Exercise in Patients With Hypermobile Joints and Knee Pain

Pain associated with knee joint hypermobility is common in the adult population, but evidence on treatment is sparse. This study investigates if high-load resistance training is superior to usual care in improving activity-related pain in young patients (18-45 years) with hypermobile joints and knee pain.

Inclusion criteria * Persistent knee pain for ≥ 3 months (self-reported) * Knee pain ≥ 30mm during the last week using a 0-100 mm visual analogue scale (VAS; 0=no pain and 100=worst imaginable pain) (self-reported) * Generalised joint hypermobility assessed with the Five-Part Hypermobility Questionnaire (positive ≥ 2/5) (self-reported) * Local knee joint hypermobility using the passive hyperextension of the knee in standing (positive \> 10 degrees of hyperextension) and confirmed in supine lying (heel resting on 20 cm high block on the bench surface), with passive knee hyperextension (positive \> 10 degrees) (objectively measured) Exclusion criteria * Diagnosed with patellar tendinopathy * Pregnancy or childbirth within the past year (due to increased levels of relaxin that could affect joint stability) * Knee surgery within the past year * Participation in regular structured resistance training within the past six months * Inability to speak and understand Danish. * All types of Ehlers-Danlos syndrome * Other heritable connective tissue disorders such as Marfan syndrome, osteogenesis imperfecta, Loeys-Dietz syndrome, Stickler syndrome, skeletal dysplasias * Autoimmune rheumatic connective tissue disorders such as lupus, rheumatoid arthritis; Chromosomal conditions such as Fragile X syndrome, Kabuki syndrome, Down syndrome * Neuromuscular disorders that can cause joints to become unstable, such as multiple sclerosis