What Is The Best Hypermobility Treatment?

What Is The Best Hypermobility Treatment?

What Is Hypermobility?

Hypermobility is the ability of your joints to move beyond their normal range of motion. This is typically a result of a connective tissue disorder due to its collagen configuration. Connective tissue is like the body’s glue, giving support and structure to organs and structures by holding them together, kind of like how tape holds things in place. There is a difference between hypermobility and flexibility which I wrote about in my previous blog.

What Causes Hypermobility?

As mentioned above, Joint Hypermobility seen in conditions such as Ehlers-Danlos syndrome (EDS), Hypermobility Spectrum Disorder (HSD), Mast Cell Activation Syndrome (MCAS), Sjogren’s Syndrome and Marfan syndrome is a connective tissue disorder. It impacts all of your joints from how your head sits on your neck to how your toes are. It can come in a spectrum of presentations going beyond joint hypermobility which is the focus of my practice and the realm of my expertise.

What Are The Symptoms Of Hypermobility?

I have written a blog on this very subject that I strongly recommend you to check out. Symptoms of hypermobility can include joint pain, stiffness, frequent dislocations or subluxations, chronic fatigue, muscle weakness, poor posture, and joint instability which can occur in all joints, particularly in the hips, knees, elbows, ribs, jaw, and shoulders.

I was interviewed to talk about hypermobility by JJ Virgin on Instagram where I talked about hypermobility, its different presentation, treatments in general, how every hypermobile patient should know about pelvic floor dysfunction, and message to healthcare providers.

How Is Hypermobility Treated?

The treatment for hypermobility typically involves a combination of strategies aimed at managing symptoms and improving joint stability. This may include physical therapy, occupational therapy, chiropractic treatment, pain management, orthotic devices, lifestyle modifications, joint-specific interventions, and education/self-management. What you should know is that whomever you see for hypermobility treatment should know and treat hypermobility. What applies to the ‘Normie’ does not apply to the Zebras!

How Can Physical Therapy Help With Hypermobility?

Physical therapy plays a crucial role in managing hypermobility by strengthening muscles, improving joint stability, and enhancing flexibility. What matters the most is that the therapist KNOWS about joint hypermobility and treats hypermobile patients and you can get hurt doing the therapy done for the non-hypermobile patients. Physical therapy modalities can be performed by a physical therapist and chiropractors whose focus in practice is functional mobility and postural training.

Can Occupational Therapy Benefit Those With Hypermobility?

Yes, occupational therapy can be beneficial for individuals with hypermobility, especially those experiencing difficulties with daily activities. Occupational therapists can provide strategies and adaptive equipment to help individuals perform activities of daily living more comfortably and efficiently. These methods can also be used by physical therapists and chiropractors who treat hypermobility with a focus on the whole body.

Can Chiropractic Care Help With Hypermobility?

Chiropractic care focuses on the diagnosis and treatment of musculoskeletal disorders, including hypermobility. Not every chiropractor is the right chiropractor for hypermobility and you should only consider upper cervical chiropractors and those treating hypermobility. With Cranio-cervical instability and the potential CSF leak, adjustment of the neck and the rest of the spine can be questionable.

What Are Some Joint Protection Techniques For Hypermobility?

In my practice the majority of my patients are hypermobile. I have found that while each person may have their default movement patterns that are dysfunctional, the best protection is to engage bigger muscle groups to make up for the lax ligaments.

It is important to understand what the tendencies are, learn what to replace them with, and avoid doing activities the wrong way. That is like needing to move your house items and learning to bubble wrap your treasured belongings instead of just putting them in a box and closing them.

At my clinic, my patients learn the basic foundations of movement and understand their bodies, their tendencies, and the how-to’s and that has been the biggest tool to avoid injuries and stay active.How Is Pain Managed In Hypermobility?

