Perineal descent (PD) is a sign of connective tissue weakness of the pelvic floor, it can be measured mechanically or radiologically. Joint hypermobility can be a sign of a generalised connective tissue abnormality, there is an increased incidence of pelvic organ prolapse and faecal incontinence amongst patients with heritable connective tissues diseases. To explore the relevance of PD and the relationship between connective tissue abnormality and pelvic floor dysfunction five studies were performed.A new mechanical device for the measurement of PD, the laser commode, and the established mechanical device, the perineometer were compared to the current gold standard method of measurement, defaecating proctography in 68 subjects. The laser commode provided a mean overall PD measurement closer to that of proctography than the perineometer but the repeatability and reproducibility of the measurements were not accurate enough for the laser commode to be used either in the subsequent parts of this research project or in a clinical setting.Perineal descent was measured using proctography and joint hypermobility was measured using the Beighton score in 70 females with pelvic floor dysfunction. No correlation was found between PD and joint mobility.A review of 323 proctograms of females with pelvic floor dysfunction found an association between PD and rectal prolapse but no association between either PD and rectocele formation or PD and rectal intussusception. The Pelvic Floor Distress Inventory questionnaires of 133 females were correlated with their proctography findings. There was no association between PD and any of the clinical symptoms. Biopsies from the rectus sheath and pelvic floor fascia of 19 females with rectal prolapse were compared to those of 8 normal controls. There was no difference in collagen or elastin content between the groups but participant numbers were small. The pelvic floor fascia of the rectal prolapse group showed a higher percentage of well organised elastin than that of the control group but this did not reach statistical significance. Perineal descent does not appear to be a consistent indicator of severe pelvic floor connective tissue abnormality or injury. This study has furthered our understanding of perineal descent and the relationships between this finding and other pelvic floor disorders caused by connective tissue weakness. Future work will focus on further histological analysis of tissue from patients with rectal prolapse in combination with the use of more sensitive methods to establish the presence of an underlying connective tissue abnormality.

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system that has high association with chronic pain syndromes such as fibromyalgia, migraine disorders, and chronic abdominal pain in adolescents with the diagnosis. Many of these disorders are characterized as central sensitization disorders, or pathological pain memory mediated by neural plasticity. Ehlers Danlos Syndrome Type 3 (EDS-3), also called joint hypermobility syndrome (JHS) is a genetic disorder of the connective tissue that causes joint laxity and is also highly associated with chronic pain syndromes as well as POTS. Methods: This study proposed to characterize POTS as a disorder of central sensitization. The hypothesis, presented within the proposed theoretical model, demonstrates that JHS leads to chronic pain that results in central sensitization and autonomic nervous system dysfunction (POTS). Other factors that were evaluated were anxiety and function. A sample size of 40 adolescents between the ages of 12 and 19 years were recruited from the cardiology and pain clinics at Children’s National Medical Center. Analysis of data utilizing Wilcoxon, Chi square, Pearson correlation, and logistic regression tests were completed using SAS 9.3. Results: In comparison to those without POTS, there were no significant associations found between having the diagnosis of POTS and any other variable studied in the model. JHS had a stronger correlation with anxiety, central sensitization, both subjectively, and objectively with hyperalgesia on Aδ sensory nerve fiber when compared to those without JHS. Subjective central sensitization was highly correlated with anxiety, function, age, and female gender. Function and central sensitization had a significant association even when removing anxiety as a covariate. Conclusions: These findings suggest that joint hypermobility may be a factor that contributes to the development of central sensitization in individuals with chronic pain. Dysautonomia is likely not a disorder of central sensitization, but rather a variable related to joint hypermobility and chronic pain in ways yet to be discovered. As previously discussed in other literature, anxiety has strong associations with central sensitization and functional disability in chronic pain syndromes, and when treated effectively may increase function in those that suffer with these disorders.

