Physiotherapy in Patients with Joint Hypermobility Syndrome
Posted on December 28, 2008
Filed Under Back Pain | Leave a Comment
Our ligaments, tendons, discs and skin are made up of forms of collagen, one of the most important structural proteins in our bodies. This gives our tissues the ability to heal, its elasticity, its integrity and its strength, allowing us to have strong and healthy joints and skin which will put up with the stresses life puts upon them. Collagen is also responsible for the strength and integrity of our arteries and many other bodily structures. Human populations show great variation in collagen function from those who are very stiff jointed to those who are very mobile jointed or “double jointed”.
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.
Joint hypermobility syndrome exhibits a series of symptoms and signs including some fragility of the tissues, slower and poorer wound healing, a propensity to joint dislocations, flexible skin and hypermobility of the joints. Along with these findings patients often complain of multiple chronic joint pains which can develop into a pain syndrome. Poor muscle balance around the major joints causes instability and incorrect muscle patterning which can cause joint and muscle pain and limit the ability to do functional things. Contact sports or vigorous physical activities are not appropriate for this group of people.
Advice to patients is very important and education should be a priority to allow them to manage their condition over the long term. Avoidance of excessive or repeated heavy lifting and other movements which put stresses and strains on the hypermobile joints is important and patients should avoid end-range postures which strain the lax ligaments. Joint protection, as in arthritic joints, is essential and patients should avoid showing off by performing “party pieces” such as dislocating a joint voluntarily or other extreme tissue manoeuvres. Stretching the joints strongly may worsen the underlying problems, and any activity carrying high risk of skin damage should be avoided.
Physiotherapists manage the multiple joint and pain problems which hypermobility patients present with. Acute injury is more likely to occur with less trauma and more easily if the person undertakes vigorous exercise of any kind. Shoulder problems are particularly common in hypermobiles as the shoulder is a naturally mobile and unstable joint in normal situations let alone when the ligaments are unusually lax. Keeping the large ball of the arm bone centred on the small socket is a challenge to the muscular control and abnormal muscle patterning is common. Patients may habitually dislocate dislocate on movements, perpetuating the pain problem.
Spinal pain, in the neck, low back or thoracic regions, is a common symptom which hypermobile patients complain of, and physiotherapists interpret this as a lack of stabilising muscle control and muscle balance. Physios do not manipulate these patients but mobilizations, core stability work, strengthening weak muscle groups and general exercise are typical approaches. Increasing the usually low muscle tone by gentle weight training or using resistive bands can help joint control in the mid positions and avoid stresses at end ranges. Hyperextension of the knee is a typical problem, leading to joint pain on weight bearing and later to osteoarthritis. Hamstring work to strengthen the muscle opposing the abnormal movement is useful, with patients typically working on the muscle balance of several body areas.
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.
Related posts
Comments
Leave a Reply