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

 

HyperMobility, Pelvic Floor, and Pelvic Pain

HyperMobility, Pelvic Floor, and Pelvic Pain

Hypermobility, hypermobile joint syndrome, EDS, HSD, MCAS, and hEDS are terms that are used interchangeably, all being connective tissue disorders. While the connective tissue is targeted with these conditions, other symptoms and signs are commonly seen such as:

  • POTS
  • Cranio-cervical instability (CSI)
  • Headaches
  • Chiari malformation
  • Digestive issues
  • Increased heartbeat
  • Anxiety
  • Pelvic instability
  • Wrist and ankle pain
  • Hip, elbow, and knee pain
  • Unexplained swelling of feet and hands
  • Clumsiness
  • Some sort of daily pain and/or bendy-ness in joints

In my practice, I see many patients with pelvic floor dysfunction and hyper-mobility who have no idea they have it hypermobility. They have suffered and been gaslit throughout their life by other doctors, health care providers, and family members. This blog looks into the correlation between the pelvic floor, hypermobility, and pelvic pain.

How Are Connective Tissue and The Pelvis Related?

The pelvis is the base of your spine and torso, and its stability directly impacts how you maintain your balance and movement. It is the ‘house’ that the pelvic floor is the ‘floor’ of and holds important organs such as the uterus, ovaries, prostate, intestine, and bladder. The 3 pieces of the pelvis are connected to each other, the spine, and hips with ligaments and tendons. Any laxity of those connective tissues leads to instability of these structures to say the least.

Unstable joints, when used, become painful to the point that sometimes breathing can cause pain. Breathing, by the way, impacts the pelvis (positively when done right and negatively when done wrong). The connective tissue connecting different parts of the pelvis to the tailbone can be involved in causing pelvic pain with walking, sitting, standing, and at rest.

With the laxity of the connective tissue, other soft tissue takes on the roles that are beyond their ‘workload’. This then can lead to tension in muscles that the hypermobile person experiences while they appear ‘normal’ to an untrained clinician. It is of utmost importance for the bendy population to seek care and advice only from clinicians who have treated hypermobility vs learning about it from a text book.

Does Posture Play A Role In Pelvic Pain & HyperMobility?

With hypermobility and its associated pelvic floor dysfunction, instability shows as flexibility. Joints sublux often which means they go beyond where they need to stop. That is like stopping in the middle of an intersection vs at the crosswalk. When it comes to pelvis instability, this means pain in the lower back, hip pain, labral tear, compressed soft tissue, clicking when moving, and forward or backward pelvic tilt.

Hyperextension of the knees, a common finding with hypermobility, pushes the top of the thigh bone toward the front of the hip socket causing pain in the hip joints. The integrity of movement and joint functionality of the hips directly impact the pelvis, what it holds inside, and what supports its stability. You cannot have a strong pelvic floor if the ‘house’ is unstable.

What Is The Holistic Treatment For Pelvic Floor Dysfunction And Pelvic Pain?

Hypermobility is a condition that you are born with and managing different ‘chapters’ of that ‘book’ is something that you should invest your time in. When it comes to postural instability impacting the pelvis, pelvic pain, and pelvic floor dysfunction, here are my recommendations to my patients:

  • Breathing

Learning proper biological breathing techniques is underestimated and undervalued and yet, it should be the focus of every musculoskeletal condition. This breathing is what we all did as babies and is not a version of breathing but is the core breathing that we know from studying babies. Place your hands on the side of your rib cage and as you breathe through your nose, push your sides outward. Not as easy as it sounds but certainly something you will be able to do easily with practice.

 

  • Postural Neurology

This is how we can see what the blueprint of your movement looks like and then present you with exercises that strengthen what seems to be weak from the assessment. To learn more about postural neurology, visit my website on functional mobility.

  • Functional Mobility Exercises

That means rehabilitating what is weak and tight with movement exercises. The question is which ones? To isolate an area to work it out is a mistake IMO. Your body works as one unit and working out an area in isolation is not going to solve the problem. With that said, I am a huge fan of developmental exercises such as Dynamic Neuromuscular Stabilization. If a helpless infant can become a running toddler without going to a gym and if we all have gone through that process, then common sense tells me that those are the right exercises to do and my brain and body are already familiar with them. Why reinvent the wheel?

  • Lifestyle Changes

Your lifestyle directly impacts your body and the wrong choices in a hypermobile person can make a much more negative impact. This goes from nutrition to workspace, to sleeping styles, and exercises. I strongly suggest you visit my blog on lifestyle.

