Moving Naturally with Hypermobility - PowerPoint Presentation

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Moving Naturally with Hypermobility

June 18, 2015Slide2

Outline

Review of

H

ypermobility

S

yndrome / EDS

Affects on

the musculoskeletal system

Role of Exercise

Role of

Sleep

Taking

stress off of the joints

Moving properly with hypermobility

Resources for patientsSlide3

Christopher Gnip, DPT, PT

Graduated from Washington University in St Louis in 2006 with a doctorate in Physical Therapy

Practicing in metro DC since 2006

Manages several clinics for Physiotherapy Associates

Interested and started learning more about hypermobility syndromes in 2010

Collected research and presented poster at National PT Conference in Feb 2015

Still needs to learn a lot more about these syndromes (We all do!!)

Not only a practitioner that treats hypermobility, but also a client

Slide4

Causes of Hypermobility Syndromes

/ Ehlers

Danlos

Syndrome

Primary reason is a collagen deficiency / mutation

Collagen is a protein found in most connective tissues throughout the

body

Collagen is the ‘glue’ that keeps connective tissues strong

Due to the deficiency, there is a laxity in most connective tissues throughout the body

Not only affects muscles, tendons, and ligaments, but can also affect other vessels, such as blood and lymphatic vesselsSlide5

Hypermobility Syndrome: ways to assess

Beighton

Scale and Brighton Criteria

Beighton

Scale

Assesses laxity in elbows, knees, thumbs, fingers and low back

4 / 9 is a major criteria for diagnosis

Will usually score less as we ageSlide6

Beighton Scale- MeasuresSlide7

Beighton

Scale- MeasuresSlide8

Beighton Scale- MeasuresSlide9

Diagnosing

Brighton Criteria

Major Criteria

Beighton

Score of 4 or more

Joint pain affecting 4 or more joints and lasting more than 3 months

Minor criteria

Beighton

score of 1, 2, or 3

Back pain or pain in one to three joints lasting more than 3 months, or spinal spondylosis,

spondylolysis

, or spondylolisthesis

Dislocation of more than one joint, or of one joint more than once; 3 or more 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, hernia, or uterine or rectal prolapsed

Mitral valve prolapse

Requirements for Diagnosis

2 major criteria

1 major and two minor criteria

4 minor criteria

2 minor criteria and a clearly affected

first-degree relativeSlide10

Effects of Joint Hypermobility Syndrome

Joint Hypermobility Syndrome

Joint Laxity

Musculo-tendinous

Issues

Chronic Pain

POTS

Cardiovascular Issues

Gastro-Intestinal Issues

Autonomic Nervous System Disturbances

Poor Sleep

Breathing Difficulty

Mast Cell Issues

Anxiety

Chronic FatigueSlide11

Affects on the musculoskeletal system

Due to the collagen defect, muscles and tendons have a decreased capacity to contract as effectively, have a greater chance of getting strained, and take longer to heal than normal

tissue

Increased risk of joint subluxations and dislocations

Muscles and tendons though have to work extra for sufferers of joint hypermobility due to the overall joint laxity

Muscle activation is even more important with joint hypermobility due to lack of static stabilitySlide12

Affects on the musculoskeletal system,

cont

…

Poor posture, joint irritation and muscle strains can lead to:

Neck pain / headaches

TMJ disorder

Shoulder pain

Hand/Elbow/Wrist pain

Low back pain

Pelvic floor dysfunctions

Patello

-femoral pain syndromes

Ankle / foot painSlide13

Life is a journey, and we need to adjust the tuner along the way….Slide14

Unfortunately, there’s usually more than one tuner….Slide15

Ways to tune your life

Get help- you’re not in this alone

Go to an MD or PT who understands hypermobility syndrome

Assess your posture and daily activities

Exercising

Might need to modify or change what you’re doing, but you need to keep moving

Moving correctly is key…Victor will focus on this in a little bit

Eat right!

Get more sleep

Don’t give up!!!Slide16

Benefits of Exercise

Controls weight – either gaining or losing weight

Helps with virtually every medical condition, including cardiovascular issues, arthritis, diabetes, stroke and chronic pain

Improves mood and decreases anxiety

Boosts energy

Helps with improved sleep

Can be fun!! Find an exercise that you enjoy doing!Slide17
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Pain with exercise

What kind of pain is it?

Ache or soreness can be OK

Burning, searing or sharp pain is not

When does the pain happen?

During the movement

Can you adjust to make it hurt less?