Pain management for hypermobility may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain medications to alleviate joint discomfort. Additionally, techniques such as heat therapy, ice packs, and massage can provide temporary relief from pain and stiffness. At times procedures such as Prolotherapy, PRP, and Stem Cells have also been helpful and the results vary from case to case. I refer my patients to the doctor that is local to my clinic who does these injections and is familiar with hypermobility. It is best to ask your rehab. clinician for a potential referral if it suits your issue.

Are Orthotic Devices Helpful For Hypermobility?

Most hypermobile patients have flat feet when standing up or have an already existing bunion. My goal as a rehab. clinician is to bring the function back to the movement and for that reason, I am a big fan of developmental kinesiology exercises such as Dynamic Neuromuscular Stabilization. While I am not a fan of orthotics as the only way to overcome feet issues, I do recommend hard orthotics that can be put in and taken out of shoes vs built-in orthotics in shoewear. That is because the loose ligaments of the foot bones are the reason behind flat feet when standing up and there is no way around that.

I also suggest shoes that are slightly above the ankle to protect the area and compression socks. You can find the hypermobility products that I share with my hypermobile patients on my website.

What Lifestyle Modifications Can Help Manage Hypermobility Symptoms?

Maintaining a healthy weight, practicing relaxation techniques to manage stress and anxiety, and getting an adequate amount of sleep, proper intake of electrolytes can all help manage symptoms of hypermobility and flare-ups and improve overall well-being. Learning how to get out of bed, how to sit and stand, how to open doors and load dishwashers, and how to sleep are some of the examples of what I go over with my patients to avoid or manage hypermobility flare-ups.

 

classroom full of attendees listening to a speaker

If you are hypermobile, the first step toward health is to find providers who are familiar with hypermobility. If you are not happy with your rehab. team, contact us today. We know your challenges and most likely have the solution for you.

Dr. Shakib

Recommended Reading:

The Difference Between Flexibility, Hyper-mobility & Instability

TMJ and Hypermobility

 

TMJ and Hypermobility

TMJ and Hypermobility

When it comes to hypermobility, all joints are impacted including the TMJ or Temporo-mandibular joint. Up to 75% of individuals with EDS experience TMJ symptoms, such as pain, clicking, or limited jaw movement. So often I hear people claiming their TMJ ruining their lives or their TMJ is getting worse day by day. In this blog, I will go over a brief anatomy of the TMJ, and why some clickings are painful and some are not. The common treatments and things you can do on your own to avoid pain and locking of this joint.

What Is The Anatomy Of The TMJ?

The TMJ is a complex joint connecting your jawbone to your skull. It consists of muscles, ligaments, a disc, and the bones of the jaw. TMJ is involved in the opening, closing, and side-to-side motions of the jaw and is crucial for activities like chewing, talking, and yawning. This joint is a ball and socket joint, like your shoulder and hip joints, and can dislocate or sublux. just like those joints.

Why Is My TMJ Clicking?

Clicking or popping sounds in the TMJ are common and while considered usually harmless by dentists and many clinicians, I disagree. Just because they may be not painful, does not make it harmless!!

pic of the skull with the anatomy of the TMJ

When painful it could indicate underlying issues with one reason being the displacement of the disc within the joint, causing irritation and inflammation. This disc is to follow the movement of the ball moving inside the socket but sometimes it gets pinched inside the joint, causing pain. Conditions like arthritis can cause pain which is typically caused by misalignment of the ball inside the socket and lack of proper joint movement. Remember the ‘harmless’ clicking that I disagreed with? This is why I disagree because these misalignments over time don’t necessarily cause any pain!!

What Other Anatomy Influences The Jaw?

The TMJ is heavily influenced by the neck and upper body through a network of muscles and nerves. Poor posture, such as slouching or forward head posture, can disrupt this interconnected system, leading to TMJ dysfunction and discomfort.

diagram of the neck and jaw

 

When posture is compromised, it can change the alignment of the spine, affecting the muscles and ligaments that support the head and jaw. This, in turn, can increase stress on the TMJ, contributing to pain and dysfunction.