Tenascin X (TNX) is a matricellular protein involved in regulating cellular functions by interacting with other extracellular matrix (ECM) proteins within the cell matrix and has anti-adhesive properties evidenced in tumours and wound healing. TNX is the only member of the tenascin family that is lost in Joint Hypermobility Syndrome (JHS) and exerts a crucial architectural function. Of importance, TNX deficient and JHS patients have gastrointestinal (GI) dysfunction. Despite this association no study has described the role of TNX in the GI tract. Thus, the aim of this thesis was to characterise the expression of TNX in the stomach and colon in mouse and human tissue. Second, we aimed to elucidate the functional role of TNX using TNX knockout (TNX KO) mice. Expression studies revealed TNX in vagal afferent endings in the mouse, and myenteric cell bodies in human stomach. In colon, TNX strongly associated with cholinergic submucous and myenteric neurons in both species, however, was not found in CGRP positive fibres. Cell bodies in nodose ganglia, dorsal root ganglia, ventral and dorsal horn were also TNX positive. Functional studies in stomach, using single fibre electrophysiology showed TNX KO mice had increased vagal afferent mechanoreceptor sensitivity. Octanoic acid breath test revealed rapid gastric emptying in TNX KO. Colonic manometry showed the amplitude and frequency of colonic contractions were reduced in TNX KO mice, particularly in the distal colon. Ussing chamber studies measuring changes in ion flux (indirect measure of secretion) showed no major difference between TNX KO and wild type (WT) mice. The specific localisation of TNX with neuronal structures in the gut is shown here for the first time suggesting that TNX is more than just an architectural protein. Indeed, its role in specific GI functions supports this observation and provides a mechanism for GI symptoms in JHS.

No description available.

Introdução: A ansiedade pode se manifestar por meio de sintomas físicos e autonômicos. Os transtornos de ansiedade são geralmente descritos por uma interação de sintomas somáticos e sinais subjetivos, o que aumenta a importância de um conhecimento mais amplo sobre como esses fatores estão relacionados e ocorrem em conjunto com distúrbios psiquiátricos e não psiquiátricas. Assim, a ansiedade pode estar associada a diversas condições médicas, entre as quais a hipermobilidade articular. A hipermobilidade articular (JHM) é caracterizada pelo aumento da flexibilidade das articulações. É um sinal de maior elasticidade que pode até ser vantajoso para algumas pessoas em atividades específicas. Por outro lado, a síndrome da hipermobilidade articular (JHS) é mais ampla do que a JHM, sendo acompanhada de sintomas clínicos, especialmente de histórico de lesões, sinais da pele, instabilidade e dor. Objetivos: A associação entre ansiedade e hipermobilidade articular foi investigada em cinco estudos, desenvolvidos com três amostras diferentes e independentes, como descrito a seguir: um grupo de estudantes universitários, uma amostra de famílias com alta agregação genética de ansiedade e hipermobilidade e uma amostra composta por bailarinas. Método: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura. Utilizando um protocolo, foi realizada uma pesquisa sistemática de artigos nas bases de dados eletrônicas PubMed, LILACS, PsycINFO e SciELO utilizando as palavras-chave \'anxiety\', \'joint\' e \'hipermobility\' e operadores booleanos. O segundo estudo foi desenvolvido como uma avaliação epidemiológica, com 2.300 estudantes universitários de ambos os sexos, com idade entre 17-35 anos, de duas universidades brasileiras. Os participantes responderam a instrumentos de autorrelato de ansiedade (Inventário de Ansiedade de Beck - BAI), Ansiedade Social (Inventário de Fobia Social - SPIN) e um questionário de screening para JHM (questionário de cinco partes para a identificação da hipermobilidade). O terceiro estudo foi desenvolvido com uma amostra de conveniência, extraída deste estudo epidemiológico, formada por 87 estudantes universitários, divididos em dois grupos, de acordo com a presença ou ausência de Transtorno de Ansiedade Social (TAS). Eles responderam aos mesmos instrumentos de autorrelato e também passaram por uma avaliação clínica, em que responderam à entrevista clínica semiestruturada para o DSM-IV (SCID-IV) e foram avaliadas de acordo com o escore de Beighton para JHM. O estudo seguinte foi desenvolvido através de um desenho longitudinal, avaliando uma amostra de famílias espanholas com alta agregação genética de ansiedade e hipermobilidade. No início do estudo, a