Malaguti C, Dal CS. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respir Care 2013; 58: 2107-12.
• Padkao T, Boonla O. Relationships between respiratory muscle strength, chest wall expansion, and functional capacity in healthy nonsmokers. J Exerc Rehabil 2020 16; 189-96.
• Reychler G, Liistro G, Pierard GE, Hermanns-Le T, Manicourt D. Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers-Danlos syndrome: A randomized controlled trial. Am J Med Genet A 2019; 179: 356-64.
• Kumar B, Lenert P. Joint hypermobility syndrome: recognizing a commonly overlooked cause of chronic pain. Am J Med 2017; 130: 640-647.
• Chohan K, Mittal N, McGillis L, et al. A review of respiratory manifestations and their management in Ehlers‐Danlos syndromes and hypermobility spectrum disorders. Chron Respir Dis 2021; 18: 14799731211025313.
• Fikree A, Aziz Q, Grahame R. Joint hypermobility syndrome. Rheum Dis Clin North Am 2013; 39: 419-30.
• ATS. Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. Am J Respir Crit Care Med 2002; 166: 111-7. ATS statement: guidelines for the six-minute walk test [published correction appears in Am J Respir Crit Care Med 2016; 15; 193: 1185].
• Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-81.
• Reinking MF, Bockrath-Pugliese K, Worrell T, Kegerreis RL, Miller-Sayers K, Farr J. Assessment of quadriceps muscle performance by hand-held, isometric, and isokinetic dynamometry in patients with knee dysfunction. J Orthop Sports Phys Ther 1996; 24: 154-9.
• Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-38.
• American Thoracic Society/European Respiratory Society. ATS/ ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518-624.
• Chanavirut R, Khaidjapho K, Jaree P, et al. Yoga exercise increases chest wall expansion and lung volumes in young healthy thais. Thai J Physiol Sci 2006; 19: 1-7.
• Şenocak MŞ. Klinik biyoistatistik. 1st ed. Hadımköy-İstanbul: Nobel Tıp Kitabevleri; 2009.
• Reuter PR. Physical therapy in sport joint hypermobility and musculoskeletal injuries in a university-aged population. Phys Ther Sport 2021; 49: 123-8.
• Cote CG, Casanova C, Marin JM, et al. Validation and comparison of reference equations for the 6-min walk distance test. Eur Respir J 2008; 31: 571-8.
• Luder G, Schmid S, Stettler M, et al. Stair climbing-An insight and comparison between women with and without joint hypermobility: A descriptive study. J Electromyogr Kinesiol 2015; 25: 161-7.
• Schubert-Hjalmarsson E, Öhman A, Kyllerman M, Beckung E. Pain, balance, activity, and participation in children with hypermobility syndrome. Pediatr Phys Ther 2012; 24: 339-44.
• Jensen BR, Olesen AT, Pedersen MT, et al. Effect of generalized joint hypermobility on knee function and muscle activation in children and adults. Muscle Nerve 2013; 48: 762-9.
• Soyucen E, Esen F. Benign joint hypermobility syndrome: a cause of childhood asthma? Med Hypotheses 2010; 74: 823-4.
• Ishida H, Suehiro T, Kurozumi C, Ono K, Watanabe S. Correlation between abdominal muscle thickness and maximal expiratory pressure. J Ultrasound Med 2015; 34: 2001-5.
• Montes AM, Baptista J, Crasto C, de Melo CA, Santos R, Vilas-Boas JP. Abdominal muscle activity during breathing with and without inspiratory and expiratory loads in healthy subjects. J Electromyogr Kinesiol 2016; 30: 143-50.
• Sirayder U, Inal-Ince D, Kepenek-Varol B, Acik C. Long-term characteristics of severe COVID-19: respiratory function, functional capacity, and quality of life. Int J Environ Res Public Health 2022; 19: 6304.