What To Do For TMJ Treatment And Pain Avoidance

While Hypermobility Spectrum Disorder (HSD), Ehlers-Danlos Syndrome (EDS), and other connective tissue disorders are for life, there are measures you can take, and conditions you can pay attention to so your TMJ can be less painful and more under control. Following is what I remind my patients to consider preventatively and when in pain.

  • Dental Visit

Make sure to ask for small child blocks for all dental work. Lockjaw can happen at the dentist’s office when the jaw is open for too long and it locks in the open position.

Get your molars checked to make sure they are closing properly. When they don’t close on top of each other malocclusion can cause tension in the neck and your whole posture.

Not all dentists know how to check for Tongue tie so this may be a visit to an orofacial functional therapist. Some people benefit from this minor procedure and some do not see any long-term benefit.

  • Postural Improvement

Your posture plays a role in the position of your neck and your head and neck, in turn, impact the position of your jaw. Forward neck is a big player in this decline in the position so all exercises that assist in postural improvement become steps in the right direction. I only use Developmental exercises such as Dynamic Neuromuscular Stabilization or DNS.

  • Breathe Biologically

The number one step in the right direction for everything movement-related is biological breathing which is how we all breathed as infants to the first few years of life before it changes based on our injuries. Here is what biological breathing is done.

  • Jawning

Drop the head down when yawning, coughing, and sneezing. This minimizes and most likely prevents open lockjaw.

  • Food

Often when the jaw is in pain, we avoid eating solid foods but chewing is better than grinding so cut your solid food into smaller pieces and don’t eat salad so much!!

When eating, make sure you keep your mouth clothes and do not put your elbows on the table. The second part has to do with better posture of the neck and midback.

  • Tongue Exercise For Jaw

Dr. Mew is a dentist whose license was actually under review for being against orthodontics! He and his dad noticed the decline and problems caused by the practice of orthodontics and the impact it has on the face and jaw. The practice of orthodontics purely started based on cosmetics and nothing more. Dr. Mew suggests the following:

  1. Relax and close your lips.
  2. With your lips sealed and teeth in contact, lift your tongue and press it against the roof of your mouth.
  3. Repeat these steps multiple times as regularly as possible.

Chew Gum And Close Your Mouth When Eating

This will practice chewing and use the muscles of mastication, which allows better positioning of the jaw. The saying ‘if you don’t use it, you lose it’ certainly applies here.

Sitting To Standing Alert

Due to craniocervical instability, I suggest my patients with hypermobility drop their chin down and hinge their torso at the hips to sit and stand. This allows limited movement of the head over the neck which in turn takes some of the stress at the TMJ.

When it comes to hypermobility, it is so important to make sure you seek care from providers who treat patients with hypermobility because the normie treatments can often actually cause further issues. If you have hypermobility and are interested in learning not only how to avoid the pain of joint hypermobility but also how to live your life mindfully and based on your hypermobility, contact me.

Dr. Shakib

Recommended Reading:

What Are Signs Of Hypermobility?

Hypermobility And Pain Relief

 

What Are Signs Of Hypermobility?

What Are Signs Of Hypermobility?

While joint flexibility can be impressive, it is commonly confused with hypermobility. Hypermobile individuals have quite a range of motion in their joints but with a set of challenges and potential health implications. In this blog, I will cover what hypermobility is and how to recognize its presence in yourself or others.

What Are Common Signs Of Hypermobility?

Recognizing hypermobility is the first step toward understanding what to do for hypermobility treatment. FI has listed some of the common signs of hypermobility that you may recognize:

  • Joint Hyperextension

Your joints can bend beyond the normal range of motion, which most refer to as “double-jointedness, especially in the knees, elbows, fingers, and thumbs.

