Who needs care from our service

We accept physiotherapy referrals for children when the condition is:

  • significantly impacting on gross motor functional ability
  • causing sleep disturbance on a regular basis
  • impacting on attendance at school.

We accept occupational therapy referrals for children when the condition is:

  • impacting on multiple functional activities such as self-care tasks (washing, dressing, using cutlery), sitting posture, attention skills and handwriting. If a child only has handwriting difficulties, then this would be something that school assist with.

Making a referral

We accept referrals from anyone involved in the child’s care.

This includes family, school, medical professionals and external support services.

Please give us as much detail as possible as to how the child’s hypermobility symptoms are currently impacting on their day-to-day activity.

What can we do for you?

Depending on the outcome of the assessment, the occupational therapist or physiotherapist is likely to recommend self-help strategies such as exercises, changing footwear or use of different equipment.

We may need to complete further assessment at home or at school.

If you have any questions or concerns, please call TOP or contact your therapist directly.

Other services

Musculoskeletal outpatients physiotherapy is the team to go to when a child is highly functioning with sport or activities but is still struggling with pain, or when a child has a single area of pain (for example back pain or knee pain).

Podiatry is the team to go to for support with finding the best insoles or foot supports where that need is present.

Joint hypermobility syndrome

Joint hypermobility syndrome is when you have very flexible joints and it causes you pain (you may think of yourself as being double-jointed).

It usually affects children and young people and often gets better as you get older.

See a GP if you:

  • often get tired, even after rest
  • keep getting pain and stiffness in your joints or muscles
  • keep getting sprains and strains
  • keep dislocating your joints (they "pop out")
  • have poor balance or co-ordination
  • have thin, stretchy skin
  • have bladder or bowel problems

These can be symptoms of joint hypermobility syndrome.

A GP will usually test the flexibility of your joints using the Beighton score.

They may also refer you for a blood test or X-ray to help rule out any other conditions like arthritis.

There's no cure for joint hypermobility syndrome.

The main treatment is improving muscle strength and fitness so your joints are better protected.

A GP may refer you to a physiotherapist, occupational therapist or podiatrist for specialist advice.

You can also pay for these services privately.

These physical therapies can help to:

  • reduce pain and the risk of dislocations
  • improve muscle strength and fitness
  • improve your posture and balance

Paracetamol and anti-inflammatory painkillers (like ibuprofen, which comes as tablets, gels and sprays) may help to ease pain.

Speak to a pharmacist about the best painkiller for you.

A GP may be able to prescribe stronger painkillers.

If you're in severe pain, a GP may be able to refer you to a pain clinic to help you cope with pain.

To help ease joint pain and stiffness, you can:

  • have warm baths
  • use hot water bottles
  • use heat-rub cream

Find physiotherapy services

Find occupational therapy services

Find a pharmacy

It may also help to join a support group like the Hypermobility Syndromes Association or Ehlers-Danlos Support UK.

If you have joint hypermobility syndrome, there are things you can do to improve joint and muscle strength and reduce strain.


  • start with low-impact exercise like swimming or cycling if you've not been active before (not doing any exercise can make your symptoms worse)

  • maintain a healthy weight

  • wear supportive shoes

  • wear special insoles (orthotics) in your shoes if a podiatrist has recommended them


  • do not overextend your joints just because you can

  • do not do repetitive exercises or activities – take regular breaks (called pacing)

Download the Alder Hey Children's NHS Foundation Trust's leaflet: Hypermobility Information for parents, carers and schools (PDF, 158kb)

Joint hypermobility syndrome can run in families and it cannot be prevented.

Usually, the joints are loose and stretchy because the ligaments that should make them stronger and support them are weak.

The weakness is because the collagen that strengthens the ligaments is different from other people's.

Most experts agree that joint hypermobility syndrome is part of a spectrum of hypermobility disorders which includes Ehlers-Danlos syndrome. Some people with hypermobility spectrum disorders do not have symptoms.

Children's Integrated Therapy Service

Speak to the team for
more information.

Case studies

Josie was referred to physiotherapy and occupational therapy by the consultant rheumatologist. Every night Josie was experiencing pain which stopped her getting a good night’s sleep and this caused her to have frequent days off school to recover.

Josie also found school work difficult because she needed to move regularly and her hands and wrists hurt when she did any writing.

The therapists saw Josie for an initial assessment. Josie and her mum answered some questions about the current problem and the therapists observed Josie completing some movements and fine motor activities. Initially the therapists recommended some core and leg strengthening exercises, hand strengthening advice and gave resources for alternative pencil grips to trial.

Later the therapists visited Josie at school for an observation and gave further advice to her teachers.

A therapist reviewed Josie three months later. The advice had worked – Josie said she was sleeping better and was getting to school too. She was still trialling different self-management strategies with her mum’s support but all agreed that she could be discharged as everyone now knew what to do. The therapist made sure mum knew that Josie could be referred back into the service in future if needed, but that she could also access advice through the service Therapy One Point in the interim.

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