Who Diagnoses Hypermobility?

Who Diagnoses Hypermobility?

Hypermobility syndrome is excessive joint flexibility causing joint pain, instability, and other related symptoms and proper diagnosis is important for proper management and treatment. In this blog, I will explore who can diagnose hypermobility syndrome, the criteria used to identify hypermobility, and why an accurate diagnosis is essential for effective treatment.

Who Can Diagnose Hypermobility Syndrome?

Typically, by the time you have reached the potential for hypermobility diagnosis, you have seen a wide range of providers with most of them gaslighting you, making you wonder if it is all in your head! Hypermobility does not just impact your joints so it is common to see specialists such as rheumatologists, cardiologists, neurologists, orthopedists, primary care physicians, physical therapists, chiropractors, acupuncturists, and massage therapists.

hand holding a pen writing on a paper on a clipboard

When seeking a diagnosis for hypermobility syndrome, individuals have several healthcare professionals to consider. While rheumatologists, orthopedic surgeons, and physiotherapists are commonly associated with diagnosing hypermobility, chiropractors also play a significant role in identifying and managing this condition. Chiropractors are trained to assess musculoskeletal issues, including joint hypermobility, and can provide valuable insights and treatment options.

Believe it or not,  joint hypermobility, is not something that is taught in schools and typically when it comes to seeking healthcare providers, those who are familiar with this condition have taken the initiative to learn about it themselves.

What Are The Criteria For Identifying Hypermobility?

One of the key criteria used to identify hypermobility is the Beighton score. This scoring system measures joint flexibility by assessing specific movements in various parts of the body. While the Beighton score is widely used, it’s not the only method for diagnosing hypermobility syndrome. When it comes to the rehab. clinicians, physical therapists, and Chiropractors who treat joint hypermobility may consider factors such as medical history, symptoms, and additional clinical examinations when making a diagnosis.

Hypermobility is a connective tissue condition and can be seen in people with Ehlers-Danlos Syndrome (EDS), Hypermobility Spectrum Disorder (HSD), Mast Cell Activation Syndrome (MCAS), and Marfan Syndrome. The physical therapists and chiropractors who treat patients with hypermobility are familiar with the different presentations that the population may present with and during the history intake, and from pattern recognition, can easily identify hypermobility.

In my practice, once I suspect EDS, knowing that there are subtypes of EDS that do not have an identified gene associated with them, I advise the patient to receive genetic counseling and subsequent testing. However, just because there may be no identified genes found does not mean that the patient is not hypermobile.

Is The Beighton Score The Same As Other Criteria?

While the Beighton score is commonly used to assess joint hypermobility, healthcare professionals may use alternative criteria or additional assessments based on their clinical judgment and expertise. Ultimately, the goal is to obtain a comprehensive understanding of the individual’s condition to guide appropriate treatment.

How Can You Vet For The Right Provider?

When seeking a healthcare provider for the diagnosis of hypermobility syndrome, it’s essential to vet for qualifications, experience, and expertise. Look for providers who have specific training or experience in musculoskeletal conditions, including hypermobility syndrome. There are resources such as EDS Society that are a good resource to start your search.

Why Is Diagnosis Important In Treatment?

A timely and accurate diagnosis of hypermobility syndrome is crucial for effective treatment and management. When it comes to joint hypermobility, the treatment rendered to the non-hypermobile population can cause pain and injury to the Bendy population. It is very important and I can’t emphasize enough, to seek care from the providers who understand hypermobility and this goes for the joint issues as well as non-joint complaints.
If you think you are hypermobile and want to know what your next option is, contact me.
Dr. Shakib

Recommended Reading:

What Is The Best Hypermobility Treatment?

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

 

How Do I Know If I Am Hypermobile?

How Do I Know If I Am Hypermobile?

Hypermobility is a connective tissue disorder which is inherited from either or both parents. While Ehlers Danlos Syndrome (EDS), is considered a rare condition, in real practice, I see plenty of people who have EDS or Hypermobility Spectrum Disorder (HSD) and Joint Hypermobility. I am convinced the bendy population has been under diagnosed and disbelieved for a LONG time! While they have found the genes causing EDS, the research for the gene identification still continues on HSD and Mast Cell Activation Syndrome (MCAS).

Historically, it seems that most of them had an rather spot lighted life as a gymnast, dancer, ballerina, cheer, acrobatics and activities where their bendy joints put them ahead of the rest of the crowd. This of course came with several injuries and accidents from the early ages. 