  • Joint Pain

Chronic joint pain, especially in large joints like the knees, hips, and shoulders, is a common symptom of hypermobility. This is most often a result of the laxity in the ligaments which is important in the stability of the joints. The fact that the Bendys’ ligaments don’t contract like the Normies, is one of the reasons why the hypermobile population typically has a weaker proprioception (knowledge of where you are in space at a given time). That is the reason why typically the ‘stop’ point of a joint in the hypermobile population is beyond what it should be, causing pain.

  • Joint Instability

Thumb being pressed showing hyperextensionHypermobility can lead to joint instability, making it easier for joints to dislocate or subluxate (partially dislocate). Again, ligament laxity and weaker proprioception play a role here. I have written a blog on hypermobility treatment that addresses this issue a bit more which I am including at the bottom of this blog.

  • Soft Skin

Most often the skin is softer because hypermobility is a connective tissue condition where the collagen makeup is different. This impacts all soft tissue including the skin. In my practice, every hypermobile patient I see has soft and sensitive skin. This means that when using sports tape, it is best to use the sensitive skin tape and remove it with an adhesive remover vs pulling it off!

  • Easy Bruising

Connective tissue includes blood vessels and because it is altered in hypermobility, it is much easier for the blood vessels to rupture and cause bruising.

  • Muscle Weakness

We typically test muscle strength by muscle testing and I know typically the claim is that muscles are weaker in the hypermobile population. I do question the lack of ‘strength’ being the muscles being weaker though. We know that the ligaments are lax so how is a muscle going to show off its strength if its connections are weak? I do see that in my practice which is fully catered to my hypermobile patients with the specific hypermobile protocols that we do, I see strength in the muscle performance. The key is to ‘frame’ the movements differently given what the hypermobile body has to offer.

  • Fatigue

The body spends quite a bit of energy trying to stabilize the joints and balance the body. With hypermobility, this most likely becomes the reason behind chronic fatigue.

  • Delayed Motor Development In Children

It seems that children with hypermobility have delays in developmental milestones such as sitting, crawling, and walking. Hypermobility is a connective tissue disorder where the collagen makeup is different. This can be from some types of Ehlers-Danlos Syndrome where the genes are identified or Hypermobility Spectrum Disorder and other types of connective tissue conditions.

  • Recurrent Joint Dislocations Or Subluxations

Frequent joint dislocations or subluxations, especially in the shoulders, knees, and fingers, are typical in hypermobile individuals. This is a common problem with a rather easy fix that requires you to be mindful of movements. We all need to understand that ‘bubble-wrapping’ our treasured belongings when moving is a smart thing to do regardless of hypermobility.

  • Joint Clicking Or Popping

Noisy joints, such as clicking or popping sounds, can occur due to joint laxity. I don’t worry about the clicking or popping since the noise is simply the release of nitrogen, oxygen, and carbon dioxide from the joint fluid. If the clicking and popping has pain, then we should look into it.

  • Flat Feet Or High Arches

Hypermobility affects all joints including the feet and its many little bones. In most cases, I see flat feet happen when standing; that is when the ligaments connecting the little bones relax and the arch collapses. In cases of high arches, I see over-compensation when walking and I only see high arches when standing to avoid pain.

  • Gastrointestinal Issues

You may experience GI symptoms such as irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD). The motility issue is from dysautonomia and also from the laxity of connective tissue. It can also be from the weak postural stabilizers and pelvic floor dysfunction. I have written blogs on hypermobility and pelvic floor dysfunction that I will include below.

  • Cardiovascular Symptoms

Mitral valve prolapse or aortic root dilatation is common especially a specific subtype of a hypermobility condition called cEDS. It is good to have a good heart health lifestyle in general anyway! Just because there is an increased chance does not mean that you are doomed so live life the right way, the preventative way- and get checked regularly depending on where you are at with your heart health.

What Are Less Common Signs Of Hypermobility?