amostra foi formada por 156 participantes; em oito anos de seguimento, a amostra foi composta por 98 sujeitos. Os participantes preencheram instrumentos de autorrelato (Inventário de Medo [FSS] e Inventário de Ansiedade Estado-Traço [IDATE]), assim como responderam à SCID-IV e foram avaliados de acordo com o escore de Beighton para JHM e critérios de Brighton para a JHS. Por último, o quinto estudo foi realizado com 145 bailarinas, divididas em três grupos: alunas de balé (n=59), professoras de balé (n=37) e bailarinas profissionais (n=49). As participantes responderam a instrumentos de autorrelato para avaliação da JHM (questionário de screening), ansiedade (BAI), ansiedade social (SPIN), pânico (Patient Health Questionnaire - Brief PHQ), sintomatologia depressiva (PHQ-9), abuso de álcool (FAST) e dor (Inventário breve de dor [BPI] e avaliação da incapacidade funcional por causa da dor [SEFIP]). As bailarinas também foram submetidas a uma avaliação clínica de acordo com o escore de Beighton e os critérios Brighton. Resultados: Dos 34 artigos inicialmente encontrados, 17 foram incluídos na revisão sistemática. Em geral, eles ratificaram a associação entre os sintomas de ansiedade (como medos e sintomas psicológicos) e JHM. No que se refere aos transtornos de ansiedade, os dados se mostraram mais heterogêneos, dependendo do tipo de transtorno, parecendo mais associados ao transtorno de pânico. No segundo estudo, desenvolvido com 2.300 estudantes universitários, os resultados indicaram importantes diferenças de gênero. Mulheres hipermóveis (mas não os homens) apresentaram correlação entre a ansiedade e a JHM, com especial atenção para a sintomatologia autonômica e pânico. A terceira amostra (87 universitários brasileiros) não apresentou diferenças no que diz respeito à associação entre TAS e JHM. No quarto estudo, desenvolvido com famílias espanholas, a JHM mostrou-se associada ao transtorno de pânico, pânico e agorafobia na primeira avaliação. A JHS foi associada à ansiedade-traço. Na avaliação de seguimento (follow-up), os dados apresentados indicaram aumento do risco para a incidência de pânico e fobia simples entre os participantes com JHS. No estudo desenvolvido com bailarinas, as participantes com JHM apresentaram maior pontuação na subescala de sintomas neurofisiológicos da BAI, embora com pontuação mais baixa na sintomatologia de ansiedade social. A JHS mostrou correlação com as subescalas de sintomas subjetivos e de pânico da BAI e com a SPIN. Os participantes com JHS também apresentaram escores mais altos em itens específicos da BAI, como tremores, medo de perder o controle e dificuldade em respirar, assim como em itens específicos da SPIN, como rubor e maior esforço para evitar críticas. Entre as bailarinas, também foi possível discutir diferenças e características importantes da JHM, JHS e dor ao longo da carreira de balé. Conclusões: A integração de dados desses diversos estudos chama a atenção para a força de características genéticas na associação entre ansiedade e a hipermobilidade. Ela também reforça a importância de identificar claramente a JHM e a JHS como duas condições clínicas diferentes. Em conjunto, os dados destes estudos sugerem que a JHS tem mais indicadores de associação com a ansiedade do que a hipermobilidade isolada\" (JHM). A correlação entre a ansiedade e a JHS é estatisticamente significativa, mas sua força foi moderada. Parece que ansiedade claramente desempenha um papel nos sintomas extra-articulares da JHS, apesar de não ser o único fator relevante nesta condição clínica. / Introduction: Anxiety manifests through physical and autonomic symptoms. Anxiety disorders are usually described as an interaction between somatic symptoms and subjective signs, and it is thus important to understand how those factors are related and co-occur with both psychiatric and non-psychiatric disorders. Thus, anxiety may be associated with diverse medical conditions, among which joint hypermobility. Joint hypermobility (JHM) is characterized by increased joint flexibility. It is a sign of higher elasticity that can even be advantageous for some people in specific activities. On the other hand, joint hypermobility syndrome (JHS) is a more complex condition that includes other clinical symptoms, especially a history of injuries, skin signs, instability and pain. Objectives: The association between anxiety and joint hypermobility was investigated in five studies, developed with three different and independent samples, as follows: a group of university students, a sample of families with high genetic aggregation of anxiety and hypermobility and a sample consisting of