Hypermobility affects approximately 10-15% of the global population, making it one of the most common yet underrecognized medical conditions. This genetic condition causes extreme joint flexibility that goes far beyond normal range of motion, often accompanied by pain and other debilitating symptoms. Understanding hypermobility is crucial for those who experience unexplained joint pain, frequent dislocations, or excessive flexibility that impacts their daily life. In this comprehensive guide, you’ll discover what hypermobility truly means, learn to recognize the symptoms of joint hypermobility syndrome, understand the genetic and environmental causes, and gain insight into how this inherited disorder affects millions of people worldwide.
What is Hypermobility?
Hypermobility, medically known as joint hypermobility, refers to joints that move beyond their normal range of motion with little effort. While many people can touch their toes or bend their fingers back slightly, individuals with hypermobility can perform movements that seem almost impossible – like placing their palms flat on the floor without bending their knees or bending their thumb back to touch their forearm.
The key difference between normal flexibility and hypermobility lies in the ease and extent of movement. Normal joint flexibility requires effort and has natural stopping points where tissues provide resistance. In hypermobility, joints move freely beyond these typical limits due to differences in connective tissue structure, particularly in collagen production and organization.
Types of Hypermobility
Medical professionals recognize several distinct types of hypermobility conditions, each with varying degrees of severity and associated symptoms:
Benign Joint Hypermobility represents the mildest form, where individuals have flexible joints without experiencing pain or other problematic symptoms. Many athletes, dancers, and gymnasts fall into this category, often benefiting from their increased flexibility without negative consequences.
Joint Hypermobility Syndrome (JHS) occurs when excessive flexibility is accompanied by symptoms such as joint pain, muscle aches, and easy bruising. This condition significantly impacts daily life and requires careful management to prevent complications.
Ehlers-Danlos Syndrome represents a more severe group of connective tissue disorders that include hypermobility along with skin hyperextensibility, tissue fragility, and other systemic symptoms. Several subtypes exist, with the hypermobile type being most common.
Marfan Syndrome is another related genetic condition affecting connective tissues, though it primarily impacts the cardiovascular system, eyes, and skeletal system, with hypermobility being one of many possible features.
Affected Body Parts
Hypermobility most commonly affects specific joints throughout the body. The fingers, wrists, and elbows frequently show excessive flexibility, allowing for movements like bending fingers backward beyond 90 degrees or hyperextending elbows significantly past their normal straightened position. The knees often hyperextend backward, sometimes creating an almost bow-legged appearance when standing.
Some individuals experience localized hypermobility affecting only certain joints, while others have generalized hypermobility involving multiple joint systems throughout their body. Spinal hypermobility presents unique challenges, as excessive movement in the spine can lead to postural problems and chronic back pain.
Joint Hypermobility Syndrome Symptoms
Joint Hypermobility Syndrome encompasses a wide range of symptoms that extend far beyond simple joint flexibility. Understanding these symptoms is crucial for proper recognition and management of the condition.
Physical Symptoms
The most recognizable symptoms of joint hypermobility syndrome center around joint-related problems. Individuals frequently experience persistent joint pain and aching that can vary in intensity throughout the day. This pain often feels different from typical exercise-related soreness, persisting even during rest periods.
Morning joint stiffness represents another hallmark symptom, with affected individuals often feeling like their joints need significant time to “warm up” before moving normally. This stiffness can last anywhere from 30 minutes to several hours after waking.
Joint dislocations and subluxations (partial dislocations) occur much more frequently in people with hypermobility. These events might happen during routine activities that wouldn’t typically cause problems for others, such as reaching overhead or turning in bed during sleep.
Joint instability creates a sensation of joints “giving way” unexpectedly, leading to falls, stumbles, or dropped objects. This instability can significantly impact confidence in physical activities and daily tasks.
Easy bruising around joints is another common feature, with individuals developing bruises from minor bumps or pressure that wouldn’t typically cause discoloration in others.
Muscle-related symptoms play an equally important role in the hypermobility syndrome picture. Chronic muscle pain and fatigue affect many individuals, often feeling like muscles are constantly working overtime to stabilize unstable joints. Poor muscle tone, despite regular activity, can make it difficult to build and maintain muscle strength.
Delayed muscle recovery after exercise or physical activity means that normal activities might leave individuals feeling exhausted for days rather than hours, significantly impacting their ability to maintain regular exercise routines.
