Epidemiology of Generalized Ligamentous Laxity in Iran: A National Study Including Different Iranian Ethnic Groups and its Relationship with Musculoskeletal Disorders

Document Type : RESEARCH PAPER


1 Department of Orthopedics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

2 Mashhad University of Medical Sciences, Mashhad, Iran

3 Research Center for Health sciences, Hamadan University of Medical Sciences, Hamadan, Iran

4 Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

5 Bone and Joint Diseases Research Center, Department of Orthopedics, Shiraz University of Medical Sciences, Shiraz, Iran

6 Orthopedic Research Center, Department of Orthopedics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

7 Department of Orthopedic Surgery, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran

8 Students Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

9 Orthopedic department, Kashani hospital, Isfahan University of Medical Sciences, Isfahan, Iran

10 Department of Hand and Microsurgery, Emam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran


Background: Ligamentous laxity is a condition that leads to joints’ hypermobility beyond their average and normal 
range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the 
epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian 
adults with different ethnic backgrounds.
Methods: A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities 
of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was 
searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that 
might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based 
on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age.
Results: In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women 
(22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) 
and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with 
sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker’s cyst, and varicose veins 
(P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its 
importance in choosing an appropriate sports activity. 
Conclusion: The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old 
population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended 
that examinations, screening, and information be provided at an early age in schools or at least in areas with a high 
prevalence as national programs. 
Level of evidence: I


1. Saremi H, Shahbazi F, Rahighi AH. Epidemiology of 
generalized ligamentous laxity in northwest of Iran: 
A pilot national study on 17–40 years old adults in 
Hamadan province. Clinical Epidemiology and Global 
Health. 2020;8(2):461-5.
2. Beighton P, Grahame R, Bird H. Introduction to 
hypermobility. InHypermobility of joints 2012 (pp. 
1-9). Springer, London.
3. Kirk JA, Ansell BM, Bywaters EG. The hypermobility 
syndrome. Musculoskeletal complaints associated 
with generalized joint hypermobility. Annals of the 
Rheumatic Diseases. 1967;26(5):419. 4. Pearsall AW, Kovaleski JE, Heitman RJ, Gurchiek LR, 
Hollis JM. The relationships between instrumented 
measurements of ankle and knee ligamentous laxity 
and generalized joint laxity. Journal of sports medicine 
and physical fitness. 2006;46(1):104.
5. Decoster LC, Vailas JC, Lindsay RH, Williams GR. 
Prevalence and features of joint hypermobility 
among adolescent athletes. Archives of pediatrics & 
adolescent medicine. 1997;151(10):989-92.
6. Eccles J, Tung J, Harrison N, Mathias C, Critchley H. 
Joint hypermobility syndrome and anxiety disorder: 
structural brain correlates. European Psychiatry. 
7. Biro F, Gewanter HL, Baum J. The Hypermobility 
Syndrome. Pediatrics. 1983;72(5):701.
8. Seçkin Ü� , Tur BS, Yılmaz Ö� , Yağcı İ�, Bodur H, Arasıl 
T. The prevalence of joint hypermobility among 
high school students. Rheumatology international. 
9. Hakim A, Grahame R. Joint hypermobility. Best Practice 
& Research Clinical Rheumatology. 2003;17(6):989-
10.Beighton P, Grahame R, Bird H. Clinical features of 
hypermobility: locomotor system and extra-articular. 
InHypermobility of joints 1999 (pp. 53-80). Springer, 
11.Lamari NM, Chueire AG, Cordeiro JA. Analysis of joint 
mobility patterns among preschool children. Sao 
Paulo Medical Journal. 2005;123(3):119-23.
12.Ramesh R, Von Arx O, Azzopardi T, Schranz PJ. The 
risk of anterior cruciate ligament rupture with 
generalised joint laxity. The Journal of bone and joint 
surgery. British volume. 2005;87(6):800-3.
13.Söderman K, Alfredson H, Pietilä T, Werner S. Risk 
factors for leg injuries in female soccer players: a 
prospective investigation during one out-door season. 
Knee Surgery, Sports Traumatology, Arthroscopy. 
14.Grahame R, Hakim AJ. Joint hypermobility syndrome 
is highly prevalent in general rheumatology clinics, 
its occurrence and clinical presentation being gender, 
age and race-related. InAnnals of the Rheumatic 
Diseases 2006 (Vol. 65, pp. 263-263). BRITISH MED 
15.Remvig L, Jensen DV. Generalised joint hypermobility 
and benign joint hypermobility syndrome. II: 
epidemiology and clinical criteria. Ugeskrift for laeger. 
16.Everman DB, Robin NH. Hypermobility syndrome. 
Pediatrics in Review. 1998;19(4):111-7.
17.Simpson MM. Benign joint hypermobility syndrome: 
evaluation, diagnosis, and management. Journal of 
Osteopathic Medicine. 2006;106(9):531-6.
18.Jamshidi AR, Shaeri HR, Akbarian M. Prevalence and 
features of joint hypermobility among school children 
in Tehran. Biol. 2004;73:189-92.
19.Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, 
Tobias JH, et al. Epidemiology of generalized joint 
laxity (hypermobility) in fourteen-year-old children 
from the UK: A population-based evaluation. Arthritis 
& Rheumatism. 2011;63(9):2819-27.
20.Scheper M, de Vries J, Verbunt J, Nollet F, Engelbert 
R. FRI0455 Is the presence of generalized joint 
hypermobility in young adult female dancers 
beneficial? Annals of the Rheumatic Diseases. 
2013;71(Suppl 3):468.
21.Bin Abd Razak HR, Bin Ali N, Howe TS. Generalized 
ligamentous laxity may be a predisposing factor for 
musculoskeletal injuries. Journal of Science and 
Medicine in Sport. 2014;17(5):474-8.
22.Saremi H, Yavarikia A, Jafari N. Generalized 
ligamentous laxity: an important predisposing factor 
for shoulder injuries in athletes. Iranian Red Crescent 
Medical Journal. 2016;18(6).
23.Okamura S, Wada N, Tazawa M, Sohmiya M, Ibe 
Y, Shimizu T, Usuda S, Shirakura K. Injuries and 
disorders among young ice skaters: relationship with 
generalized joint laxity and tightness. Open access 
journal of sports medicine. 2014;5:191.
24.Tingle A, Bennett O, Wallis A, Palmer S. The links 
between Generalized Joint Laxity and the incidence, 
prevalence and severity of limb injuries related to 
physical exercise: a systematic literature review. 
Physical Therapy Reviews. 2018;23(4-5):259-72.
25.Shakeri H, Ahi S, Arab A. The Relationship Between 
General Hypermobility and Foot Arch in Healthy 
Adult Females. USWR. 2012;2(1):51-6.
26.Burkhead WZ, Rockwood CA. Treatment of instability 
of the shoulder with an exercise program. J Bone Joint 
Surg Am. 1992;74(6):890-6.
Volume 10, Issue 3
March 2022
Pages 286-292
  • Receive Date: 26 September 2021
  • Revise Date: 02 January 2022
  • Accept Date: 07 February 2022
  • First Publish Date: 15 February 2022