ballet dancers. Methods: The first study was developed as a systematic review of the literature. Using a protocol, we conducted a systematic search of articles in the electronic databases PubMed, LILACS, PsycInfo e SciELO, using the keywords anxiety, joint and hypermobility and Boolean operators. The second study was developed as an epidemiological survey, with 2,300 university students of both genders, aged 17-35 years, from two Brazilian universities. Participants completed self-reporting instruments asessing anxiety (Beck Anxiety Inventory BAI), social anxiety (Social Phobia Inventory SPIN) and a screening questionnaire for JHM (the five-part questionnaire for identifying hypermobility). The third study was developed with a convenience sample of the epidemiological study, consisting of 87 university students, divided into two groups, according to the presence or absence of social anxiety disorder (SAD). The volunteers completed the same self-rating instruments and underwent a clinical evaluation that included the Semi-structured Clinical Interview for DSM-IV (SCID-IV) and the Beighton score for JHM. The fourth study had a longitudinal design and included a sample of Spanish families with high genetic aggregation of anxiety and hypermobility. At baseline, the sample consisted of 156 participants; at eight yearsof follow-up, the sample comprised 98 subjects. The volunteers completed self-reting instruments (Fear Survey Schedule [FSS] and Spielberger Stait-Trait Anxiety Inventory [STAI]) and underwent a clinical evalution including the SCID-IV, the Beighton score for JHM and also the Brighton criteria to assess the JHS. Lastly, the fifth study included 145 dancers, divided into three groups: ballet students (n=59), ballet teachers (n=37) and professional ballerinas (n=49). The participants completed self-rating instruments assessing JHM (five-part questionnaire), anxiety (BAI), social anxiety (SPIN), panic (Patient Health Questionnaire - Brief PHQ), depressive symptomatology (PHQ-9), alcohol abuse (FAST) and pain (Brief Pain Inventory [BPI] and Self-Estimated Functional Inability because of Pain [SEFIP]). Ballet dancers also underwent a clinical evaluation based on the Beighton score and Brighton criteria. Results: From 34 articles initially found, 17 were included in the systematic review. In general, they ratified the association between anxiety symptoms (such as fears and psychological distress) and JHM. In regard to anxiety disorders, data were less homogeneous and varied according to the type of disorder, with stronger association between hypermobility and panic disorder. In the second study, which involved a sample of 2,300 university students, results suggested important gender-related differences. Hypermobile women (but not men) presented a correlation between anxiety and JHM, with special emphasis on autonomic and panic symptomatology. The third sample (87 Brazilian university students) did not present significant differences in regard to the association between SAD and JHM. In the fourth study, developed with Spanish families, JHM was associated with panic disorder and panic with agoraphobia at baseline. JHS was associated with trait anxiety at baseline. At follow-up, the data showed an increased risk for the incidence of panic and simple phobia among participants with JHS. Among ballet dancers, participants with JHM had higher scores in neurophysiological subscale of the BAI, but less social anxiety symptomatology. JHS correlated with the subjective and panic subscales of the BAI and with SPIN. Participants with JHS also presented higher scores in specific items of BAI, such as trembling, fear of losing control and difficulty breathing, as in specific items of SPIN, such as blushing and higher efforts to avoid criticism. In the study developed with ballet dancers, it was also possible to discuss differences between important features of JHM, JHS and pain throughout the ballet career. Conclusions: The integrated data of these five studies draw attention to the strength of genetic features in the association between anxiety and hypermobility. Their results also highlighted the importance of clearly identifying JHM and JHS as two different clinical conditions. Taken together, our data suggest that JHS seems to be more consistently associated with anxiety than the isolated hypermobility (JHM). Nevertheless, although the correlation between anxiety and JHS was statistically significant, its strength was moderate. It seems that anxiety clearly play a role in extra-articular symptoms of the JHS, although not being the only relevant factor in this clinical condition.