Skin manifestations often accompany joint hypermobility, including unusually soft and stretchy skin that may feel velvety to the touch. Easy scarring and poor wound healing can result in more prominent scars from minor injuries, and cuts or scrapes may take longer to heal completely.
Secondary Symptoms
Many individuals with joint hypermobility syndrome experience cardiovascular symptoms that can be quite alarming. Heart palpitations, or the sensation of the heart racing or beating irregularly, occur frequently and may be related to autonomic nervous system dysfunction.
Dizziness upon standing, medically known as orthostatic intolerance, can range from mild lightheadedness to severe dizziness that requires sitting or lying down immediately. Blood pressure fluctuations often accompany these episodes, with some individuals experiencing both high and low blood pressure at different times.
Digestive issues represent another significant category of secondary symptoms. Gastroparesis, or delayed stomach emptying, can cause nausea, bloating, and irregular eating patterns. Many individuals also experience symptoms similar to irritable bowel syndrome, including abdominal pain, irregular bowel movements, and digestive discomfort. Acid reflux and gastroesophageal reflux disease (GERD) occur more frequently in people with connective tissue disorders.
Neurological symptoms can significantly impact daily functioning. Headaches and migraines occur more frequently in individuals with hypermobility, often triggered by neck instability or tension. Poor proprioception, or reduced awareness of body position in space, can lead to frequent trips, falls, or difficulty navigating in low-light conditions. Coordination difficulties may manifest as clumsiness or difficulty with fine motor tasks like handwriting or buttoning clothing.
Psychological and Emotional Impact
The psychological impact of living with joint hypermobility syndrome extends far beyond the physical symptoms. Chronic pain affects mental health significantly, with many individuals developing anxiety or depression related to their persistent symptoms and uncertain daily functioning.
Anxiety specifically related to joint instability can develop, where individuals become fearful of certain movements or activities that might trigger dislocations or pain episodes. This can lead to activity avoidance and further physical deconditioning.
The impact on self-esteem and body image can be profound, particularly when individuals feel their body is unreliable or unpredictable. Many people with hypermobility describe feeling betrayed by their own bodies.
Social implications of having an invisible disability create additional challenges. Others may not understand why someone who appears healthy has limitations or needs accommodations, leading to feelings of isolation or frustration in social and professional settings.
Causes and Risk Factors
Understanding the causes and risk factors for hypermobility provides insight into why some individuals develop this condition while others do not. The development of hypermobility involves a complex interplay of genetic, developmental, and environmental factors.
Genetic Factors
Genetics play the primary role in hypermobility development, with most cases following an autosomal dominant inheritance pattern. This means that if one parent has hypermobility, each child has a 50% chance of inheriting the condition. However, the expression of symptoms can vary significantly even within the same family.
Family history assessment often reveals multiple generations affected by hypermobility, though symptoms and severity may differ among family members. Some individuals may have only mild flexibility without symptoms, while others in the same family experience significant joint problems.
Genetic mutations affecting collagen and other connective tissue proteins contribute to hypermobility development. These mutations can affect how collagen fibers are formed, cross-linked, or organized within tissues, leading to weaker or more elastic connective tissues throughout the body.
Certain ethnic populations show higher prevalence rates of hypermobility, suggesting genetic variations that may have been advantageous in specific environments or activities throughout human evolution.
Connective Tissue Abnormalities
The underlying cause of hypermobility lies in abnormalities affecting connective tissue structure and function. Collagen, the primary structural protein in connective tissues, may be produced in altered quantities or with structural differences that affect tissue strength and elasticity.
Different types of collagen serve various functions throughout the body, and defects in specific collagen types can lead to different patterns of hypermobility and associated symptoms. Type I collagen affects skin and bones, while Type III collagen primarily impacts blood vessels and organ structure.
Elastin abnormalities also contribute to tissue hyperextensibility, affecting how tissues stretch and return to their original shape. When elastin function is impaired, tissues may remain stretched or fail to provide adequate resistance to movement.
Proteoglycan issues involve problems with structural proteins that help organize the extracellular matrix – the framework that gives tissues their shape and strength. When this framework is disrupted, tissues become less stable and more prone to excessive movement.
