Clinical Bottom Line
“How could I apply this information?”
The author suggests that hypermobility may negatively affect performance on the Functional Reach and Lateral Reach Tests. In this study, schoolchildren from India with increased knee hypermobility reached a shorter distance on the Functional Reach Test. In addition, taller boys and girls reached a longer distance on the Functional Reach Test and taller girls reached further on the Lateral Reach Test. The data suggest that hypermobility has a negative effect on functional balance especially when reaching forward. The clinician may find it helpful, when assessing balance in children, to evaluate knee joint hypermobility. Information gained from using both of these clinical measures together may provide information about underlying mechanisms of postural control as well as balance. This information will assist the clinician in identifying and providing more focused intervention aimed at increasing functional balance when treating children with excessive range of motion at the knee.
“What should I be mindful about when applying this information?”
The participants in the study are from India and, as the author stated, the functional reach norms from India are different from the norms from the United States. Therefore, the distances reached in this study may not be directly applicable to children outside India. In addition, these measurements were taken on a population developing typically. Other factors, which may affect a child's balance when performing the Functional Reach Test (such as forefoot pronation, hip alignment [anteversion], and muscle strength), were not considered. As a consequence, clinicians should be cautious when drawing conclusions and designing treatment strategies for children with knee joint hypomobility. Treatment strategies should not be developed without considering additional information such as postural alignment, lower extremity muscle strength, and proprioceptive awareness. Although an analysis of variance was used, the author reported only correlational data and not differences between groups. Because of the design of the study, we cannot say that hypermobility causes the test results, only that the 2 findings are related. Further research on children with hypermobility linked to a developmental diagnosis is needed.
Julia Looper, PT, PhD
University of Puget Sound, Tacoma, Washington
Penny Coyner, PT, MPT, PCS
Northwest Pediatric Therapies, Issaquah, Washington