Introdução: A ansiedade pode se manifestar por meio de sintomas físicos e autonômicos. Os transtornos de ansiedade são geralmente descritos por uma interação de sintomas somáticos e sinais subjetivos, o que aumenta a importância de um conhecimento mais amplo sobre como esses fatores estão relacionados e ocorrem em conjunto com distúrbios psiquiátricos e não psiquiátricas. Assim, a ansiedade pode estar associada a diversas condições médicas, entre as quais a hipermobilidade articular. A hipermobilidade articular (JHM) é caracterizada pelo aumento da flexibilidade das articulações. É um sinal de maior elasticidade que pode até ser vantajoso para algumas pessoas em atividades específicas. Por outro lado, a síndrome da hipermobilidade articular (JHS) é mais ampla do que a JHM, sendo acompanhada de sintomas clínicos, especialmente de histórico de lesões, sinais da pele, instabilidade e dor. Objetivos: A associação entre ansiedade e hipermobilidade articular foi investigada em cinco estudos, desenvolvidos com três amostras diferentes e independentes, como descrito a seguir: um grupo de estudantes universitários, uma amostra de famílias com alta agregação genética de ansiedade e hipermobilidade e uma amostra composta por bailarinas. Método: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura. Utilizando um protocolo, foi realizada uma pesquisa sistemática de artigos nas bases de dados eletrônicas PubMed, LILACS, PsycINFO e SciELO utilizando as palavras-chave \'anxiety\', \'joint\' e \'hipermobility\' e operadores booleanos. O segundo estudo foi desenvolvido como uma avaliação epidemiológica, com 2.300 estudantes universitários de ambos os sexos, com idade entre 17-35 anos, de duas universidades brasileiras. Os participantes responderam a instrumentos de autorrelato de ansiedade (Inventário de Ansiedade de Beck - BAI), Ansiedade Social (Inventário de Fobia Social - SPIN) e um questionário de screening para JHM (questionário de cinco partes para a identificação da hipermobilidade). O terceiro estudo foi desenvolvido com uma amostra de conveniência, extraída deste estudo epidemiológico, formada por 87 estudantes universitários, divididos em dois grupos, de acordo com a presença ou ausência de Transtorno de Ansiedade Social (TAS). Eles responderam aos mesmos instrumentos de autorrelato e também passaram por uma avaliação clínica, em que responderam à entrevista clínica semiestruturada para o DSM-IV (SCID-IV) e foram avaliadas de acordo com o escore de Beighton para JHM. O estudo seguinte foi desenvolvido através de um desenho longitudinal, avaliando uma amostra de famílias espanholas com alta agregação genética de ansiedade e hipermobilidade. No início do estudo, a amostra foi formada por 156 participantes; em oito anos de seguimento, a amostra foi composta por 98 sujeitos. Os participantes preencheram instrumentos de autorrelato (Inventário de Medo [FSS] e Inventário de Ansiedade Estado-Traço [IDATE]), assim como responderam à SCID-IV e foram avaliados de acordo com o escore de Beighton para JHM e critérios de Brighton para a JHS. Por último, o quinto estudo foi realizado com 145 bailarinas, divididas em três grupos: alunas de balé (n=59), professoras de balé (n=37) e bailarinas profissionais (n=49). As participantes responderam a instrumentos de autorrelato para avaliação da JHM (questionário de screening), ansiedade (BAI), ansiedade social (SPIN), pânico (Patient Health Questionnaire - Brief PHQ), sintomatologia depressiva (PHQ-9), abuso de álcool (FAST) e dor (Inventário breve de dor [BPI] e avaliação da incapacidade funcional por causa da dor [SEFIP]). As bailarinas também foram submetidas a uma avaliação clínica de acordo com o escore de Beighton e os critérios Brighton. Resultados: Dos 34 artigos inicialmente encontrados, 17 foram incluídos na revisão sistemática. Em geral, eles ratificaram a associação entre os sintomas de ansiedade (como medos e sintomas psicológicos) e JHM. No que se refere aos transtornos de ansiedade, os dados se mostraram mais heterogêneos, dependendo do tipo de transtorno, parecendo mais associados ao transtorno de pânico. No segundo estudo, desenvolvido com 2.300 estudantes universitários, os resultados indicaram importantes diferenças de gênero. Mulheres hipermóveis (mas não os homens) apresentaram correlação entre a ansiedade e a JHM, com especial atenção para a sintomatologia autonômica e pânico. A terceira amostra (87 universitários