The following list of less common signs of hypermobility will still allow you to recognize hypermobility so you can better understand the why behind your symptoms and ‘bubble wrap’ your movement safer and better while addressing the non-joint related symptoms with a clinician and health care provider who understands hypermobility.

  • Autonomic Dysfunction

In my practice, I see many patients with different levels of dysautonomia, which is a dysfunction of the autonomic nervous system. This is part of your nervous system in charge of things in your body that you don’t have much control over, like digestive movements, blood vessel constriction/dilation, and heart beat. Symptoms of dysautonomia can include POTS which can be feeling dizzy when getting up to even fainting, lightheadedness, palpitations, and temperature dysregulation.

Managing stress plays a big role in the intensity and frequency of the presentations here so taking the right electrolytes makes a difference. You can take a look at my favorite products on my website.

  • Chronic Pain Syndromes

While joint pain is common in hypermobility, some individuals may also experience widespread chronic pain conditions such as fibromyalgia or complex regional pain syndrome (CRPS). In my practice, I have seen a few CRPS patients who were not hypermobile and I have never seen a hypermobile person with CRPS. Fibromyalgia is a whole different blog and what my view on that is!

  • Temporomandibular Joint (TMJ) Dysfunction

Hypermobility impacts all joints including the temporomandibular joint or TMJ. This in part is related to cranio-cervical instability, and neck and breathing issues that exist. I see plenty of patients with TMJ issues who are not hypermobile and while Craniocervical instability is rather unique to connective tissue disorders, instability of the head over the neck is seen in plenty of non-hypermobile patients.

  • Neurological Symptoms

Your nerves are soft tissue that does not like to be compressed or stretched. They are capable of both but don’t like them over a long time or to the extreme. Because hypermobility is a connective tissue disorder, and the joints, muscles, and all tissues including the internal organs are more ‘loose’, they can put pressure (from let’s say muscles lagging and buckling over the nerve passing through) or overly stretch because the joints are loose. Other presentations end up putting undue stress on the nerves causing issues with pain and nerve symptoms.

  • Psychological Symptoms

Chronic pain and physical limitations associated with hypermobility can contribute to psychological symptoms such as anxiety, depression, or mood disorders. This can also be another presentation of dysautonomia.

  • Dental Issues

Some hypermobile individuals have thin enamel over their teeth which makes them get dental cavities more often. Many are also mouth breathers which dries up their saliva which protects our teeth. Because hypermobility is a connective tissue disorder and our gums are connective tissue, it is easy to see the gums receding causing issues with oral health.

  • Vision Problems

Certain eye conditions, such as myopia (nearsightedness), astigmatism, or retinal detachment, because our eyes are also connective tissue.

  • Skin Disorders

While soft skin is a common sign of hypermobility, stretch marks and scar tissue are seen in some hypermobile individuals.

  • Endocrine Dysfunction

There seems to be a relationship between hypermobility, adrenal insufficiency, and thyroid dysfunction. Is it because autoimmunity is common among the hypermobile population and the common type of autoimmunity is Hashimotos? Adrenal glands are in charge of fight or flight and stress management so it seems to not be surprising that it is commonly seen among the hypermobile population.

The correlation between the two seems to exist but how they are related is still not clear. Perhaps when we understand why ADHD exists and what causes it, we can connect the dots here!

If you have hypermobility, it is so important to make sure you see clinicians and health care providers who know and treat hypermobility. For instance in my world which is physical medicine, my treatment for the Bendy population is very much customized to the group; while I see mostly hypermobile patients, I know how to avoid injuries while trying to treat the painful joints and weak posture. The agenda has to go beyond pain to prevent injuries which has its unique protocol.

If you are hypermobile or think you may be hypermobile, contact me and if you are in another state or country, contact me here for telehealth coaching related to your joint instability, postural imbalance, and pelvic floor dysfunction stemming from that.

Dr. Shakib

Recommended Reading:

Hypermobility And Pain Relief

Pelvic Floor Dysfunction In The HyperMobile Population