Extracellular matrix disruption affects the overall architecture of connective tissues, leading to weakened joint capsules, ligaments, and other supporting structures that normally limit joint movement to safe ranges.
Developmental Factors
Age-related changes in hypermobility follow predictable patterns throughout life. Children and adolescents typically show maximum flexibility, with hypermobility often becoming less pronounced as individuals age and connective tissues naturally stiffen.
Hormonal influences play a significant role in hypermobility expression, particularly in females. Estrogen and relaxin, hormones that naturally increase tissue flexibility, can exacerbate hypermobility symptoms. This explains why many women notice increased joint problems during menstrual cycles, pregnancy, or hormonal transitions.
Growth and development during puberty can temporarily worsen hypermobility symptoms as rapid growth may outpace the development of adequate muscle strength and coordination to support increasingly mobile joints.
Gender differences in hypermobility prevalence show females being affected more commonly than males, likely due to both hormonal factors and potential differences in connective tissue structure between sexes.
Environmental and Lifestyle Factors
While genetics provide the foundation for hypermobility, environmental and lifestyle factors can influence symptom development and severity. Participation in activities requiring extreme flexibility, such as dance, gymnastics, or certain sports, may reveal underlying hypermobility that might otherwise go unnoticed.
Physical activity history can either help or harm individuals with hypermobility. Appropriate exercise can strengthen muscles and improve joint stability, while excessive or inappropriate activity may lead to overuse injuries and joint damage.
Joint use patterns and occupational factors contribute to symptom development when repetitive motions or sustained positions stress already unstable joints. Jobs requiring extensive computer use, lifting, or maintaining awkward positions may exacerbate symptoms.
Previous injuries can create a cascade effect in hypermobile individuals, where one injured joint leads to compensatory movements that stress other joints, potentially triggering widespread symptoms.
Pregnancy effects extend beyond hormonal changes to include the physical demands of carrying additional weight and the mechanical changes in posture and gait that occur during pregnancy and postpartum recovery.
How Hypermobility is Identified
Identifying hypermobility requires a systematic approach combining clinical assessment tools, thorough medical history evaluation, and careful consideration of other conditions that may present similar symptoms.
Clinical Assessment Tools
The Beighton Score represents the gold standard for assessing joint hypermobility, using a nine-point scale to evaluate specific joint movements. This assessment includes checking if individuals can place their palms flat on the floor with straight knees, bend their thumbs to touch their forearms, hyperextend their elbows and knees beyond 10 degrees, and bend their fifth fingers back beyond 90 degrees.
The Brighton Criteria provide comprehensive diagnostic criteria for Joint Hypermobility Syndrome, combining the Beighton Score with symptom assessment and family history. These criteria help differentiate between benign hypermobility and symptomatic joint hypermobility syndrome.
The 5-Point Questionnaire serves as a screening tool that can identify individuals who may benefit from more detailed assessment. This simple questionnaire asks about childhood flexibility, current joint mobility, and associated symptoms.
Physical examination components extend beyond joint mobility testing to include assessment of skin texture, scar quality, and other features that may suggest connective tissue disorders.
Medical History Evaluation
Family history assessment forms a crucial component of hypermobility evaluation, as the genetic nature of the condition means other family members are likely to be affected. Healthcare providers look for patterns of joint problems, unusual flexibility, or related conditions in parents, siblings, and children.
Symptom timeline evaluation helps establish when symptoms first appeared and how they have progressed over time. Many individuals with hypermobility report being unusually flexible as children, with pain and other symptoms developing during adolescence or early adulthood.
Previous injuries and surgeries often show patterns typical of hypermobility, such as frequent sprains, dislocations, or surgeries for conditions like hernias or prolapsed organs that occur more commonly in people with connective tissue disorders.
Associated conditions screening involves looking for other health problems that commonly occur alongside hypermobility, such as digestive issues, cardiovascular symptoms, or chronic pain conditions.
Differential Diagnosis Considerations
Healthcare providers must carefully distinguish hypermobility from other connective tissue disorders that may present similar symptoms but require different management approaches. Ehlers-Danlos Syndrome, Marfan Syndrome, and other genetic conditions may share features with hypermobility but have additional implications for health and treatment.
Inflammatory arthritis conditions like rheumatoid arthritis or lupus can sometimes be confused with hypermobility, particularly when joint pain is prominent. Blood tests and imaging studies help differentiate these conditions.