brasileiros) não apresentou diferenças no que diz respeito à associação entre TAS e JHM. No quarto estudo, desenvolvido com famílias espanholas, a JHM mostrou-se associada ao transtorno de pânico, pânico e agorafobia na primeira avaliação. A JHS foi associada à ansiedade-traço. Na avaliação de seguimento (follow-up), os dados apresentados indicaram aumento do risco para a incidência de pânico e fobia simples entre os participantes com JHS. No estudo desenvolvido com bailarinas, as participantes com JHM apresentaram maior pontuação na subescala de sintomas neurofisiológicos da BAI, embora com pontuação mais baixa na sintomatologia de ansiedade social. A JHS mostrou correlação com as subescalas de sintomas subjetivos e de pânico da BAI e com a SPIN. Os participantes com JHS também apresentaram escores mais altos em itens específicos da BAI, como tremores, medo de perder o controle e dificuldade em respirar, assim como em itens específicos da SPIN, como rubor e maior esforço para evitar críticas. Entre as bailarinas, também foi possível discutir diferenças e características importantes da JHM, JHS e dor ao longo da carreira de balé. Conclusões: A integração de dados desses diversos estudos chama a atenção para a força de características genéticas na associação entre ansiedade e a hipermobilidade. Ela também reforça a importância de identificar claramente a JHM e a JHS como duas condições clínicas diferentes. Em conjunto, os dados destes estudos sugerem que a JHS tem mais indicadores de associação com a ansiedade do que a hipermobilidade isolada\" (JHM). A correlação entre a ansiedade e a JHS é estatisticamente significativa, mas sua força foi moderada. Parece que ansiedade claramente desempenha um papel nos sintomas extra-articulares da JHS, apesar de não ser o único fator relevante nesta condição clínica. / Introduction: Anxiety manifests through physical and autonomic symptoms. Anxiety disorders are usually described as an interaction between somatic symptoms and subjective signs, and it is thus important to understand how those factors are related and co-occur with both psychiatric and non-psychiatric disorders. Thus, anxiety may be associated with diverse medical conditions, among which joint hypermobility. Joint hypermobility (JHM) is characterized by increased joint flexibility. It is a sign of higher elasticity that can even be advantageous for some people in specific activities. On the other hand, joint hypermobility syndrome (JHS) is a more complex condition that includes other clinical symptoms, especially a history of injuries, skin signs, instability and pain. Objectives: The association between anxiety and joint hypermobility was investigated in five studies, developed with three different and independent samples, as follows: a group of university students, a sample of families with high genetic aggregation of anxiety and hypermobility and a sample consisting of ballet dancers. Methods: The first study was developed as a systematic review of the literature. Using a protocol, we conducted a systematic search of articles in the electronic databases PubMed, LILACS, PsycInfo e SciELO, using the keywords anxiety, joint and hypermobility and Boolean operators. The second study was developed as an epidemiological survey, with 2,300 university students of both genders, aged 17-35 years, from two Brazilian universities. Participants completed self-reporting instruments asessing anxiety (Beck Anxiety Inventory BAI), social anxiety (Social Phobia Inventory SPIN) and a screening questionnaire for JHM (the five-part questionnaire for identifying hypermobility). The third study was developed with a convenience sample of the epidemiological study, consisting of 87 university students, divided into two groups, according to the presence or absence of social anxiety disorder (SAD). The volunteers completed the same self-rating instruments and underwent a clinical evaluation that included the Semi-structured Clinical Interview for DSM-IV (SCID-IV) and the Beighton score for JHM. The fourth study had a longitudinal design and included a sample of Spanish families with high genetic aggregation of anxiety and hypermobility. At baseline, the sample consisted of 156 participants; at eight yearsof follow-up, the sample comprised 98 subjects. The volunteers completed self-reting instruments (Fear Survey Schedule [FSS] and Spielberger Stait-Trait Anxiety Inventory [STAI]) and underwent a