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.
The typical signs and symptoms of joint hypermobility syndrome are a hyperextensible skin, hypermobile joints, tendency to dislocations, fragile tissues, poor wound healing and a tendency to bruise easily. Chronic joint and limb pain is also common and many sufferers live with constant and multiple pain complaints. Patients show many abnormal muscle balances and have difficulty stabilising their joints appropriately, causing incorrect muscle uses which can lead to pain problems. Functional limitation is common in this group, who cannot participate in contact or vigorous sports without significant joint injuries and pain.
Advice to patients is very important and education should be a priority to allow them to manage their condition over the long term. Avoidance of excessive or repeated heavy lifting and other movements which put stresses and strains on the hypermobile joints is important and patients should avoid end-range postures which strain the lax ligaments. Joint protection, as in arthritic joints, is essential and patients should avoid showing off by performing "party pieces" such as dislocating a joint voluntarily or other extreme tissue manoeuvres. Stretching the joints strongly may worsen the underlying problems, and any activity carrying high risk of skin damage should be avoided.
The stresses and strains of daily life and recreational activities tend to result in more acute injuries and pain complaints in hypermobile patients which are managed by physiotherapy to the joints and muscles. Even in normal circumstances the shoulder is very mobile yet unstable but in hypermobile patients the lax connective tissue makes the joint very unstable and difficult to control. The shoulder and surrounding muscle must keep the large ball of the arm bone aligned with the small socket during large movements and this is difficult with hypermobility, leading to abnormal muscle patterns and pain. It is common to have pain due to this and to repeated dislocations.
Spinal pain is common in hypermobility perhaps secondary to the difficulty in keeping good stability of the joints as forces act upon them. Gentle mobilizations can be performed for local problems but manipulation is likely to be unwise. General exercises to keep the joint moving can be helpful but end range and stretching exercises should be avoided. Gentle weight training and core stability work may help stabilise the spine and other joints, increasing the muscle tone to hold joints in their mid ranges and prevent excessive play. The knees may bend back excessively and suffer arthritic change in time, so work on the hamstrings to counteract this in standing is an option. Often patients need to work on several areas, maintaining muscle strength and control.
All postures and activities are a challenge to a patient with hypermobility as unsuitable stresses are very easy to apply, causing pain. The patterns of muscle activity are abnormal when the joints are under load, pushing them into end range positions where the ligaments and capsules suffer from strains. Physiotherapy retraining of poor muscle balance can be helpful but patients need to be constantly vigilant and work at their weaknesses persistently. The most important factor overall is patient education as the condition is a long term one and all physical activities challenge the joints. - 16650
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.
The typical signs and symptoms of joint hypermobility syndrome are a hyperextensible skin, hypermobile joints, tendency to dislocations, fragile tissues, poor wound healing and a tendency to bruise easily. Chronic joint and limb pain is also common and many sufferers live with constant and multiple pain complaints. Patients show many abnormal muscle balances and have difficulty stabilising their joints appropriately, causing incorrect muscle uses which can lead to pain problems. Functional limitation is common in this group, who cannot participate in contact or vigorous sports without significant joint injuries and pain.
Advice to patients is very important and education should be a priority to allow them to manage their condition over the long term. Avoidance of excessive or repeated heavy lifting and other movements which put stresses and strains on the hypermobile joints is important and patients should avoid end-range postures which strain the lax ligaments. Joint protection, as in arthritic joints, is essential and patients should avoid showing off by performing "party pieces" such as dislocating a joint voluntarily or other extreme tissue manoeuvres. Stretching the joints strongly may worsen the underlying problems, and any activity carrying high risk of skin damage should be avoided.
The stresses and strains of daily life and recreational activities tend to result in more acute injuries and pain complaints in hypermobile patients which are managed by physiotherapy to the joints and muscles. Even in normal circumstances the shoulder is very mobile yet unstable but in hypermobile patients the lax connective tissue makes the joint very unstable and difficult to control. The shoulder and surrounding muscle must keep the large ball of the arm bone aligned with the small socket during large movements and this is difficult with hypermobility, leading to abnormal muscle patterns and pain. It is common to have pain due to this and to repeated dislocations.
Spinal pain is common in hypermobility perhaps secondary to the difficulty in keeping good stability of the joints as forces act upon them. Gentle mobilizations can be performed for local problems but manipulation is likely to be unwise. General exercises to keep the joint moving can be helpful but end range and stretching exercises should be avoided. Gentle weight training and core stability work may help stabilise the spine and other joints, increasing the muscle tone to hold joints in their mid ranges and prevent excessive play. The knees may bend back excessively and suffer arthritic change in time, so work on the hamstrings to counteract this in standing is an option. Often patients need to work on several areas, maintaining muscle strength and control.
All postures and activities are a challenge to a patient with hypermobility as unsuitable stresses are very easy to apply, causing pain. The patterns of muscle activity are abnormal when the joints are under load, pushing them into end range positions where the ligaments and capsules suffer from strains. Physiotherapy retraining of poor muscle balance can be helpful but patients need to be constantly vigilant and work at their weaknesses persistently. The most important factor overall is patient education as the condition is a long term one and all physical activities challenge the joints. - 16650
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.
