Hypermobility Spectrum Disorder covers a large spectrum of symptoms. Hypermobility can range from a single joint or area where the ligaments are not as taut and do not support the joint adequately to systemic connective disorders such as hypermobile Ehlers-Danlos Syndrome (EDS).
Read this month in our blog for more details about hypermobility and learn how Physical Therapy and Occupational Therapy can help with symptom management.
We do treat this spectrum of symptoms here at PTSC. You can call our front office to schedule an appointment for a PT or OT evaluation. You may need a physician’s referral based upon your insurance needs.
What is Hypermobility?
Hypermobility of a joint means that someone has excessive motion beyond the expected normal range of motion. You can have an isolated joint where the ligaments are lax or less taut so they are not adequately supporting the joint. It can also mean that someone has symptomatic hypermobility through the joints of the entire body. As we have learned more information and identified different factors, the names of the classifications of hypermobility have shifted.
Here is one example of classification:
Hypermobility Spectrum Classifications |
|
Generalized | Through the body |
Peripheral | Hands and/or feet |
Localized | Single joint or single area |
Historical | Joint hypermobility thru the body |
Joint hypermobility is considered to be primarily an inherited connective tissue disorder. It is estimated that 10 million people in the US have this diagnosis. It is also considered to be under-recognized. Even though we continue to learn more about hypermobility, there is still much we do not know. We do not know all the causes and factors that contribute to these symptoms but we do tend to agree that there are multiple factors that impact the symptoms.
Ehlers-Danlos Syndrome (EDS) is a specific form of hypermobility. It is a connective tissue disorder that impacts the entire body and multiple systems from joints to gastrointestinal system. There are multiple classifications of EDS. The most common is hypermobile Ehlers-Danlos (hEDS).
Symptoms can include but not limited to:
Bones/Joints | Sprains, subluxation, dislocations, chronic pain |
Autonomic Nervous System | Brain fog, fatigue, poor sleep, exercise intolerance, temperature dysregulation |
Cardiovascular | Mitral valve prolapse |
Neurological | Dizziness, nerve compression |
Skin | Slow healing, easy bruising, hyper-extensible |
Misc | Anxiety, Irritable Bowel Syndrome, heartburn |
As you can see, there are multiple consequences and issues that can come from EDS and having a system connective tissue disorder because connective tissue is extensive through the body. There can be a lot of pain associated with EDS in particular but also hypermobility in general. We have some theories about why this is but no single cause has been identified. It may be due to a complex combination of increased activation and overstimulation of the sensory nerve endings because the joints are not adequately supported. In addition, there can be micro-traumas from overuse or incorrect stability in the joints. With more lax joints and decreased connective tissue supporting the joints, it sets the stage for increased protective mode of the nervous system to decrease risk of injury. With increased protection mode, comes more guarding, muscle tension and pain.
As we have continued to study hypermobility, we are seeing patterns where the symptoms change as people age. Specifically with EDS but again with hypermobility in general, young children tend to have mostly hypermobility which contribute to increased sprains, strains, joint subluxation or dislocations. Later in adolescence through adulthood, pain becomes more the primary concern. Later in adulthood, pain tends to subside but is replaced with significant stiffness around the joints.
What can Physical Therapy and Occupational Therapy
do to help with hypermobility?
1. Posture awareness and correction as poor posture can put excessive stress on joints and muscles through the body.
2. Education on correct body mechanics to decrease risk of injury
3. Address imbalances between loose joints and tight muscles with therapeutic exercises
4. Balance, proprioception (awareness of where we are in space) training
5. Pain management with manual therapy
6. Endurance training with specific parameters for a safe intensity
7. Sleep hygiene education
8. Relaxation techniques for pain management
9. Education on pacing and energy conservation including use of adaptive equipment plus fine motor training (OT).
Spinal Stabilization exercises
Joint stability and protection including taping, braces
Education to decrease fear of movement.
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