  • Supportive Garments

In some cases, individuals with hypermobility may benefit from wearing support garments like high-top shoes and garter belts that go higher up to the belly button. Also things like rolling a towel or small blanket at the bottom of their feet on the bed to limit ankle extension.

Hypermobility is not a life sentence and learning how to manage it brings great comfort to your day. You can visit the EDS website for the list of providers familiar with the bendy population. If you have pelvic floor dysfunction and are hypermobile, I strongly encourage you to contact me.

Dr. Shakib

How To Prevent Ankle Injuries If You Have Hypermobility

How To Prevent Ankle Injuries If You Have Hypermobility

Hypermobility, EDS, and HSD are all conditions that can result in ankle hyper-mobility. Hypermobility in any joint means an increased risk of injury due to excess movement in the joint. In the ankles this can look like repetitively rolling your ankles, dislocating your ankle, or just ankle pain and aching in general. If you want to learn how to treat ankle hypermobility and what you can do to stabilize your ankles then this blog is for you!

What Causes Ankle Hypermobility 

Hyper-mobility can be associated with a range of conditions such as:

  • Ehlers-Danlos Syndrome
  • Hypermobility Spectrum Disorder
  • Mast Cell Activation Syndrome

For a more in-depth look at what can cause ankle hyper-mobility I suggest you read my blog, “ Treatment options for Ankle Pain from Hypermobility”.

Hypermobile Ankle Injuries

Hypermobile does not mean flexible, it actually means unstable. When it comes to the ankle joints instability can result in ankle injuries doing something as simple as walking. These injuries include:

  • Sprain
  • Strain
  • Fracture
  • Stress Fracture

Because a hype- mobile ankle can go beyond a normal range of motion there is more room for error when you trip, roll your ankle, or miss a step. This is why it’s important for someone with hyper-mobile ankles to provide extra stability to their ankles. Now, before you go buy a pricey ankle brace you may want to keep reading. 

Best Exercises for Ankle Stability and Injury Prevention 

The best way to strengthen your ankle and increase stability is with functional movement exercises. Exercises where you have a band around your foot and pull against it are not going to do anything for your stability in movement like walking, hiking, or working out which is where you need it the most! 

The most important thing to keep in mind when picking and choosing which ankle-strengthening exercises are best for you and which are simply not worth your time is that your feet should be connected to the floor! Anything else is not going to address how your ankle stabilizes when you’re on your feet. Here are some ankle stability exercises we use with our patients which can range from beginner to advanced. 

  • Single-Leg Stand 

This exercise is the perfect beginner exercise! If you have hypermobile ankles then your balance is certainly impacted! After all, our feet are our connection to  the ground, so if the connection is faulty, then all the structures above will be impacted. It would be like building a house on an unstable surface.

Now we are not just balancing for the sake of balancing, but to functionally stand on one leg requires a neutral spine, biological breathing, and keeping the heel, ball of the foot, and all toes on the floor. Watch the video below to learn how. 

  • Standing Ankle Hinge (ankle mobility) 

Ankle mobility is important, even for someone who is hyper-mobile! Note that mobility exercises are not the same as stretching! The point of stretching is to increase range of motion, but with a hyper-mobile person, we already have an excess range of motion! Instead, mobility exercises work on the strength and integrity of a joint through a range of motion. Which is exactly what is practiced in the exercise below.

For this ankle hinge exercise, you are controlling the amount of dorsi flexion and plantar flexion that occurs while the whole body is working to stabilize you. Focus on keeping your toes connected to the ground and not letting the arch of your foot collapse for the best results. 

  • Runners Bear 

What I have found to be the most effective form of functional exercise to improve stability in a hyper-mobile person is Dynamic Neuromuscular Stabilization (DNS). DNS is a type of rehabilitative exercise that follows the path that every baby goes through to go from a helpless infant to a running toddler. 

The exercise shown in the video below is a variation of the 11-month baby move, Bear, to include ankle stability and foot activation. 

Are Ankle Braces Good for Hypermobility 

The simple answer is, no! Putting an ankle brace on a hyper-mobile ankle is like putting a bandaid on a wound that needs stitches! Now with that said, if you are playing sports, that ankle brace may give you a bit more resistance before the joint has gone beyond its ‘stopping’ point.

If you’re a very active person with hypermobility, during the non-practice or game times, I prefer taping vs bracing in conjunction with the stabilizing exercises. We are not talking about immobilizing the joint but more of a kinesiology tape that has a stretch to it. My go-to is RockTape because they seem to last longer and not come off the body as fast. This kind of taping stimulates the sensory input to the brain for better stabilization and proprioception.

Where To Start If You Are Hyper-Mobile?