After the exercise

Vary the exercise if it continues to cause pain

Decreased reps, weight

Improved form / posture

Increased rest in betweenSlide19

Breaking the negative cycle of painSlide20

Pain Threshold

Increased activity leads to stress on joints / tissues and make joints more prone to inflammation

Staying under this threshold can help build up strength and stability in joints and help to raise thresholdSlide21

Pain Threshold

Goal is to raise the threshold in order to tolerate more activities, whether simple tasks such as sitting or more challenging tasks like biking, without causing increased pain

If you don’t do any activity, the pain threshold will lower and the negative cycle of pain will continue to worsenSlide22
Slide23

Importance of sleep

Time for body to heal itself

Vital for improved awareness and memory

Can help decrease chances of heart disease, diabetes and obesity

Decreased feelings of fatigue

Decreased anxietySlide24

JHS and Sleep

Research has shown that during the night, there are adrenaline surges as the body tries to regulate blood pressure

These adrenaline surges leads to momentary wake cycles (a lot of us don’t even realize) that disrupts your normal sleep rhythm

Can be asleep for 8 hours but still wake up feeling tired because of all the constant disruptions while sleeping

Have you gotten a sleep study performed?

Speak to your doctor about supplements to help sleep? Beta blockers?Slide25

Tips for better sleeping

Positioning

With neck issues, try not to sleep on stomach

Use of pillows

If side sleeper, try to use pillow that keeps head in a level position

Use of a body pillow to keep shoulders and hips in a neutral position

Use of a contoured pillow can help

Travel pillow on long flights / trips

Practice mindfulness before going to sleep

Make bedroom place for sleep – don’t watch TV /

Ipads

No caffeine or alcohol prior to going to sleep

Try to get on a consistent schedule and stick with itSlide26

Daily Activities / Postures

What are your normal activities that you perform on a regular basis?

Typing / Writing

Carrying a child

Cleaning / Dishes

Repetitive lifting

How do you tend to posture yourself?

Legs crossed

Knee hyperextension

Forward shoulders or head postureSlide27

Daily Activities / Postures

Low stress activities that are performed multiple times or for a significant amount of time can have same impact on tissues as a high impact activity performed seldom

Don’t disregard the small activities in your life and focus on the big things….often the small things are just as important

Patients with hypermobility tend to posture at their end ranges because that’s where they feel ‘most stable’, but these end range postures often puts even more stress on already lax joints and strained musclesSlide28

Sitting PosturesSlide29

Sitting Postures

What’s your preferred posture?Slide30

Evolution of bad postureSlide31

Role of bracing

Bracing can help support joints

If it supports joints, muscles and tendons don’t have to work as hard

Bracing can cause inactivity of muscle groups, so be aware of using it for too long

Examples of bracing:

Clavicular / scapular bracing

Wrist / thumb

bracing

SI belt

Knee / ankle bracingSlide32

POTS (Postural Orthostatic Tachycardia Syndrome)

Common in patients with hypermobility / EDS

Associated with excessive increase in heartrate upon standing

Symptoms can range from mild to severe and can affect most activities of daily living

In HJS /EDS, elasticity in blood vessels can lead to blood pooling and low blood pressure, which then causes the increased heart rate upon standing

Treatments:

increasing fluid intake to 2-3 liters per

day

increasing

salt consumption to 3,000 mg to 10,000 mg per

day

wearing

compression

stockings

raising

the head of the bed (to conserve blood

volume)

reclined

exercises such as rowing, recumbent bicycling and

swimming

a

healthy

diet

avoiding

substances and situations that worsen orthostatic

symptoms

medications

meant to improve symptomsSlide33

Mast Cell Activation Syndrome

A collection of disorders characterized by:

Accumulation of pathologic mast cells in potentially any or all organs and tissues

Aberrant release of variable subsets of mast cell mediators, leading to one or more symptoms

Has been correlated to be higher in patients with connective tissue dysfunctions

Can be a result of overreaction to environmental allergens

Can lead to multiple symptoms including skin rashes, abdominal cramping, headaches, diarrhea, and joint pain

Is some of your joint pain coming from allergens in the environment? Slide34

What to do next?

Realize that the body has a great ability to repair itself

Need to assess all the various stresses that we are putting the body through and assess which ones are the easiest to change

Look at your daily positions and postures, repeated movements and activities, and see if slight modifications can decrease stress on joints enough to decrease pain

Monitor your sleep and rest times and allow the body the chance to heal itself

Make sure your diet is balanced and you’re receiving the proper nutrients to help the body repair

Know that you’re not alone in this battle and that there are people who want to help you through this journey.