Beighton Score Self-Check

What the Beighton score is

 

The Beighton score was developed by Professor Peter Beighton in the 1970s, adapted from an earlier method by Carter and Wilkinson, as a quick way to record how far a person's joints move compared with the general population. It is the measure named in the 2017 international diagnostic criteria for hypermobile Ehlers-Danlos syndrome, and it also appears in the criteria for hypermobility spectrum disorders.

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Nine points, one mark each, scored out of nine. Four of the tests are done on both the left and the right, which accounts for eight of the points. The ninth is a single forward bend.

 

The nine points, and how each one is tested

 

Technique matters more than most people expect. A joint moved by someone else will travel further than a joint you move yourself, which is one reason self-testing tends to read lower than a clinician's assessment.

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1 and 2. Little finger extension, left and right. Rest your forearm flat on a table, palm down. Keeping the hand still, lift the little finger back towards the wrist. One point per hand if it passes 90 degrees from the plane of the hand.

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3 and 4. Thumb to forearm, left and right. Hold the arm out with the wrist relaxed, bend the wrist gently forward, then draw the thumb down towards the inside of the forearm. One point per hand if the thumb touches.

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5 and 6. Elbow hyperextension, left and right. Straighten the arm fully with the palm facing up. One point per elbow if it goes more than 10 degrees past straight.

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7 and 8. Knee hyperextension, left and right. Stand with the legs straight and locked, viewed from the side. One point per knee if it bows backwards more than 10 degrees past straight.

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9. Forward bend, palms flat on the floor. Stand with the feet together and the knees straight, then bend forward. One point if both palms rest flat on the floor.

 

What your score means

 

The threshold for a positive screen changes with age, because joints stiffen over a lifetime.

Under 18: a positive screen is 6 or more out of 9.
18 to 50: a positive screen is 5 or more out of 9.
Over 50: a positive screen is 4 or more out of 9.

 

A score at or above the threshold suggests generalised joint hypermobility. On its own that is not a disorder and not a diagnosis. Many people are hypermobile and have no symptoms at all.

 

Hypermobility is more common in women, in children, and in some ethnic groups.

 

A score below the threshold does not rule hypermobility out. It means generalised laxity was not picked up by these nine points, which is a different statement.

 

Where the Beighton score falls short

 

Eight of the nine points sit at or above the knee. There is nothing for the hip, nothing for the ankle, and nothing for any of the joints of the foot, of which there are around thirty in each one.

That gap matters when your symptoms are in your feet. Someone can score two or three out of nine, be told they are not hypermobile, and still have a midfoot that flattens under load, an ankle that gives way on uneven ground, and a big toe joint that moves far more than it should.

 

The score is also a snapshot of range only. It says nothing about strength, control, fatigue, pain, or how a joint behaves in the fourth hour of a shift rather than the first.

 

What we use in clinic

 

The Beighton score is a starting point rather than the whole assessment. Alongside it we use the Lower Limb Assessment Score, a twelve point measure covering the hip, knee, ankle, rearfoot, midfoot and big toe joint, so the joints doing the work of carrying you are actually examined.

 

We also look at foot posture standing and moving, ankle range and how the midfoot behaves under load, single leg balance and calf endurance, footwear and how quickly it breaks down, and ultrasound imaging when a tendon, plantar fascia or bursa needs checking.

 

What to do next

 

If your score is at or above the threshold and you have foot or ankle symptoms, an assessment is worthwhile. If your score is below the threshold and you still have those symptoms, it is still worthwhile, for the reason above.

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Things worth getting looked at: ankles that roll or feel like they give way, heel or arch pain that settles and then returns, feet that tire quickly with standing or walking, shoes that break down unusually fast or wear unevenly, and a child who avoids sport or talks about tired legs.

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Podiatrists do not diagnose hypermobile Ehlers-Danlos syndrome. That is a medical diagnosis. What we can do is examine and document what is happening below the knee, treat the foot and leg symptoms, and point you towards the right referral pathway when the wider picture warrants it. You can read more about how we assess and treat hypermobility and hEDS.

 

Common questions

 

Is the Beighton score a diagnosis?
No. It is a screening measure of joint range. It contributes to the diagnostic criteria for hypermobile Ehlers-Danlos syndrome, but diagnosis is a medical process that also considers skin, tissue, family history and other features.

 

How accurate is testing myself at home?
Self-testing usually reads lower than a clinician's assessment. A clinician moves the joint for you and can feel where it actually stops, which is difficult to reproduce on yourself, particularly at the elbows and knees.

 

Can my score change?
Yes. Scores generally fall with age as tissues stiffen. They can also vary with warm-up, time of day, pregnancy and injury.

 

I scored zero but my feet still hurt. What now?
That is common, and it is the main limitation of this screen. None of the nine points test the foot or the ankle. A lower limb assessment looks at the joints the Beighton score skips.

 

What is the difference between the Beighton score and the Brighton criteria?
They are different things with confusingly similar names. The Beighton score is the nine point measure of joint range. The Brighton criteria were an older set of diagnostic criteria for joint hypermobility syndrome, which used the Beighton score as one component. The current framework is the 2017 international criteria for hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.

 

Does hypermobility need treatment?
Only when it is causing symptoms. Many hypermobile people have no problems and need nothing. When there is pain, instability or fatigue, the focus is usually on strength, control, footwear and load rather than on changing the range itself.