Our ligaments, tendons, discs and skin are made up of forms of collagen, one of the most important structural proteins in our bodies. This gives our tissues the ability to heal, its elasticity, its integrity and its strength, allowing us to have strong and healthy joints and skin which will put up with the stresses life puts upon them. Collagen is also responsible for the strength and integrity of our arteries and many other bodily structures. Human populations show great variation in collagen function from those who are very stiff jointed to those who are very mobile jointed or "double jointed".
Ehlers-Danloss Syndrome (EDS) is an inheritable condition which affects the synthesis and viability of collagen as a structural protein. There are at least 10 forms of this condition but Ehlers-Danloss III (three) is also known as benign joint hypermobility syndrome, benign because there are no life-threatening symptoms as occur in some of the other types. These people have smooth, velvety and flexible skin and remarkably hypermobile joints, along with chronic joint or limb pains and recurrent joint dislocations, mostly of the shoulder and the patella. Slow or abnormal wound healing with large and relatively weak scars can also be a feature.
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.
As it takes far less trauma to damage a hypermobile joint than a normal one the incidence of acute injuries is higher in these patients as they go about their daily activities. The joint injuries and general painful problems which occur are managed by physiotherapy intervention. The shoulder is a highly mobile but unstable joint in the best circumstances and in hypermobile patients it presents particular problems of stability. The socket is small and the shoulder girdle muscle control must keep the humeral head aligned against it, difficult if the pattern of muscle action is abnormal. Repeated subluxation or dislocation with consequent pain is common and difficult to treat.
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. - 14130
Ehlers-Danloss Syndrome (EDS) is an inheritable condition which affects the synthesis and viability of collagen as a structural protein. There are at least 10 forms of this condition but Ehlers-Danloss III (three) is also known as benign joint hypermobility syndrome, benign because there are no life-threatening symptoms as occur in some of the other types. These people have smooth, velvety and flexible skin and remarkably hypermobile joints, along with chronic joint or limb pains and recurrent joint dislocations, mostly of the shoulder and the patella. Slow or abnormal wound healing with large and relatively weak scars can also be a feature.
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.
As it takes far less trauma to damage a hypermobile joint than a normal one the incidence of acute injuries is higher in these patients as they go about their daily activities. The joint injuries and general painful problems which occur are managed by physiotherapy intervention. The shoulder is a highly mobile but unstable joint in the best circumstances and in hypermobile patients it presents particular problems of stability. The socket is small and the shoulder girdle muscle control must keep the humeral head aligned against it, difficult if the pattern of muscle action is abnormal. Repeated subluxation or dislocation with consequent pain is common and difficult to treat.
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. - 14130
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. 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 London.
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