Hypermobility Syndrome

Hypermobility Syndrome

What is hypermobility?

 

Hypermobility is when joints, such as your knee or shoulder, move beyond their normal range. Those who have hypermobile joints are sometimes referred to as “double jointed.” It can occur at one or several joints, often after trauma related injury, or can be generalized throughout the body due to genetic predisposition. It can range from mild joint laxity to extreme mobility to joint instability/dislocations. Often a hypermobile joint is the result of compensation for a hypomobile (restricted) joint somewhere else. This is often seen in spinal segments where there is postural dysfunction/poor posture.

 

Examples of hypermobility:

  • Passive extension of each fifth finger greater than 90 degrees
  • Passive apposition of each thumb to the flexor surface of the forearm
  • Hyperextension of each elbow greater than 10 degrees
  • Hyperextension of each knee greater than 10 degrees
  • Ability to place the palms on the floor with knees fully extended
  • During pregnancy due to release of the hormone relaxin
  • Gymnasts and dancers tend to be more hypermobile

Thick bands of tissue called ligaments help hold our joints together and keep them from moving too much or too far. For those who have hypermobility, those ligaments are loose or weak. Though hypermobility itself does not necessarily mean pain and dysfunction, people with joint laxity may be at risk of musculoskeletal injuries such as:

  • Dislocated joints, which is a separation of two bones where they meet at a joint
  • Sprains and strains
  • Joint Pain
  • Tendonitis
  • Osteoarthritis
  • Nerve Impingement (carpal tunnel)

 

What causes hypermobility?

 

Traumatic injuries to a joint such as a dislocation or subluxation from a sport injury, car accident or fall can lead to permanent hypermobility at the specific joint that was injured. Examples would include a dislocated shoulder or “rolling an ankle.” Even a violent sneeze or cough can put a rib or SI joint out of place and cause a lot of back pain. The injury essentially tears or over-stretches the ligaments that hold the joint together. Since ligaments do not have contractile qualities like muscle tissue, once stretched, they never return to their original length. Therefore, that joint now has to rely on your muscles to support it because it no longer has structural support from the ligaments. In this case, without proper rehab/exercise to strengthen the surrounding musculature, the person may become prone to continued re-injury (subluxations and dislocations).

 

When referring to generalized hypermobility, it is believed that genetic information is passed on which predisposes the development of hypermobile joints in the children whose parent(s) have the condition. Genes that are responsible for the production of collagen, an important protein that helps to glue tissues together, are suspected of playing a role. Having this genetic predisposition does not necessarily mean the person will experience pain, but they may be more prone to joint injuries and development of certain conditions.

 

Some medical conditions predispose a person to hypermobility such as Rheumatoid Arthritis, Ehlers-Danlos syndrome, Marfans syndrome, Hemiplegia and Paralysis. 

 

How can Athletic Therapy help?

 

Athletic Therapy and Massage Therapy can help to determine the underlying cause of your pain which is very important for determining the proper course of treatment. For example, is there a history of trauma or is there a genetic predisposition? Is the pain secondary to a hypomobile area which also needs to be treated? Is there a postural dysfunction contributing to this problem? Which specific muscle(s) need to be strengthened in order to give the joint (s) the stability they need to function pain free and prevent re-injury? What activities should you avoid doing to reduce the probability of re-injury? These are all important questions an Athletic Therapist or RMT would take into consideration in order to develop an effective treatment plan. Some of the treatment goals may include:

 

  •  Pain reduction/elimination
  •  Improve muscle strength and fitnessCorrect posture
  • Improve your sense of your body’s position and movement
  • Correct dysfunctional movement patterns of individual joints

 

An athletic therapist or RMT may advise you to follow a program that includes strength and balance training, specified stretches and pacing techniques. Specific exercises would be demonstrated and prescribed for you to work on either in the clinic during appointments or on your own at home (depending on your preference). Treatment may include manual therapy (myofascial release, trigger point release to the surrounding musculature and mobilization techniques to surrounding joints that may be hypomobile, taping of an unstable joint, etc.) A treatment plan that fits your lifestyle, schedule and budget can be developed in order to give the highest chance of successful, long lasting treatment results.

 

*Pacing involves balancing periods of activity with periods of rest, and aids in long term progress.

 

 

References:

http://www.nhs.uk/Conditions/Joint-hypermobility/Pages/Treatment.aspx

http://morphopedics.wikidot.com/ehlers-danlos-syndrome

http://www.nlm.nih.gov/medlineplus/ency/article/003295.htm

Clinical Massage Therapy by Fiona Rattray & Linda Ludwig