The more I stretch the worse I feel! Hypermobility and how to feel better!

Hypermobile skater

While its wonderful to have a flexible body, what if you are a person who has so MUCH flexibility that it is a cause of pain, weakness, poor balance, clumsiness, frequent joint dislocations,ankle sprains and/ or slow to heal injuries.

This type of body is one with Hypermobility Syndrome where the joints exceed the normal expected movement for that joint.It is frequently an inherited disorder which renders the collagen found in our ligaments less firm than they should be. The job of ligaments is to perform as tight binders that hold our bones in good stable contact with each other. The job of muscles is to move those bones for us. If the collagen is weaker than it should be it allows for this excessive movement on our  joints but may also affect any body part where collagen in found i.e. ligaments which suspend the bladder, heart valves, and walls of veins.The range of hypermobillity is wide ranging from totally asymptomatic to total disability.

Please note that a person may also experience a single joint as being loose or lax after an injury : for example a person has a fall and dislocates a shoulder : this shoulder may well remain hypermobile due to ligament damage in that particular incident. We  treat this  as a one- off joint problem with appropriate and effective rehabilitation targeted to that specific joint.

Hypermobility Syndrome is diagnosed on the basis of the Beighton Scale with the allocation of one point for each lax joint. See www.physio-pedia.com/Beighton_score for more details on this assessment.


It is present in about 20% of individuals in varying degrees and many have no symptoms at all.

The majority of patients we see at Trimetrics have had a history of chronic pain,recurrent injuries which do not seem to heal fully .This results often in  an  inabilty to exercise effectively and a worry about exercising at all. Many have had careers as dancers gymnasts or yoga.It is understandable that to  some degree, hypermobile individuals are pre selected for these activities on account of their “flexibility”. Many present with a history of chronic knee, lower back or shoulder pain and instability. A frequent complaint we hear is ” I have tried everything yet still I am in pain” Hypermobility is an often missed diagnosis by therapists,trainers and doctors They  respond to injury differently and do not always heal in the same way or in the same expected time frame, as those with more normal collagen in their bodies

The incidence of hypermobility is generally higher in women and highest currently in the U.K.where it is regarded as an important connective tissue disorder and children are routinely screened for it in elementary school. Many high scoring Beighton individuals there are under the care of a rheumatologist for life as they may experience gastro intestinal or auto immune symptoms in addition to painful joints.  do not respond to injury and healing in the same way as those with more normal collagen in their bodies.They may need specific medication for short periods or when newly injured.

An individual with this disorder also may live with chronic low grade joint pain as their joints are not as supported as they need to be.Inflammation due to chronic stress at the ligament’s  attachment point onthe bone( enthesis )  is often a source of pain.This can be extremely disabling when it occurs over many joints in the body resulting in sever chronic pain.

There can also be a psychological aspect to hyper mobility : anxiety is a common issue as a hyper mobile person’s proprioception ( awareness of where the body is in space )is not accurate, resulting in poor  balance,frequent falls or fear of falling, and chronic clumsiness. They never know quite where their bodies are in space and when an injury may occur with little provocation.

Interestingly, one of the complaints hypermobile patients have is that they always feel ” tight ” and try to use stretching exercise, yoga etc to get “relief “. This is the body’s attempt to stabilise the hypermobile joints with excessive tightening and gripping in the large global muscles i.e. quads,pecs,calf muscles etc which is NOT effective in releasing the tightness and usually generates more pain and frustration!

The excellent news is that we at Trimetrics,  have many years of experience of sucessful treatment and and management of Hypermobility Syndrome due to the volume of referrals we receive from rheumatologists and sports medicine physicians.We have developed a very specific exercise approach based on where the patient is on the Beighton Scale, which is extremely beneficial for hypermobile patients. Strong muscles inside and out with specific exercise safety guidelines in place with balance,co cordination training make a huge difference for hypermobile patients.
Trimetrics program has  main tenets:

1. Reduce pain.

Knowledge is power. We ensure that our patients understand the nature of the issue and the reasons for their pain and recurring injuries. We explain the rationale for  the effective treatment we as experienced physiotherapists can provide, and the results we can expect.Where indicated, a patient’s physician or rheumatologist may prescribe medication short term to reduce painful inflammation. This  allows the patient to get moving and sleeping since this is  often affected.

We may  begin by releasing the chronically tight,painful,OVER dominant muscles ideally  myofascial release using foam roller and / or  IMS / Functional Dry Needling .These are effective in  releasing the old held muscle  gripping patterns that are very energy expensive for the patient, and itself a cause of painful trigger points.We address the tightness where is actually is,in the muscles.We do NOT routinely stretch joints.This feels wonderful to a hypermobile person!

2. Realign the pelvis and spine: This is essential  so that correct exercise information is messaged to the brain.We know from research that a mis aligned pelvis is not a good basis for a balanced symmetrical core strengthening program.

3. Pilates based spine and core strengthening to stabilize,to  build strength from the powerful deep inner spine muscles and progress to the outer system ( arms/ legs etc).This exercise is progressive so we are adding demand in all movement directions, as the patient’s body strengthens week by week.

A hypermobile body responds really well to an equipment based ( Reformer/ chair / cadillac ) Pilates program which delivers exactly the type of experience the hypermobile body needs : ie the sense of  safe stable and progressive exercise, which will not generate any additional pain.

We use a ” closed chain ” approach meaning that we use the equipment to bombard the nervous system with posturally stimulating information which assists the patient to pull their strength from the deep spine / core muscles. This is the system of deep muscles we want to use to stabilise the spine and limbs rather than use and over use, the big and often over dominant global muscles.Closed chain means that hands, feet, knees are always in contact with a hard surface, small ball, magic circle etc.

A feeling of safety is very important for hyper mobile patients. We begin in the safest positions (supine,side lying and prone) so that the patient can learn where their bones are and how to access their core muscles, without the stress of gravity.

If feeling or accessing the deep core system is hard for the patient, we use a Real Time Ultrasound test so that the patient and therapist can clearly see the abdominal muscles, and cue their activation with the ultrasound… our patients love this tool.

As goals are mastered, we increase the challenges in kneeling,sitting standing and jumping drills on the Reformer, Chair and Cadillac. We incorporate balance,propriocption training into each exercise using Pilates discs and Bosu. Tactile cues and imagery are very powerful tools in elicitng deeper postural and muscular reactions. A program of one to one Pilates training, twice a week over a 6 week period generates excellent results. We guide our patients to exercise and sports which will reinforce their new patterns so that core strength, balance and co ordination are always being progressed for continued fitness, endurance and…. painlessness!

Please check out these excellent links for more information :

www.arthritisresearchuk.org

www.dynakids.org

 

For assessment  and treatment please call us at 604 982 0366 for an initial 60 minute appoinment or email info@trimetricsphysio.com

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