Unfortunately, joint hypermobility is one of the many presentations that the bendy population has. The connective tissue disorder does not just impact the joints but the blood vessels, internal organs and all ligaments and soft tissue. That means the function of the whole body can change ranging from digestion to mood, skin to vision!

What are the signs of hypermobility?

Here are some of the common signs of hypermobility:

Joint flexibility beyond the norm:

You are able to bend your fingers, elbows, shoulders, hips, knees and ankles beyond what others can do. That is because your ligaments can stretch way more than others. This means that it is much easier for you to sublux (step before dislocation) your joints doing just the normal things. Of course, as stated above, there is a spectrum of presentations but joint subluxation is not uncommon by any means!

Joint pain and instability:

The bendy population is too familiar with chronic joint pain, especially in the knees, hips, and shoulders. The joints may also feel unstable, leading to a higher risk of sprains and dislocations. Many times, as children, the hypermobile person remembers not doing well with running and feeling pain in the knees, ankles and feet; this is when adults don’t understand what is going on and the child gets different labels.

Frequent injuries:

With joint instability comes frequent injuries. If you notice that you seem to get injured easily, especially during physical activities, it could be a sign of hypermobility. With frequent injuries, the person tries to avoid many activities or recovers from injury slower and this becomes another opportunity for labeling!

Soft or stretchy skin:

Hypermobility is a connective tissue disorder that of course impacts the skin. Some individuals with hypermobility may have soft, stretchy skin that can be pulled away from the body more than usual. This is often seen in conditions like Ehlers-Danlos syndrome.

Chronic fatigue and muscle pain:

Hypermobility is not just about joints; it can also impact the surrounding muscles. Chronic fatigue and muscle pain are common complaints among hypermobile individuals. The body may have to work harder to stabilize joints, leading to muscle overuse and discomfort.

Can I check myself to see if I am Hypermobile?

You can use Beighton score to see if you are hypermobile. That is what is used to determine joint hypermobility in EDS but it is the same findings regardless of it you have the EDS genes or not!

Beighton score involves thumbs, little fingers, elbows, and knees. Score 4 or more out of 9, and you might just be a hypermobile but here is the deal: Take a picture of yourself each time so this is the last time you show what you can do!! If you are asked to show, just pull out the pics and show what you can!

Thumb-to-Wrist Test:

Bend your wrist forward and try to bring your thumb to your forearm, do it on both sides (each side gets 1 point)

Pinky Extension:

Try to extend your little finger back and see if it goes to 90 degree or more; do on both sides and give each side 1 point if you can

Elbow Extension:

Extend your arms and see if your elbows go beyond a straight line so much that they stick up toward the ceiling; give 1 point to each elbow if you can do this.

Knee Extension:

Can your knees extend beyond a straight line so they bow out the other way? Does that happen on both sides? If so, add another 2 points.

Flex Forward:

Can you reach forward, touch the ground and have the palm of your hands flat on the floor? If so, this one gets 1 point

What should you do if you are hypermobile?

Joint hypermobile groups on FB and consult the EDS Society Professional Provider List. This is where you will find those providers who treat hypermobile patients. I have taken the mission to interview the providers who are in California and have my opinion as to how seasoned they are in treating the bendy population. Make sure you call their office and ask your questions which should start with if they treat people with EDS or HSD and what percent of the practice is that population.

Rehab clinicians such as Chiropractors, Occupational Therapists and Physical Therapists, can range from doing just adjustments, at home-activities and physical therapy of the joint in pain to someone like myself who is a chiropractor that focuses on the whole body stabilization and functional movement and does lifestyle modification to avoid circumstances that put my patients in an injury-potential zone. I do postural neurology, neuro-kinesiology, pelvic floor dysfunction and some gentle spinal manipulation and treat primarily the EDS, HSD and Joint Hypermobility crowd. Not every chiropractor does that and frankly in the world of physical therapy where most EDS and HSD patients consider, the normie methods actually do you arm.

Remember

You maybe thinking why me, why is it so hard to do x,y,z and go down the ‘wrong’ neighborhood of thinking. What I suggest you do is to look at moving. When we move locations, we box our belongings; some go in a box with hardly any care and others go with the items bubble wrapped, marked and handled with care. When done right, the one that is wrapped carefully always makes it safe and the ones that are not, can actually get damaged more.

Just because you have joint hypermobility does not mean you are doomed! If you learn how to move (which is the same for the normies too), when you know how some activities are simply not good ones to have, you are actually being safe and smart.

If you have joint hypermobility, please make sure you only see rehab. clinicians that treat EDS, HSD amd hypermobility patients. ***Contact me***** This needs to be adjusted to the new contact page****** because I know I can help.

Dr. Shakib