clinical evalution including the SCID-IV, the Beighton score for JHM and also the Brighton criteria to assess the JHS. Lastly, the fifth study included 145 dancers, divided into three groups: ballet students (n=59), ballet teachers (n=37) and professional ballerinas (n=49). The participants completed self-rating instruments assessing JHM (five-part questionnaire), anxiety (BAI), social anxiety (SPIN), panic (Patient Health Questionnaire - Brief PHQ), depressive symptomatology (PHQ-9), alcohol abuse (FAST) and pain (Brief Pain Inventory [BPI] and Self-Estimated Functional Inability because of Pain [SEFIP]). Ballet dancers also underwent a clinical evaluation based on the Beighton score and Brighton criteria. Results: From 34 articles initially found, 17 were included in the systematic review. In general, they ratified the association between anxiety symptoms (such as fears and psychological distress) and JHM. In regard to anxiety disorders, data were less homogeneous and varied according to the type of disorder, with stronger association between hypermobility and panic disorder. In the second study, which involved a sample of 2,300 university students, results suggested important gender-related differences. Hypermobile women (but not men) presented a correlation between anxiety and JHM, with special emphasis on autonomic and panic symptomatology. The third sample (87 Brazilian university students) did not present significant differences in regard to the association between SAD and JHM. In the fourth study, developed with Spanish families, JHM was associated with panic disorder and panic with agoraphobia at baseline. JHS was associated with trait anxiety at baseline. At follow-up, the data showed an increased risk for the incidence of panic and simple phobia among participants with JHS. Among ballet dancers, participants with JHM had higher scores in neurophysiological subscale of the BAI, but less social anxiety symptomatology. JHS correlated with the subjective and panic subscales of the BAI and with SPIN. Participants with JHS also presented higher scores in specific items of BAI, such as trembling, fear of losing control and difficulty breathing, as in specific items of SPIN, such as blushing and higher efforts to avoid criticism. In the study developed with ballet dancers, it was also possible to discuss differences between important features of JHM, JHS and pain throughout the ballet career. Conclusions: The integrated data of these five studies draw attention to the strength of genetic features in the association between anxiety and hypermobility. Their results also highlighted the importance of clearly identifying JHM and JHS as two different clinical conditions. Taken together, our data suggest that JHS seems to be more consistently associated with anxiety than the isolated hypermobility (JHM). Nevertheless, although the correlation between anxiety and JHS was statistically significant, its strength was moderate. It seems that anxiety clearly play a role in extra-articular symptoms of the JHS, although not being the only relevant factor in this clinical condition.

Title: Ankle joint hypermobility in relation to the postural stability evaluated by the postural somatooscillography method Objectives: The aim of this dissertation is to assess the influence of the local joint hypermobility on the postural stabilization measured by postural somatooscilography. It also compares the postural stabilization ability in case of local ankle joint hypermobility to the constitutional hypermobility on the lower limb including acre. Methods: This thesis has been composed by means of descriptive-associative method using the quantitative research comparing two groups of twelve subjects. The research part was evaluated under standard conditions using the monopedal postural provocation test "3 steps - standing on one leg" which was measured on the instable platform "Posturomed". The test results were logged in application Microswing 6. The recorded data was exported and evaluated by "Posturomed Commander" software. Results: The research has not proved a significant statistical difference between the group with local ankle joint hypermobility and constitutional hypermobility. However, the group with local ankle joint hypermobility was found to have slightly worse results, primarily in the ability of long-term stabilization. Keywords: postural stability, Posturomed, ankle joint,...