Mechanical joint problems, such as ligament tears or structural abnormalities, may cause symptoms similar to those seen in hypermobility but typically affect only specific joints rather than showing the generalized pattern typical of genetic hypermobility.
Fibromyalgia overlap represents a particular challenge, as many individuals with hypermobility also meet criteria for fibromyalgia. These conditions can coexist, and distinguishing between them is important for developing appropriate management strategies.
Daily Life Impact and Challenges
Living with hypermobility creates unique challenges that affect virtually every aspect of daily life, from physical activities and work performance to educational achievement and social relationships.
Physical Activity and Exercise
Sports participation presents both opportunities and challenges for individuals with hypermobility. The increased flexibility can provide advantages in activities like gymnastics, dance, swimming, or martial arts, where extreme range of motion is beneficial. Many elite athletes in these sports have some degree of hypermobility.
However, exercise tolerance can be significantly impaired due to rapid fatigue and poor endurance. The muscles must work harder to stabilize hypermobile joints, leading to earlier exhaustion and longer recovery periods compared to individuals with normal joint mobility.
Injury risk increases substantially in hypermobile individuals, particularly for certain types of injuries like sprains, strains, and dislocations. Contact sports or activities with sudden direction changes may pose particular risks.
Activity modification becomes necessary for many people with hypermobility, requiring careful selection of exercises and sports that provide benefits without excessive risk. Low-impact activities like swimming, cycling, or carefully structured strength training often work better than high-impact sports.
Occupational Considerations
Job performance can be significantly impacted by hypermobility symptoms, particularly in physically demanding occupations. Chronic pain, fatigue, and joint instability may affect productivity, attendance, and the ability to perform certain job tasks safely.
Ergonomic needs become crucial for individuals with hypermobility, requiring workplace modifications such as supportive seating, adjustable desks, frequent break opportunities, and tools designed to reduce joint stress.
Career choices may be influenced by hypermobility, with some individuals gravitating toward professions that can accommodate their physical limitations while others may find their symptoms interfere with their desired career paths.
Disability considerations become relevant when hypermobility symptoms significantly impair work capacity. Understanding when and how to seek disability accommodations or benefits requires careful documentation and advocacy.
Educational Impact
School performance can suffer when hypermobility symptoms interfere with concentration, attendance, or physical participation in school activities. Chronic pain and fatigue can make it difficult to focus during classes or complete assignments on time.
Physical education participation often requires modifications to prevent injury while still allowing students to benefit from physical activity. Teachers and coaches need education about hypermobility to provide appropriate accommodations.
Handwriting difficulties are common due to poor proprioception and joint instability in the hands and wrists. Students may benefit from typing accommodations or other assistive technologies for written work.
Concentration issues related to pain and discomfort can affect academic performance across all subjects, potentially requiring accommodations such as extended test time or the ability to change positions frequently during exams.
Social and Relationship Effects
Social activities may become challenging when symptoms interfere with participation in recreational activities or social gatherings. The unpredictable nature of symptoms can make it difficult to commit to social plans in advance.
Relationship dynamics can be affected when partners, family members, or friends struggle to understand the impact of an invisible condition. Education and communication become essential for maintaining supportive relationships.
Parenting challenges arise when hypermobility symptoms interfere with the physical demands of childcare, such as lifting children, playing actively, or maintaining energy throughout long parenting days.
Self-advocacy skills become essential for communicating needs and limitations to others while maintaining independence and dignity. Learning to explain hypermobility to employers, teachers, healthcare providers, and others requires practice and confidence.
Associated Conditions and Comorbidities
Hypermobility rarely occurs in isolation, with many individuals experiencing additional conditions that may share common underlying mechanisms or develop as complications of joint instability and chronic symptoms.
Commonly Associated Conditions
Postural Orthostatic Tachycardia Syndrome (POTS) affects a significant percentage of individuals with hypermobility, causing rapid heart rate increases upon standing along with dizziness, fatigue, and other autonomic symptoms. This condition may result from blood vessel elasticity changes that affect blood pressure regulation.
Mast Cell Activation Syndrome (MCAS) appears to occur more frequently in people with hypermobility, causing symptoms like flushing, gastrointestinal problems, and allergic-type reactions. The connection between connective tissue disorders and mast cell dysfunction is an area of active research.
