title: The functional consequences of generalized joint hypermobility: a cross-sectional study.
abstract: BACKGROUND
  Generalized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance. Therefore, the purpose of the study was to establish the association between GJH and functional status and to explore the contribution of physical fitness and musculoskeletal complaints to this association.
  
  
  METHODS
  A total of 72 female participants (mean age (SD; range): 19.6 (2.2; 17-24)) were recruited among students from the Amsterdam School of Health Professions (ASHP) (n = 36) and the Amsterdam School of Arts (ASA), Academy for dance and theater (n = 36) in Amsterdam, The Netherlands. From each participant the following data was collected: Functional status performance (self-reported Physical activity level) and capacity (walking distance and jumping capacity: side hop (SH) and square hop (SQH)), presence of GJH (Beighton score ≥4), muscle strength, musculoskeletal complaints (pain and fatigue) and demographic characteristics (age and BMI).
  
  
  RESULTS
  GJH was negatively associated with all capacity measures of functional status. Subjects with GJH had a reduced walking distance (B(SE):-75.5(10.5), p = <.0001) and jumping capacity (SH: B(SE):-10.10(5.0), p = .048, and SQH: B(SE):-11.2(5.1), p = .024) in comparison to subjects without GJH, when controlling for confounding: age, BMI and musculoskeletal complaints. In participants with GJH, functional status was not associated with performance measures.
  
  
  CONCLUSIONS
  GJH was independently associated with lower walking and jumping capacity, potentially due to the compromised structural integrity of connective tissue. However, pain, fatigue and muscle strength were also important contributors to functional status.
authors.affiliation: Amsterdam School of Health Professions, Education of Physiotherapy, Amsterdam, The Netherlands. m.c.scheper@hva.nl.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Scheper
authors.forename: Janneke E
authors.initials: JE
authors.lastname: de Vries
authors.forename: Birgit
authors.initials: B
authors.lastname: Juul-Kristensen
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
authors.forename: Raoul H H
authors.initials: RH
authors.lastname: Engelbert
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003615:Dancing; D005080:Exercise Test; D017079:Exercise Tolerance; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D007593:Joint Instability / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007596:Joints / Q000503:physiopathology*; D015999:Multivariate Analysis; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology*; D059352:Musculoskeletal Pain / Q000209:etiology / Q000503:physiopathology; D009426:Netherlands; D010147:Pain Measurement; D010809:Physical Fitness; D055815:Young Adult