TrimetricsPhysio.com

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

Winter Olympics - 2010 Winter Olympic Games Vancouver - Day FourteenWhile 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 slow to heal sprains…
This type of body is one with Hypermobility Syndrome where joints exceed the normal expected movement for that joint.It is frequently an inherited disorder which renders the collagen found in our ligaments. If the collagen is weaker than it should be it allows for this excessive movement on 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.
Hypermobility 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.It is present in about 20 % of individuals in varying degrees.
The majority of patients we see at Trimetrics have had careers as dancers gymnasts or
yoga as to some degree indivuduals are pre selected for these activites on account of their ” flexibility “. Many present with a history of chronic knee,lower back or shoulder pain and instability for which no treatment has been effective.The incidence of hypermobility is generally higher in women and highest in the U.K.where it is regarded as a connective tissue disorder and children are routinely screened for it in elementary school. Many individuals there are under the care of a rheumatologist for life as their bodies do not respond to injury and healing in the same way as those with more normal collagen in their bodies.
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. There can be an accompanying anxiety issue as this person’s proprioception ( awareness of where the body is in space ) is poor resulting in balance,frequent falls or fear of falling, and clumsiness.They never know quite where their bodies are in space and when an injury may occur with little provocation.
Interstingly,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 at Trimetrics we have developed a very specific exercise approach which is extremely beneficial for hypermobile patients.Strong muscles inside and out with specific exercise safety guidelines in place,make a huge difference for hypermobile patients.
Trimetrics program has 3 main tenets:
1.Release the chronically tight,painful,OVER dominant muscles with IMS / Functional Dry Needling followed by myofascial relase on a foam roller.This releases the old held gripping pattern that is energy expensive and itself a cause of painful trigger points.We address the tightnes where is actually is,in the muscles. We not stretch joints.This feels wonderful to a hypermobile person !
2 Realign the pelvis and spine 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.
This type of body responds really well to an equipment based ( Reformer/ chair / cadillac ) Pilates program. 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 safe postions ( 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 feelin or accessing the deep core system is hard for the patient, we use a Real Time Ultraosund 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 this UK link for very current research information www.hypermobility.org

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