Hypermobility Part 2

 

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In part one of ‘Hypermobility’ we looked at what is Hypermobility Syndrome and some general ways to potentially identify hypermobiltiy issues.

Management of Hypermobilty Syndrome include various modalities – general advice, reassurance, passive mobilisations, exercise to improve posture, muscle balance and endurance, joint stabilisation, proprioception and joint awareness, rehabilitation, lifestyle modifications and chronic pain management are the mainstay of treatment. Good muscle tone, particularly the deep postural muscles, help protect against injury and improve joint stability.



PRIMARY TRAINING

  1. COGNITIVE STAGE. Gaining a high awareness of finding lumbar spine neutral and training the deep postural muscles. Start supine to train independence of the pelvis and lower spine from the thoracic spine without global muscle substitution. As soon as possible move to crawling, standing etc.
  2. TRAIN BREATHING. Lateral costal and diaghragmatic breathing, maintaining lumbar spine neutral.
  3. Train middle and lower fibres of TVA and the PELVIC FLOOR. Drawing in the abdomen “up and in” without any global substitution. As soon as possible train in weight-bearing and functional postures.
  4. Bilateral activation of the LUMBAR MULTIFIDUS, with co-contraction of TVA while maintaining lumbar neutral and controlling lateral costal diaphragmatic breathing. Quadriped kneeling with a strong emphasis on technique for example.

SECONDARY TRAINING

Training during normal lumbar spine movement. Begin with stability training for the cervical spine (especially the deep neck flexors and upper traps), thoracic spine (scapular retractors often need strengthening), shoulders, lumbar spine, hips, knees and ankles. The use of wobble boards and swiss balls will enhance proprioception. Finally progress to functional movement patterns, returning to stability areas of concern where appropriate, and encompass any sporting or recreational activities.

Cardiovascular exercise may be integrated only once stability has been addressed. As soon as strength improves, normal sporting activities can be included, providing they are built up slowly and non contact is preferable for those suffering from Hypermobilty Sydndrome. Walking, cycling, deep water running, swimming are good low-impact choices. Vary mode of exercise to reduce the chance of overstraining a joint or tissue involved.

Review and re-educate sitting and standing habits. Harmful postures often adopted in an attempt to improve stability include hip slumping, hyperextending hips/knees, sway back, buttressing the knees when standing or when moving from sitting to standing, sitting with outstretched knees unsupported, sitting with legs in W position, sitting with legs tucked under buttock or in meditation style crossed legged (potential to stretch the collateral ligaments of the knee).

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Posture offsets are not uncommon. 

Stretching can be performed in a controlled manner with proprioceptive awareness to maintain muscle length and increase circulation, rather than with the aim of improving range of motion. Careful, controlled, supported stretching for tight tissues only, and held for no longer than 15 seconds. Short stiff muscles can result from misalignments and altered recruitment patterns.

Relaxation, rest and breathing. It is only during deep sleep that muscles can fully relax. When sleep is disturbed, muscles fatigue.

The body in which we live influences our understanding of who we are and where we fit in society. Successful management of the Hypermobile individual requires they have an internal sense of control, to feel they can change their life by changing their behaviour and feel responsible for their health.

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REFERENCES

Grahame, Rodney & Keer, Rosemary (2003). Hypermobility Syndrome. Recognition & Management for Physiotherapists. Butterworth Heinemann.

Panjabi, M.M (1992a). The Stabilising System of the spine. Part 1. Function, dysfunction and enhancement. Journal of Spinal Disorders, 5, 383-9.



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