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.
Physiotherapists manage the multiple joint and pain problems which hypermobility patients present with. Acute injury is more likely to occur with less trauma and more easily if the person undertakes vigorous exercise of any kind. Shoulder problems are particularly common in hypermobiles as the shoulder is a naturally mobile and unstable joint in normal situations let alone when the ligaments are unusually lax. Keeping the large ball of the arm bone centred on the small socket is a challenge to the muscular control and abnormal muscle patterning is common. Patients may habitually dislocate dislocate on movements, perpetuating the pain problem.
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.
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. - 16004
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.
Physiotherapists manage the multiple joint and pain problems which hypermobility patients present with. Acute injury is more likely to occur with less trauma and more easily if the person undertakes vigorous exercise of any kind. Shoulder problems are particularly common in hypermobiles as the shoulder is a naturally mobile and unstable joint in normal situations let alone when the ligaments are unusually lax. Keeping the large ball of the arm bone centred on the small socket is a challenge to the muscular control and abnormal muscle patterning is common. Patients may habitually dislocate dislocate on movements, perpetuating the pain problem.
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.
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. - 16004
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.
