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Official Chiropractors for Southend United F.C. & West Ham United F.C. Women

Hypermobility

Hypermobility

Hi everybody, Jenny here, one of the chiropractors at Backworks.

Why hypermobility?

With it having been EDS (Ehlers-Danlos Syndrome) awareness month (May) I thought I would take the opportunity to talk about hypermobility. Ehlers-Danlos syndromes are a collection of genetic connective tissue disorders affecting the whole body, and one of the characteristic features of EDS is hypermobility.

What is it and who is affected?

Hypermobility is the medical term for joints that move too far e.g. beyond their normal range of movement. We see a lot of patients at the clinic that are hypermobile (also known as double-jointed to some), most don’t even realise they are. It is very common in the general population, but most common in childhood/ adolescence, females, and Asian and Afro-Caribbean ethnicities.

To understand hypermobility we need to understand what “collagen” is. Collagen is one of the major building blocks of bones, skin, tendons and ligaments. Ultimately collagen makes up everything in our body and can be found in other structures such as blood vessels and even teeth! You can think of it as the “glue” that holds all these things together. In fact, the word collagen comes from the Greek word “kólla”, which means glue.

Hypermobility is an often inherited abnormality of this collagen, leaving it weaker than it should be. As a result, tissues in the body will be fragile, which makes ligaments and joints loose and stretchy.

Most people with hypermobile joints have no other related medical problems. However, some people suffer from a “hypermobility syndrome”, where there can be a whole host of pain, joint and ligament injuries, fatigue and other associated symptoms along with hypermobility. It may be a relief for those people to find an explanation to unify so many of the unusual things they have noticed about their bodies.

Hypermobility Syndromes

Hypermobility may be a sign of a more substantial underlying condition which can vary in degrees of severity. Of these Joint Hypermobility Syndrome (JHS) is the most common.

Joint hypermobility syndrome can include a wide array of symptoms, but the muscles and joints are most often affected, hence the name. People with JHS often develop chronic joint pain and stiffness, most commonly in the joints of the neck, shoulders, back, hips, and knees. However, smaller joints such as the ankles, wrists, and elbows often are affected too.

Joint pain often comes from the muscles and tendons around the joint rather than the joint itself. Therefore, imaging alone will not show anything that will indicate this diagnosis. Hypermobile people can often and easily injure soft tissues around joints because their joints can twist and over-extend too easily. This could also result in frequent partial or full joint dislocations in various parts of the body.

Most people with joint hypermobility syndrome don’t look sick, and so others around them may struggle to sympathise, and with such a complex set of symptoms, it can take a long time to finally reach the diagnosis.

In addition to joint problems, because of the excessive “stretchiness” of the body’s connective tissues, the other symptoms can include:

  • Hernias
  • Gastro-oesophageal reflux disease (GORD).
  • Dislocation of more than one joint, or of one joint more than once
  • Soft-tissue problems (e.g., tendonitis, bursitis)
  • Tall, thin body shape
  • Skin hyper-extensibility, stretch marks, thin skin, or abnormal scarring
  • Drooping eyelids, nearsightedness
  • Varicose veins, unexplained bruises
  • Difficulty sleeping and fatigue

People with lax joints fall along a broad spectrum, from those with joint hypermobility but only mild or no related symptoms, to those moderately affected by JHS, to those more severely affected, many of whom truly have the hypermobile type of EDS, which again can vary hugely in severity.

A clinician may assess the presence of hypermobility by using the Beighton Scale. This however is only one of many criteria to establish the diagnosis of a hypermobility syndrome.

How to manage it

The short-term management of these musculoskeletal symptoms primarily consists of medication for pain relief, alongside exercise and physical therapy (chiropractic, osteopathy, physiotherapy). Long-term management includes strengthening of the tissues around loose joints to stabilize and protect them.

Here are a few bits of advice:

DO

swimming or water exercises, walking, cycling, Pilates, or Tai Chi

AVOID

high-impact exercises, such as sports that involve running, jumping, or physical contact and avoid over-exercising

DO

light resistance exercises, which are the cornerstone of strengthening and stabilisation.

AVOID

most forms of stretching that involve grabbing a joint and pulling or pushing on it to “loosen it up.” Many people are reluctant to give up stretching because it “feels so good” but in reality, it isn’t helping.

DO

be persistent and consistent. You don’t need to spend an hour in the gym. Even on days when you are “too tired” or “don’t have time” to exercise, 5 minutes of light weights for shoulder strengthening and 5 minutes of isometrics for core strengthening every day will yield big benefits in the long run. No “two-week cure” here.

AVOID

heavy lifting, pulling, and pushing. Be particularly careful around the house and in the garden, where odd-shaped weights and unusual angles often lead to injury.

AVOID

hyper-extending your joints. That is, don’t straighten your arms out fully so that your elbows lock, and don’t straighten your knees to the point that they lock. This applies to carrying groceries or a gallon of water just as much as it does to doing exercises with weights.

You should think about seeing your GP or contact us now on 01702 342329 for further information if you:

  • Keep dislocating your joints
  • Keep getting strains
  • Have poor balance or coordination
  • Have thin, stretchy skin
  • Have digestive issues like diarrhoea or constipation
  • Have ongoing pain or stiffness in your joints or muscles

References

Russek, L.N & Lenert, P. 1999. Hypermobility Syndrome. Physical Therapy. [Online]. 79(6), 591–599. [1999]. Available from: https://doi.org/10.1093/ptj/79.6.591

Kumar, B & Lenert, P. 2017. Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain. The American Journal of Medicine. [Online]. 130(6), 640-647. [09 March 2017]. Available from: https://doi.org/10.1016/j.amjmed.2017.02.013

Hakim, A. 2015. What are hypermobility syndromes?. [Online]. [29 May 2020]. Available from: https://www.hypermobility.org/what-are-hypermobility-syndromes

https://www.nhs.uk/conditions/joint-hypermobility-syndrome/

https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/joint-hypermobility

https://www.ehlers-danlos.com/assessing-joint-hypermobility/
Picture of Posted by Jon Hicks

Posted by Jon Hicks

Registered Chiropractor 03717