Hypermobility & The Beighton Scale

Do you ever worry about your flexibility? Are your joints too stiff or too mobile? Certain sports such as ballet and gymnastics encourage flexibility, whereas other sports such as cycling tend to produce more tightness. As a former gymnast, I am very familiar with hypermobility – doing full splits and achieving crazy positions with my body was easy. While a certain amount of flexibility is desired, too much can be hazardous to our bodies. Excessive laxity can also indicate joint or connect tissue disorders such as Ehlers-Danlos syndrome.

The Beighton Scale is a way to test the amount of mobility you have in your joints. There are 5 tests used to calculate a total score. You get 1 point if you can do the movement and you get 0 if you cannot. When you add up your points at the end, the minimum score you can get is 0 and the maximum is 9. Here are the tests:

  1. Can you put your hands flat on the floor with your knees straight?

    • Yes = 1. No = 0

  2. Can your elbow bend backwards (hyperextend)?

    • Right side: Yes = 1. No = 0

    • Left side: Yes = 1. No = 0

  3. Can your knee bend backwards (hyperextend)?

    • Right side: Yes = 1. No = 0

    • Left side: Yes = 1. No = 0

  4. Can you bend your thumb to the front of your forearm?

    • Right side: Yes = 1. No = 0

    • Left side: Yes = 1. No = 0

  5. Can you bend your little finger back to a 90-degree angle from your hand?

    • Right side: Yes = 1. No = 0

    • Left side: Yes = 1. No = 0

A score of 0-3 indicates no hypermobility. A score of 4 or more indicates some hypermobility. A score of 9 is a severe case.

Below are some examples of scoring. Note the neon green lines are used to show angles. The image of the knee shows a straight line, thus no hyperextension. The first elbow (left) is straight, but the second elbow (right) shows hyperextension. The bottom two pictures show the thumb does not touch the forearm and the little finger does not bend to 90-degrees from the back of the hand.

While every individual is different and this test only examines a few joints in our bodies, a person scoring a 0 should generally focus on stretching and a person with a high score would likely benefit from strengthening with minimal stretching. A higher score is more common in children and females, while a lower score is more frequently seen in older adults and males. There is also a genetic role in mobility, and many people find there are similar amounts of flexibility throughout their family.

I used to score a 5 on the Beighton Scale. I could put my hands flat on the floor and I had hyperextension in both knees and elbows. However, now I only score a 2. Both of my arms still hyperextend, but I developed sturdier joints with lots of strengthening (especially hamstrings) and less aggressive stretching.

As a physical therapist, I find it is easier to work with someone who has a low score than a high score. Stretching tends to come easier for people than a long term strengthening program. If you think about a rubber band, it is easier to stretch it out than to tighten it up. Injuries can happen at both ends of the spectrum, so it is important to work on your specific weaknesses. A hypermobile individual is at a higher risk of loose ligaments, dislocations, and hyperextension injuries. A person lacking mobility can be more prone to overuse injuries and arthritis. It is really essential to remember you should never stretch into pain. If you are tight, stretching should still be gentle. Additionally, do not to bounce when you hold a stretch because it can damage ligaments and tendons.

What do you score on the Beighton Scale?

Do you believe you have injuries related to being too flexible or having areas that are too tight?