They are everywhere; colorful therapy balls have migrated from the clinic to the classroom. You can buy a base or a whole chair with a ball attached. But do kids with hypermobility benefit from using them, or will they create more problems than they solve?
Hypermobility in infants and very young children is common, and decreases over time in typical children. But then there are the kids with low muscle tone or connective tissue disorders. These kids do not commonly see a decrease in their loose joints over time. They do become stronger, and they can become more stable and steady. But they can still display considerable flexibility over time.
In fact, hypermobility can increase with each overstretched ligament or damaged joint. It is as simple as basic construction principles: when the foundation is shaky, the structures around the foundation receive some of the forces from action and movement that the foundation should have absorbed. A child who has an unstable pelvis will experience more forces in their upper spine and in their knees as the muscles try to compensate for the extra movement at the pelvis. Over-stretching, excessive tightening of the wrong structures, and damage to joint surfaces are the result of excessive force absorption.
In this situation, another symptom becomes more and more obvious: fatigue. Well-aligned joints are designed to decrease effort during movement, like a Swiss clock. Damaged joints and joints that don’t glide correctly due to lax ligaments and weak muscles require more effort to do the same job. Hence fatigue sets in just from the extra effort required. This is true even if the connective tissue that creates muscles and ligaments is of good quality. Some genetic connective tissue disorders are characterized by incomplete or faulty construction of connective tissue. These children are starting out with a foundation that is unstable and weak before any forces have been applied. They will become weak and tired more quickly than a child with the same level of instability but with stronger connective tissue.
While sitting on a therapy ball-chair, the expectation is that the dynamic movement of the ball will activate core musculature and provide a dynamic position that helps a child achieve core stability. Sounds great! But…this assumes that the physical structures needed are capable of doing so, and that the child is also able to write or play, using his arms and hands effectively at the same time. It also assumes that the child will notice when his alignment has decreased and will take action to prevent compensation. I think that is a lot to ask of most kids, even most teens. They just want to get their homework done and over.
Based on all of these concerns, I recommend that children with hypermobility be closely evaluated and monitored by a therapist before they use a therapy ball set-up as a chair for play or schoolwork. The extra effort to sustain and achieve good alignment is likely to be difficult to manage as they concentrate on a task like handwriting. The risk is that they fatigue the supporting musculature, recruit compensatory muscles for support, and place more strain on joints and ligaments without awareness. Yes, I am saying that there is a chance that the use of these chairs with some kids can make things worse.
A better idea for kids with hypermobility? A more supportive seating set-up. Reduce the physical demands while your child is working, and leave exercising on a ball to therapy sessions and your therapy home program. Therapists are skilled at designing programs that target specific muscles to develop balanced control around a joint while protecting it at the same time. They are also great at assessing work stations and chairs to determine which designs will give your child support and dynamic positioning at the same time without excessive fatigue. This is one of my favorite tasks as an OT. I know that a well-designed seating set-up will provide a pay-off every time a child sits down for a meal, plays at a table, or does their homework. Sometimes it means that joint protection and support have to be blanked with dynamic control, and my training helps families to parse it out for the best result possible for their child.
Looking for more ideas with your hypermobile child? Check out Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior and Should Hypermobile Kids Use Backpacks? to start the school year.
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