Joint Hypermobility Syndrome

                                                                                         

Our skin, discs, tendons, ligaments and many other tissues all rely on the protein collagen for their structural integrity, ensuring normal flexibility, healing capacity, strength and cohesiveness. This allows us to put the considerable daily stresses on these tissues without problems and collagen is also very involved in the strength and elasticity of internal organs such as our arteries. Some people are called "double jointed" because they are so bendy whilst others have very stiff and tight joints. Collagen is a very important protein in our connective tissues, at least partly dictating what activities we can perform and how we recover from injury.

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.

Self management in hypermobility syndrome is the main aim of intervention, with patient education taking a strong role to equip the patient to manage their lifelong condition. Due to the abnormally large ranges of joint movement they are vulnerable to ligament or joint strain if they are held posturally at end range or moved with momentum. Hypermobile patients should practice joint protection like arthritic patients, avoiding party pieces like showing off with extreme movements or joint dislocations. Yoga or high momentum activities such as contact sports are particularly unsuitable for these patients.

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.

About the author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Edinburgh or elsewhere in the UK.

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