Hypermobility – Keeping It In The Box!
Hypermobility syndrome or HMS as it is sometimes known covers a large spectrum of symptoms. Hypermobility comes in many forms from someone being able to place their hands flat on the floor and hyperextending their elbows and knees with ease to a more severe presentation effecting the vascular system, digestive tract, heart valves, bladder and many other soft tissues of the body.
Many people walk around most of their lives unaware that they have this pathology as to them having excessive joint range of movement is normal and in some circumstances (as in dancing) it can be an asset. It isn’t until they start to experience muscular skeletal pain that they may seek help and are finally diagnosed, however the condition is still not fully understood and its symptoms can sometimes be dismissed by the medical profession and mismanaged.
Compared to other pathologies hypermobility is a relatively new one as far as diagnosis is concerned. Most clinicians initially use the Beighton criteria to diagnose. This test looks at the flexibility of the spine, elbows, fingers, wrist and knees to determine their range of movement. They use these measures of joint range along with levels of joint pain, recurrent subluxation, levels of fatigue, bruising etc to lead to a diagnosis of a hypermobility syndrome. HMS can be separated into two forms; joint hypermobility syndrome (JHS) or Ehlers Danlos syndrome (EDS) this terminology is often interchangeable with clinicians.
Symptoms can include:
- general joint hypermobility
- recurrent subluxation
- joint pain
- family history
- skin involvement/fragility
- arterial/ heart involvement
- intestinal problems
- congenital hip dislocation • increased spinal curvature • excessive bruising
- bladder problems
As you can see from the above list the symptoms can be vast and complex depending of the severity of the condition.
As Pilates teachers we have all had a client who never feels the end range of a stretch, presents with excessive joint range and never seem to be able to stabilise. Some of these clients are just hypermobile with no other symptoms, but others may report pain and problems with daily function. As teachers the type of muscular skeletal symptoms that we may see with a hypermobile client are:
- laxity in joints
- poor proprioception
- fatigues quickly
- subluxation – fingers, elbows, shoulders, patella
- effusion following trauma
- trigger points
When devising a safe and effective Pilates programme for these clients it is important to be aware of any of these symptoms to prevent over working or over stressing the joints as this can cause repetitive micro trauma to these type of tissues. Remembering that if this client has poor proprioception and a decreased awareness of joint position then you have to reeducate their sense of joint position by what I refer to as “keeping it in the box”! This basically means keeping the range of movement small and working where possible with a closed chain pattern to help reeducate this awareness and gain effective control of their movement patterns.
The emphasis of controlling range of movement and postural reeducation can be the key factors when devising a Pilates programme for this type of client. Of course they can also present with tightness, especially in the thorax. This area can get particularly locked up and breathing can be shallow and apical, as they may hold them selves from this region due to the general lack of stability elsewhere, In this instance breath work can be invaluable.
With a more extreme presentation of the condition the client may well fatigue quickly which could mean that a shorter session is required. Often they may not show this during the session as the fatigue could be a delayed reaction, so its alway best to start with a shorter session, then check how they where 48 hours later. Ideally seeing the clients for a couple of shorter sessions a week is best with some basic home exercises to follow through even if its just postural awareness.
Working with this type of client can be extremely rewarding as it can help manage their condition long term, but teachers do need to be aware of adapting and keeping movements basic. Remember, keep it in the box!
To learn more about how to adapt Pilates for HMS Mary will be presenting her workshop “Hypermobility: Keeping it in the box!” later this year. To find out more contact firstname.lastname@example.org.