Physiotherapy in Patients with Joint Hypermobility Syndrome
Our skin, discs, tendons, ligaments and many other tissues all rely on the protein collagen for their structural integrity, ensuring normal flexibility, healing capacity, strength and cohesiveness. This allows us to put the considerable daily stresses on these tissues without problems and collagen is also very involved in the strength and elasticity of internal organs such as our arteries. Some people are called “double jointed” because they are so bendy whilst others have very stiff and tight joints. Collagen is a very important protein in our connective tissues, at least partly dictating what activities we can perform and how we recover from injury.
Ehlers-Danloss syndrome is caused by an abnormality in the way collagen is produced and acted upon in the body, causing an inheritable deficiency in the strength of the substance. 10 forms of EDS are known to exist, with much overlap, and EDS Three is considered the same as benign joint hypermobility syndrome, called benign because the serious changes such as in the arteries are not present in this form. Very hypermobile joints are the most obvious sign of this syndrome, with a smooth, flexible skin which tends to heal slowly and scar poorly in terms of wide and thin scars.
Patients with joint hypermobility syndrome show various symptoms and signs: joint hyper-mobility; less skin strength; reduced healing of wounds; easy bruising; skin flexibility and likelihood to dislocate easily. Sufferers from this syndrome may develop a chronic pain syndrome with constant and persistent joint pain, with incorrect muscle balances leading to joint stability problems and poor muscle balance. Functionally hypermobile patients can be very limited in normal activities or suffer pain when undertaking them and are unable to join in with vigorous activities or contact sports.
Self management in hypermobility syndrome is the main aim of intervention, with patient education taking a strong role to equip the patient to manage their lifelong condition. Due to the abnormally large ranges of joint movement they are vulnerable to ligament or joint strain if they are held posturally at end range or moved with momentum. Hypermobile patients should practice joint protection like arthritic patients, avoiding party pieces like showing off with extreme movements or joint dislocations. Yoga or high momentum activities such as contact sports are particularly unsuitable for these patients.
The stresses and strains of daily life and recreational activities tend to result in more acute injuries and pain complaints in hypermobile patients which are managed by physiotherapy to the joints and muscles. Even in normal circumstances the shoulder is very mobile yet unstable but in hypermobile patients the lax connective tissue makes the joint very unstable and difficult to control. The shoulder and surrounding muscle must keep the large ball of the arm bone aligned with the small socket during large movements and this is difficult with hypermobility, leading to abnormal muscle patterns and pain. It is common to have pain due to this and to repeated dislocations.
Spinal pain is common in hypermobility perhaps secondary to the difficulty in keeping good stability of the joints as forces act upon them. Gentle mobilizations can be performed for local problems but manipulation is likely to be unwise. General exercises to keep the joint moving can be helpful but end range and stretching exercises should be avoided. Gentle weight training and core stability work may help stabilise the spine and other joints, increasing the muscle tone to hold joints in their mid ranges and prevent excessive play. The knees may bend back excessively and suffer arthritic change in time, so work on the hamstrings to counteract this in standing is an option. Often patients need to work on several areas, maintaining muscle strength and control.
Hypermobility is a lifelong chronic condition so sufferers are faced with managing this daily in all their postures and activities. Dysfunctional muscle patterns are common when the joints are significantly stressed, forcing them into unsuitable positions where they suffer strains. Physiotherapists can help with retraining of muscle patterns and treatment of painful joints but the largest component is self management and therefore patient education.
Tags: alternative medicine, back injury, back pain, back pain relief, Frozen Shoulder, health, injury management, pain management, physical fitness, physiotherapists, Physiotherapy, Piriformis Syndrome, sciatica, Your Health & Body