Hyper-mobility (EDS, HSD, MCAS) is not a death sentence and you are not doomed to just deal with pain. Do know that there are many steps you can take to start decreasing symptoms and you are not alone. It is best to seek care from clinicians that are familiar with hypermobility and treating patients with hyper-mobility. Search for hyper-mobile doctors and clinicians near you and interview them. Treating hypermobile bodies is not the same as the rest of the population and a clinician being in practice for even a long-time does not qualify them to know how to treat a hypermobile person. If you are hyper-mobile and are ready to provide your body with the stability it needs, contact me and ask whom I refer my hypermobile patients to for their health needs.

Dr Shakib

What Are The Treatment Options for Ankle Pain Caused by Hypermobility?

What Are The Treatment Options for Ankle Pain Caused by Hypermobility?

Hypermobility is an excessive range of motion in joints. It is different from being flexibile and can cause discomfort, injury, and pain in the affected joints, including the ankle. Ankle pain is a common complaint amongst hypermobile individuals and the instability leads to falls and further injuries. In this blog, we will explore the causes, symptoms, treatment, and best exercises for hypermobility and ankle pain.

What Causes Hypermobility In The Ankles?

Hypermobility can be caused by a genetic predisposition or an underlying medical condition such as Ehlers-Danlos Syndrome(EDS). In cases of EDS or Hypermobile Spectrum Disorders (HDS), excess activation of mast cells cause looseness of the ligaments. This looseness results in joint instability.

Now, certain activities that require repetitive ankle movements in extreme ranges, such as ballet, gymnastics, dance, and cheer certainly feed the problem. These activities over-encourage the ligaments to be pushed to the extreme. This causes injuries that linger for a long time if not, a lifetime.

Whether you have EDS or another hypermobile condition, instability in the feet and ankles is something that should be addressed sooner rather than later. Our feet and ankles are our base and are what connect us to the ground. If that connection is unstable then everything above is going to be impacted.

Symptoms Of Hypermobility In Ankles

Symptoms of hypermobility include joint pain, fatigue, and frequent dislocations which can vary from person to person. Depending on the severity of the hypermobility and the joints affected symptoms may vary. In the case of ankle hypermobility, some of the common symptoms include:

  • Ankle pain
  • Swelling
  • Instability
  • Foot pain
  • Repetitive rolling of the ankle and
  • Feeling of the ankle giving way or buckling

As mentioned above, issues in the feet and ankles impact the structures above which can also result in overall poor posture, dysfunctional movement, knee issues, hip pain, lower back problems, and more.

Treatment Options for Hypermobile Ankles

The best treatment for hypermobility and ankle pain must focus on stabilizing the ankle joint and strengthening the deep muscles of the feet. And that’s not accomplished with ankle braces! Also, in treatment, it is important to not disregard the structures above the ankles but should include functional movement of the whole body.

Let’s talk about braces here! No brace is going to provide support to fix a problem. The only brace that provides value, in my opinion, is worn in bed to support the degree of extension at the foot and ankle which is accentuated by the weight of the blanket over the feet while sleeping. This brace simply limits how far extended and outwardly rotated the foot can get both movements being excess in hypermobile persons.

Now, regardless of the physical rehabilitation provider (Chiropractor or physical therapist) the following needs to happen when it comes to the treatment of hypermobile ankles and feet:

  1. Functional Movement such as Dynamic Neuromuscular Stabilization (DNS). This is movement according to the natural design and addresses the ankles, not in isolation, but in full body movements. Remember, the feet and ankles serve as the base for the rest of the body and are not an isolated issue.
  2. Postural Neurology: The brain controls every function in the body! With lack of function, certain parts of the brain, in regards to movement and posture can actually shrink. The good news is we can activate weak parts of the brain with specific exercises including proprioception, balance, and stability.
  3. Biological Breathing: Would you believe that almost every patient that walks into my office is not breathing correctly? This dysfunction directly affects movement and posture resulting in compensatory patterns and negatively impacting stabilization.

Exercises for Ankle Hypermobility

The best exercises for ankle hypermobility are those that include how the ankle functions with the rest of the body, not just in isolation. Here are some specific exercises that may help:

Ankle Hinge:

 Single-Leg Stand:

This is exactly what it sounds like! You practice standing on one leg at a time focusing on the whole foot and toes being engaged into the floor. The entire spine must be neutral and done with proper breathing. This is going to work on your balance and ankle stability while the rest of the body plays its part. This is a great exercise to work into your daily routine with an activity like brushing your teeth.

Bear Advanced Ankle Stability:

What To Do If You Have Hypermobility and Ankle Pain

If you know you are hyper-mobile, or suspect this, and want to find pain relief, full body stabilization, and postural correction all in one office, contact me.  Remember, you don’t have to be in pain to address the problem now.

