Exercise in Patients With Hypermobile Joints and Knee Pain

Inclusion criteria

• Persistent knee pain for ≥ 3 months (self-reported)

• Knee pain ≥ 30mm during the last week using a 0-100 mm visual analogue scale (VAS; 0=no pain and 100=worst imaginable pain) (self-reported)

• Generalised joint hypermobility assessed with the Five-Part Hypermobility Questionnaire (positive ≥ 2/5) (self-reported)

• Local knee joint hypermobility using the passive hyperextension of the knee in standing (positive > 10 degrees of hyperextension) and confirmed in supine lying (heel resting on 20 cm high block on the bench surface), with passive knee hyperextension (positive > 10 degrees) (objectively measured)

Exclusion criteria

• Diagnosed with patellar tendinopathy

• Pregnancy or childbirth within the past year (due to increased levels of relaxin that could affect joint stability)

• Knee surgery within the past year

• Participation in regular structured resistance training within the past six months

• Inability to speak and understand Danish.

• All types of Ehlers-Danlos syndrome

• Other heritable connective tissue disorders such as Marfan syndrome, osteogenesis imperfecta, Loeys-Dietz syndrome, Stickler syndrome, skeletal dysplasias

• Autoimmune rheumatic connective tissue disorders such as lupus, rheumatoid arthritis; Chromosomal conditions such as Fragile X syndrome, Kabuki syndrome, Down syndrome

• Neuromuscular disorders that can cause joints to become unstable, such as multiple sclerosis