Physiotherapy For Hypermobility Syndrome -The Power of Therapy

Introduction

Hypermobility syndrome is a musculoskeletal disorder that affects the muscles and joints. It was first described by Kerk in 1967. Hypermobility syndrome, also known as benign hypertrophy joint syndrome, is characterized by increased laxity of multiple joints. It is mostly seen during childhood and reduces with aging. Hypermobility syndrome affects the tendons, joints, muscles, and connective tissues. Hypermobility is not a variant of arthritis. but it can result in osteoarthritis in some cases. A few syndromes that show hypermobility of joints are:

• Ehlers Danlos syndrome.

• Systemic lupus erythematosus.

• Rheumatoid arthritis.

• Marfan's syndrome.

What Is the Prevalence of Hypermobility Syndrome?

Hypermobility syndrome is seen more commonly during childhood than in adults. It is more common among girls than boys.

What Are the Signs and Symptoms Associated With Hypermobility Syndrome?

A few possible signs and symptoms associated with hypermobility syndrome are:

• A recurrent sprain in the ankles.

• Meniscus tears.

• Acute dislocation of the joint.

• Subluxation (incomplete joint dislocation).

• Scoliosis (bending of the back of shoulders).

• Fibromyalgia.

• Arthritis (pain and swelling in the joints).

• Nerve compression diseases such as carpal tunnel syndrome.

• Continuous lethargy and fatigue.

• Severe back pain.

• Tendinitis (tears in the tendon).

• Urinary incontinence.

How Is Hypermobility Syndrome Diagnosed?

Physiotherapists assess the affected joint by using two different types of assessment criteria for diagnosing hypermobility syndrome such as:

• The Beighton Score: It is a scoring system for assessing the hypermobile joints.

• Brighton Criteria: These scores are used to diagnose hypermobility syndrome.

What Are Different Physiotherapy Exercises for the Management of Hypermobility Syndrome?

Various physical exercises trained by the certified physiotherapist for the management of hypermobility syndrome are:

• Active Mobilization Exercises: Different types of mobilization exercises, such as arm circles, shoulder rolls, wrist circles, spine flexion exercises, and thoracic rotations while sitting, are a few exercises recommended by the physiotherapist for alleviating pain in the joints.

• Strengthening Exercises: A few exercises that help strengthen muscles in hypermobility syndrome are shuttle runs, bunny hops, squat thrusts, sitting to standing exercises, and jumping jacks. Physiotherapists decide the no of repetitions and time duration of each exercise based on the underlying condition. These exercises help stabilize the muscles around the areas with hypermobile joints.

• Proprioception Exercise: Various balancing exercises are taught by the physiotherapist for improvement in unsound limb positions and abnormal joint postures. These exercises help improve proprioception and are performed for a minimum of two to three minutes. A few balancing and coordination exercises that help in hypermobility syndrome are:

1. Trampoline jump.

2. Walking with closed eyes under the supervision of physiotherapists.

3. Single leg balance exercises.

4. Single leg ball rolling exercise.

5. Board balance wood exercise.

• Control Neutral Joint Position Exercise: The physiotherapist first identifies the abnormal joint posture of the symptomatic joint and tries to retrain the postural muscles to reposition and realign the joint.

• Re-train Dynamic Control: Various dynamic control exercises and sports activities are designed to improve the joint positioning of the affected joint. Few exercises, like hip flexion with spinal neutral maintenance exercises, are done under the supervision of trained physiotherapists.

• Motion Control: These exercises help improve the range of motion of the affected joint muscles. Sitting and standing repetition exercises help to improve pain and laxity of the affected joint muscles.

• Manual Therapy Exercises: Various massaging exercises help to reduce pain due to hypermobile joints and improve joint stabilization.

• Taping or Bracing Exercises: Various taping or bracing exercises are trained by physiotherapists to combat muscular pain due to joint hypermobility syndrome.

• Low-Impact Aerobic Exercises: A few low-impact aerobic exercises like swimming and cycling help to improve joint mobility without straining the muscles much.

• Hydrotherapy: A few exercises which are done in the water pools help to improve joint mobility and help the patients to perform the exercise effectively without putting much stress on the affected joints.

• Other Newer Modalities: Other newer modalities which are currently being included in physiotherapy exercises, like electric stimulation therapy and heat or cold compression therapies, help to improve joint mobility.

Few Best Physiotherapy Exercises for Hypermobility:

• Squats: Stand with the feet apart while keeping your knees slightly bent. Try to bend slowly till below the knees. Keep the knees out with the chest up. Then stand again back on the knees slowly.

• Hamstring Stretch: Try sitting on a chair with good posture. Extend the right leg by bending the left leg and try reaching the ankles. Hold the position for 30 seconds.

• Hamstring Curls: Bring the heels as close to the glutes as possible while lying on the stomach. Hold the body in the same position for around 10 seconds.

Other simple home exercises like push-ups and 90-degree lat stretches can also help manage hypermobility syndrome.

What Are the Goals of Physiotherapy Exercises for Managing Hypermobility Joint Syndrome?

Different goals of physiotherapy exercises for the management of symptoms associated with hypermobility syndrome are:

• Aims to reduce pain.

• For reduction of swelling.

• For strengthening the affected muscles and joints.

• To decrease the laxity of ligaments.

• To help the patient in performing their daily activities.

• To help improve range of motion.

• To improve postural and motor control.

• Rehabilitation of gait (balance and coordination while walking).

• Improvement of muscle tone.

Things to Keep In Mind While Under Physiotherapy Program:

• It is advised to the patients to keep track of the improved symptoms and inform the trainer in follow-up visits.

• In case of worsening symptoms, inform the physiotherapist. Physiotherapists usually refer patients to a specialized doctor for further management.

• It is recommended to perform only specific sets of exercises in intensity as advised by the physiotherapist.

• Avoid overdoing exercises.

Take Away Points:

Overall, physiotherapy helps tremendously in the rehabilitation and early mobilization of the affected joints. It also helps alleviate pain and improve muscle strength. Physiotherapy also focuses on assessing the hypermobile joints and managing the underlying pain. It is advised to enroll in physiotherapy programs if diagnosed with hypermobility syndrome for early recovery. Apart from physiotherapy, maintaining healthy body weight is important to reduce the loads on joints and ligaments.

Conclusion

Hypermobility is most commonly seen in children but can affect adults, also. It affects the quality of life by hampering daily activities due to underlying pain in the joints and surrounding muscles. Physiotherapy exercises benefit patients with hypermobility joint syndrome quite effectively. Early diagnosis of hypermobility syndrome using the Beighton score and Brighton criteria is very crucial. However, further research is needed to determine the specific sets of exercises and their intensity for hypermobility joint syndrome.