Hypermobility: Beighton Score

Are you hypermobile? In the next couple of hypermobility-based posts, we will look at some of the testing criteria used to help diagnose hypermobility a bit more specifically (some you can do yourself today). From here we aim to gain a more rounded knowledge, and understand its relevance so we can best manage symptoms and optimise performance in this prevalent and often misunderstood population.

Let’s start by looking at the Beighton Score.

This is a scoring system which has been used for years as an indicator of widespread hypermobility. It can be seen more as a research tool and a quick indicator of generalised hypermobility. As a clinical tool it’s quick and straightforward, but should not be relied upon as the gospel in terms of diagnosis of general hypermobility. Here are two important things to consider when using this scoring system.

  1. A high Beighton score does not mean that the individual has hypermobility syndrome, something we touched on briefly in out first hypermobility post with relation to the performer. Other symptoms also need to be present, which we will go in to next time.
  2. The joints that are assessed are set to 5 specific movements/tests, a low score should also be considered when assessing someone with widespread pain. This is because hypermobility can be present in some joints that are not on the Beighton testing list, including the jaw (TMJ), shoulders, hips, and ankles.

So, what is tested?

Figure 1 Shows the tests described in Table 2 (below)
Table 1 Shows the Beighton Scoring system, associated pictures can be seen in Figure 1 over

What’s your score? Mine (as seen in the table) is 3.

Some issues with the Beighton scoring system are that the joints were not specifically selected to accurately reflect generalised hypermobility and therefore doesn't take into consideration hypermobility in other joints. It was chosen on a functional basis, for ease and efficiency without the need for equipment, to give an indication of a widespread level of mobility that require require further investigation. However, this resulted in two thirds of the joints being upper limb and many of the major joints disregarded, with only single plane of joint movement being measured. The measuring system is ‘all or nothing’, which determines the presence of hypermobility and gives no indication of its severity or direction.

Validity when using the Beighton scale is questionable, and it’s important to be aware of this when using it. As always, a clinical assessment and history taking is crucial to gain the full picture. Alternative tools to measure hypermobility do exist, which we will delve into another time. However, with over 300 joints in the body, it is unlikely any single assessment method will ever truly capture all variable presentations of generalised joint hypermobility.

If we now venture into the realms of hypermobility syndrome – with the Beighton score being the initial assessment for joint hypermobility. Historically, a score of 4/9 or higher is generally considered to be a good indication of hypermobility syndrome. However as previously mentioned the Beighton score is a quick assessment of joint hypermobility and is not the sole criteria for a cast-iron diagnosis. The next clinical step is utilising the Brighton criteria, which includes other major and minor indicators for a more comprehensive diagnosis of hypermobility syndrome. We will look at this in the next hypermobility blog post which is coming soon.

Many thanks for reading,

Sophie

@sophielanephysio

Learn more about your Hypermobility in the performer and how best to support it to enhance health and performance by keeping an eye our for Production Education, coming soon.