How to treat hypermobility disorders (Ehlers-Danlos Syndrome, Marfan’s, General Hypermobility Joint Syndrome, etc)
Many in the physical medicine world tend to think that people only have problems when joints are too stuff, rigid, or fixated. Many practitioners don’t even check for hyper mobility and assume a joint can ONLY be fixated. Contrary to this opinion, it’s the patient with hyper mobile joints that is the most difficult to manage because there are so few tools that traditional PT, chiropractic, and medicine has to combat these conditions. These patients often get mismanaged and misdiagnosed, and end up with instability, muscle tightness, and chronic pain. Often times these patients are told that, “you move great, better than most!” and their complaints are dismissed as being made up. Many practitioners whose world revolves around the “everything is fixated” model cannot fathom how someone can be TOO mobile (at the joint level). Since these patients also often have tight muscles, it helps them fit these patients into their box of fixation=pain. But when muscles are attempted to be released without first solidifying the ligaments, this is where problems can become worse for those with hypermobility. Since around a quarter of the population has hypermobility disorders on some level, it’s important for healthcare practitioners to become better educated on this topic, and important for patients to seek someone that understands these conditions and manages them appropriately.
This isn’t a space where I’m going to delve deep into the various types of hypermobility disorders, but a few of the most common are Ehlers-Danlos Syndrome (ED), Marfan’s, and General Hypermobility Syndrome (GHS). GHS is by far the most common of the lot, with an estimated reach of 20% of the population. Essentially these are all conditions where there is ligament laxity throughout the body. Where muscle are movers of bones, ligaments are the connective tissue that hold our bones together and create stability (the glue). Here are some examples:
When joints are too lax and there is hypermobility at the joint level, muscles tend to tighten up to protect the joint. As I eluded to earlier, oftentimes chiropractic practitioners mistake muscle tension for joint tension and want to manipulate or adjust the joint, which will inevitably make this patient worse because their problem isn’t one of joint fixation. Conversely, most massage therapists, PT’s, etc will try and release tension at the muscle level, however this is also problematic if the muscle is essentially acting as a ligament and providing stability at the joint level. Relaxing a muscle that is tight because it’s protecting a joint will lead to more joint instability and inevitably the muscle will tighten up again quickly; it’s a neurological pattern.
It’s important for patients suffering from hypermobility disorders to seek practitioners that are familiar with these conditions, who have the tools necessary to create joint stability. Once there is stability in the joints, muscles typically will relax on their own because there is no longer a need for them to compensate for the ligaments. Manual chiropractic adjustments, yoga, stretching, rolling, and intense exercise (done too early) are all recipes for disaster in this patient population.
In populations that have hypermobility disorders we work to create stability at the two joints in the body that have more proprioceptors (a type of nerve responsible for positional sense) that anywhere else in the body- the TMJ and SI joint. Through neuromuscular re-education, proprioceptive feedback, and specific home base rehab we aid in the body’s ability to maintain stability. We do this by utilizing a technique called Sacro Occipital Technique (SOT), incorporating a specific cranial work that focuses on the dural connection to nerve roots, and exercises that are centered around posterior chain activation. Sometimes we will recommend SI belts and/or dental orthotics to help maintain stability, and occasionally injections into the SI or TMJ can be helpful to fortify ligaments in those areas that aren’t responding as fast as we’d like.
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