Dr. Shakib

Hypermobility and Pelvic Wellness

Hypermobility and Pelvic Wellness

Pelvic health requires a balance in the pelvis, the house that the pelvic floor is the ‘floor’ of and hypermobility is more about instability vs flexibility. Hypermobility and pelvic health, therefore, are intimately related and important subjects to explore in this blog.  In this blog post, we’ll explore the relationship between hypermobility and pelvic wellness and provide tips for managing both conditions.

Hypermobility vs Instability

Hypermobility is a condition that affects the connective tissues in the body, causing them to be more flexible than normal. This can result in joints that move beyond their normal range of motion, leading to pain, inflammation, and instability. Hypermobility can be genetic or acquired, and is more common in women than men.

Hypermobility when at a younger age in elementary through even early 20s seems to be the advantage when doing gymnastics, cheer, acrobatics, and dance. This is always exciting and encouraging to participate in the activities that make you ‘shine’; however, the overuse of already unstable body parts over time will catch up later on mostly in the 30s and beyond.

One of the areas that can be most affected by hypermobility is the pelvic region. The pelvic floor is made up of muscles, ligaments, and tissues that support the bladder, uterus, and other organs. Of course, there is more to the dysfunction in the pelvis than just the internal organs. You can read all about what pelvic floor dysfunction can look like in my blog.

The Subtle Symptoms of Pelvic Floor Dysfunction?

Pelvic floor dysfunction can cause a range of symptoms, including incontinence, pain during sex, and chronic pelvic pain. Individuals with hypermobility may be more susceptible to developing pelvic floor dysfunction because the connective tissues in their body are less able to provide the necessary support. Here are the subtle signs of pelvic floor dysfunction that are most often missed and considered their own separate issues! You can learn more about this in my blog: ‘ Pelvic Floor Dysfunction Symptoms’.

  • “Lower back pain
  • Pain in the back joints of the pelvis (SI Joints)
  • Pain in the front pubic area
  • Arched lower back
  • Slouched lower back
  • Slouched mid-back or hunchback
  • Military posture with the chest pushed out
  • A V-stance where the torso is positioned behind the hip joints on the side view
  • Chronic forward neck
  • Inability to bend down below the knees
  • Habitually standing on one leg with the other leg bent
  • Chronic one-sided pain in the lower extremity
  • Hip pain on one or both sides”

Tips To Manage Hypermobility & Pelvic Wellness

  1. Exercise regularly but your exercises need to be low-impact and specific. I find Dynamic Neuromuscular Stabilization (DNS),  baby exercises, to be the most effective type of exercise. So much so that it has become the source of attraction among hypermobile and EDS individuals in my region.
  2. Practice good posture: Good posture helps reduce the strain on your joints and pelvic floor muscles which is easier said than done. I use Postural Neurology to work on the brain because if the brain gives the command to move and hold your posture a certain way, your body will follow. This is why gadgets and tools claiming to help you with your posture do NOT work! UNLESS they work on changing the map of movement (Homunculus) and posture in your brain the effects won’t last.
  3. Use proper lifting techniques: When lifting heavy objects, make sure to use proper technique to avoid putting unnecessary strain on your joints and pelvic floor. I strongly suggest you follow me on IG and subscribe to my YouTube channel for the specifics of movement.
  4. Maintain a healthy weight: Being overweight can put additional strain on the joints and pelvic floor muscles. This increases the risk of both hypermobility and pelvic floor dysfunction. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.
  5. Consider pelvic floor therapy: Not all physical therapists and chiropractors are trained in pelvic floor dysfunction and not every pelvic floor therapy treatment involves internal manual treatment. In my practice, I first start stabilizing the pelvis, the house that the pelvic floor is the floor of, BEFORE anything else. No sense in working on anything else when the whole house is shaky and unstable.
  6. Be mindful of your activities: if playing sports, take it easy during ovulation and/or menstruation when the level of relaxed soft tissue goes even higher.
  7. Hypermobile toes and ankles

    Hypermobility and Pelvic Floor Dysfunction

    Wear DuoJoint, a brace I have designed for hypermobile ankles to be worn at night to address the over-extension of the ankles and feet at night. This is important because your feet are the points of contact with the ground and without stable feet and ankles, everything above is unstable. DuoJoint at the time of writing this blog is not available but search for it online to see where you can purchase it now.

  8. Manage stress: Stress can contribute to both hypermobility and pelvic floor dysfunction. Finding ways to manage stress, such as meditation, yoga, or therapy, can help improve overall well-being and reduce the risk of these conditions.

Dr. Shakib