Collagen is an extremely important connective tissue protein in our bodies, making up significant amounts of our skin, tendons, discs and ligaments. Collagen gives structure to these organs, allowing them to heal normally, to have elasticity, to be strong and to hold together well under the stresses of functional life. It also gives our major blood vessels and other organs the strength they need to remain working correctly. People vary very greatly in the suppleness of their joints and skin and show the whole range from very stiff jointed to very mobile 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.
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.
Patient education for sufferers from benign joint hypermobility syndrome is vital if they are to learn to manage the condition through their lives. The joints will not tolerate significant strains and stresses so end range posture should be avoided as this strains the ligaments and can give pain. Repeated lifting of heavy objects is also likely to be unhelpful. Arthritic patients practice joint protection to manage their condition and this is also important for hypermobile patients, so dislocating a shoulder at a party for fun or getting into extreme positions should be avoided. Strong joint stretching may be unwise as in yoga as may activities with a high risk of joint, tissue or skin damage.
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.
Hypermobile patients complain commonly of neck, thoracic and lumbar pain, perhaps related to the difficulties keeping spinal stability and the correct muscle balances around the spine. Manipulation is likely to be unhelpful although mobilization techniques, general exercises, strengthening stability muscles and concentrating on core stability are all useful approaches. Gentle weight training can elevate muscle tone to allow the joints to be maintained in a mid range position during movement, avoiding too much play. Knee hyperextension is common and can lead to osteoarthritis, leading physiotherapists to work at the balancing muscles, the hamstrings, to counteract this. Patients often have a few areas of the body which need constant training for best muscle balance and control.
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.
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.
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.
Patient education for sufferers from benign joint hypermobility syndrome is vital if they are to learn to manage the condition through their lives. The joints will not tolerate significant strains and stresses so end range posture should be avoided as this strains the ligaments and can give pain. Repeated lifting of heavy objects is also likely to be unhelpful. Arthritic patients practice joint protection to manage their condition and this is also important for hypermobile patients, so dislocating a shoulder at a party for fun or getting into extreme positions should be avoided. Strong joint stretching may be unwise as in yoga as may activities with a high risk of joint, tissue or skin damage.
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.
Hypermobile patients complain commonly of neck, thoracic and lumbar pain, perhaps related to the difficulties keeping spinal stability and the correct muscle balances around the spine. Manipulation is likely to be unhelpful although mobilization techniques, general exercises, strengthening stability muscles and concentrating on core stability are all useful approaches. Gentle weight training can elevate muscle tone to allow the joints to be maintained in a mid range position during movement, avoiding too much play. Knee hyperextension is common and can lead to osteoarthritis, leading physiotherapists to work at the balancing muscles, the hamstrings, to counteract this. Patients often have a few areas of the body which need constant training for best muscle balance and control.
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.
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy 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 Manchester.
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