Thesis title: Prevalence of hypermobility and its potential impact on ice hockey players injuries. Objectives: The primary goal of this thesis is to outline joint hypermobility based on available literature sources. Focus is on ice hockey players due to reason ice hockey is muscle and contact based sport. Secondary goal is to chart hypermobility presence on ice hockey players and detect possible connection between hypermobility and their previous musculoskeletal system injuries. There will be training improvement suggestions set according to analytical study results. Methods: Theoretical part is based on foreign literature and researches. Practical part quantitative analysis monitors selected joints injury frequency and is focused on joint hypermobility presence in selected junior professional male hockey players, 16 to 19 years old. Information regarding injuries where gathered by questionnaire and joint hypermobility test was set by test battery created for this research using clinical physical tests by Janda, by Sachse, and by Hospital del Mar criteria. Results were analyzed in Microsoft Excel 2010. Hypermobility and injured segments matches were further analyzed. Results: Results of this thesis clearly stated the answers for research questions which were placed. Prevalence of hypermobility in...

Gymnastics is noted for involving highly specialized strength, power, agility and flexibility. Flexibility is perhaps the single greatest discriminator of gymnastics from other sports. The extreme ranges of motion achieved by gymnasts require long periods of training, often occupying more than a decade. Gymnasts also start training at an early age (particularly female gymnasts), and the effect of gymnastics training on these young athletes is poorly understood. One of the concerns of many gymnastics professionals is the training of the spine in hyperextension—the ubiquitous ‘arch’ seen in many gymnastics positions and movements. Training in spine hyperextension usually begins in early childhood through performance of a skill known as a back-bend. Does practising a back-bend and other hyperextension exercises harm young gymnasts? Current information on spine stretching among gymnasts indicates that, within reason, spine stretching does not appear to be an unusual threat to gymnasts’ health. However, the paucity of information demands that further study be undertaken.

Abstract Background: Musculoskeletal discomfort is common among professional orchestra musicians and according to the literature some anatomical areas, such as the neck, upper back and upper extremities, seem to be more frequently affected than others. There are also suggestions made that general joint hypermobility could be a potential risk factor for musculoskeletal discomfort among musicians. Furthermore, there seems to be a higher perceived feeling of psychosocial demands and stress among musicians in comparison to the general workforce. Aim: Investigate the prevalence of, and associations between, musculoskeletal discomfort, general joint hypermobility, psychosocial factors and stress among Swedish big band musicians. A further aim was to investigate associations between musculoskeletal discomfort, general joint hypermobility, psychosocial factors and stress, respectively. Method & Material: This study was part of a larger national survey on professional orchestra musicians in Sweden. This study focused on professional jazz musicians and included data from all three professional big bands in Sweden. The study presents the prevalence of musculoskeletal discomfort, general joint hypermobility, psychosocial factors and stress among professional Swedish big band musicians. 32 musicians completed the survey. Results: The study showed a high prevalence of musculoskeletal discomfort and general joint hypermobility. There were no statistically significant relationships between musculoskeletal discomfort and general joint hypermobility but between psychosocial demands and musculoskeletal discomfort in the anatomical subgroup low back/hip, and between negative stress and musculoskeletal discomfort in the anatomical subgroup low back/hip. Conclusion: In accordance with existing studies on classical orchestra musicians, this study found a high prevalence of musculoskeletal discomfort and general joint hypermobility among Swedish big band musicians. There was a statistically significant association with the relationship between psychosocial demands and musculoskeletal discomfort in the anatomical subgroup low back/hip and between negative stress and musculoskeletal discomfort in the anatomical subgroup low back/hip. Key words: big band musicians, musculoskeletal discomfort, general joint hypermobility, psychosocial factors, stress.