Gastroparesis and other digestive disorders result from connective tissue weakness affecting the digestive tract. Delayed stomach emptying, acid reflux, and irregular bowel function can significantly impact nutrition and quality of life.
Temporomandibular Joint (TMJ) disorder frequently affects individuals with hypermobility, as the jaw joints may be particularly susceptible to instability and dysfunction. This can cause jaw pain, clicking, and difficulty chewing.
Anxiety and depression occur at higher rates in people with hypermobility, potentially resulting from the stress of living with chronic symptoms, sleep disruption, or shared neurochemical pathways.
Overlapping Syndromes
Fibromyalgia shares many features with hypermobility syndrome, including widespread pain, fatigue, and sleep disturbances. Many individuals meet criteria for both conditions, and distinguishing between them can be challenging for healthcare providers.
Chronic Fatigue Syndrome overlaps with hypermobility in terms of energy limitations and exercise intolerance. The fatigue experienced in hypermobility may result from muscles working overtime to stabilize unstable joints.
Irritable Bowel Syndrome symptoms commonly occur in people with hypermobility, possibly due to connective tissue weakness affecting intestinal function or shared autonomic nervous system dysfunction.
Migraine headaches occur more frequently in individuals with hypermobility, potentially related to neck instability, vascular changes, or shared genetic factors that affect both conditions.
Long-term Complications
Early onset arthritis can develop in hypermobile joints due to increased wear and tear from abnormal movement patterns and joint instability. This premature joint degeneration may require earlier intervention than typically expected.
Chronic pain development can occur through pain sensitization mechanisms, where the nervous system becomes hypersensitive to pain signals. This can result in pain that persists even when tissue damage has healed.
Postural problems frequently develop as individuals compensate for joint instability by adopting protective postures that may create imbalances and additional stress on the spine and supporting muscles.
Cardiovascular complications may arise from vascular connective tissue weakness, potentially affecting heart valve function, blood vessel integrity, or blood pressure regulation over time.
Living with Hypermobility
Successfully managing life with hypermobility requires developing comprehensive strategies for daily adaptation, building strong support systems, and becoming an effective self-advocate for appropriate care and accommodations.
Daily Adaptation Strategies
Joint protection techniques form the foundation of daily hypermobility management, involving conscious efforts to avoid positions and movements that stress vulnerable joints. This includes learning to lift objects close to the body, avoiding prolonged static positions, and using larger, stronger joints when possible instead of smaller, more vulnerable ones.
Energy conservation becomes crucial for managing the fatigue that commonly accompanies hypermobility. This involves planning activities during peak energy times, breaking large tasks into smaller components, and alternating periods of activity with rest to prevent overwhelming the body’s limited energy reserves.
Pain management approaches that don’t rely solely on medications include heat and cold therapy, gentle movement, relaxation techniques, and pacing activities to prevent pain flares. Many individuals find that consistent, gentle exercise helps maintain joint stability and reduce pain over time.
Ergonomic considerations extend beyond the workplace to include home environment modifications such as supportive furniture, kitchen tools designed to reduce joint stress, and bathroom safety equipment to prevent falls and injuries.
Support Systems
Healthcare team coordination becomes essential when managing the complex, multi-system effects of hypermobility. This may include primary care physicians, rheumatologists, physical therapists, cardiologists, gastroenterologists, and mental health professionals who understand connective tissue disorders.
Family and friend support requires education about hypermobility to help loved ones understand the condition’s impact and provide appropriate support without being overprotective or dismissive of symptoms.
Support groups, both in-person and online, provide valuable connections with others who understand the unique challenges of living with hypermobility. These communities offer practical advice, emotional support, and advocacy resources.
Online communities have become particularly valuable for individuals with rare conditions like hypermobility, offering 24/7 access to support and information from others worldwide who share similar experiences.
Self-Advocacy and Education
Understanding your condition thoroughly empowers individuals to become informed patients who can effectively communicate with healthcare providers and make educated decisions about their care. This includes learning about current research, treatment options, and potential complications.
Communicating with healthcare providers effectively requires preparation, clear documentation of symptoms, and persistence in seeking appropriate care. Many individuals benefit from keeping symptom diaries and preparing questions in advance of medical appointments.
Workplace and school advocacy involves understanding legal rights to accommodations and effectively communicating needs to supervisors, teachers, and administrators. This may include requesting flexible schedules, ergonomic equipment, or modified duties.
Raising awareness about invisible disabilities helps create understanding in communities and workplaces while potentially helping others recognize their own symptoms and seek appropriate evaluation.
Research and Future Outlook
The field of hypermobility research continues to evolve rapidly, with new discoveries enhancing understanding of the condition and pointing toward improved diagnostic and management approaches in the future.
Current Research Directions
Genetic research focuses on identifying new genetic markers associated with hypermobility and related conditions. Scientists are working to understand how specific genetic variations translate into the clinical features observed in affected individuals, which may lead to more precise diagnostic testing and personalized approaches to care.
Biomarker development aims to create laboratory tests that can objectively measure aspects of connective tissue function, potentially leading to earlier diagnosis and better monitoring of disease progression or treatment responses.
Epidemiological studies work to better understand the true prevalence of hypermobility and associated conditions across different populations, age groups, and geographic regions. This research helps identify risk factors and patterns that may inform prevention strategies.
Outcome research examines long-term prognosis for individuals with hypermobility, helping healthcare providers and patients better understand what to expect over time and how different management approaches affect quality of life and functional outcomes.
Emerging Understanding
Connective tissue science continues to reveal new details about how collagen, elastin, and other structural proteins function in health and disease. These discoveries may lead to targeted approaches for strengthening connective tissues or preventing their deterioration.
Pain mechanism research explores how and why chronic pain develops in hypermobility, investigating the roles of inflammation, nerve sensitization, and central nervous system processing. Understanding these mechanisms may lead to more effective pain management strategies.
Autonomic dysfunction research examines the connections between connective tissue disorders and nervous system function, particularly regarding cardiovascular symptoms, digestive problems, and temperature regulation issues common in hypermobility.
Gender and hormonal factors research investigates why females are more commonly affected by symptomatic hypermobility and how hormonal changes throughout life influence symptom severity and progression.
Future Implications
Improved diagnostic tools may eventually include genetic testing, biomarker panels, or advanced imaging techniques that can identify hypermobility and predict symptom development more accurately than current clinical assessments alone.
Personalized approaches to care may become possible as research reveals how genetic variations, lifestyle factors, and other individual characteristics influence treatment responses. This could lead to tailored exercise programs, targeted medications, or customized monitoring approaches.
Prevention strategies may emerge as understanding of risk factors improves, potentially allowing for early interventions in at-risk individuals to prevent or minimize symptom development.
Quality of life improvements may result from better recognition of hypermobility by healthcare providers, improved access to appropriate care, and development of more effective management strategies based on research findings.
Conclusion
Hypermobility represents a complex genetic condition that affects millions of people worldwide, causing excessive joint flexibility accompanied by a wide range of symptoms that can significantly impact daily life. From joint pain and instability to cardiovascular symptoms and digestive problems, the effects of hypermobility extend far beyond simple flexibility, creating challenges in work, school, relationships, and recreational activities.
Understanding the genetic and developmental causes of hypermobility helps explain why this condition runs in families and affects individuals differently throughout their lives. The recognition that hypermobility involves abnormalities in connective tissue structure provides insight into why symptoms can be so varied and widespread throughout the body.
Proper identification of hypermobility through clinical assessment tools and comprehensive medical evaluation is crucial for distinguishing this condition from other disorders and ensuring appropriate support and management. The impact on daily life can be substantial, affecting everything from career choices to social relationships, but with proper understanding and adaptation strategies, individuals with hypermobility can lead fulfilling lives.
Living well with hypermobility requires developing comprehensive adaptation strategies, building strong support systems, and becoming an effective advocate for appropriate care and accommodations. The association with other conditions means that individuals often need coordinated care from multiple healthcare providers who understand connective tissue disorders.
Current research continues to advance understanding of hypermobility, offering hope for improved diagnostic tools, more effective management strategies, and better quality of life for those affected. As awareness of this condition grows among healthcare providers and the general public, individuals with hypermobility can expect better recognition, understanding, and support.
If you experience symptoms consistent with hypermobility – including excessive joint flexibility accompanied by pain, frequent injuries, or other concerning symptoms – seeking evaluation from a healthcare provider familiar with connective tissue disorders is an important step toward understanding your condition and accessing appropriate care and support.