This weeks comment on Physiotherapy and Sports Therapy topics has been inspired by a recent influx of people to the clinic who have previously been diagnosed with hyper-mobility syndrome. Sounds scary eh? Not to us. In fact I’m not sure it means anything at all really. Remember anything with syndrome on is the medical professions way of confessing up and saying we don’t really understand this! So in today’s Blog we hope to dis-spell some myths about hyper-mobility as a cause of your pain.
Definition Of Hyper-Mobility
“Hyper-mobility is defined as an abnormally increased range of joint motion due to excessive laxity of the constraining soft tissues.” According to to Stanford University. I like this. Succinct and to the point. Further attention for those not in the trade should be paid to defining what “soft tissues” are. Basically anything that is not bone. Soft tissues that can affect joints are muscles, fascia, ligaments, tendons and joint capsules.
The same article very importantly goes onto to say that in most cases they term this finding “benign.” This is to say that this clinical finding is not relevant to any symptoms within the body. There are of course some exceptions but I think that goes beyond the scope of the this article!
Does It Really Exist?
So if in the vast majority of cases the hyper-mobility is termed as “benign” does it have a bearing on the pain you feel? Probably not. I’d like to go back to the definition we used above. I know I’m being unusually pedantic today, but bear with me.
Abnormally is the word I want to look at. Who decides what is abnormal? Sadly, previously, it has been Physiotherapy textbooks which define normal ranges of movement. In fact I believe Physiotherapy students are still tested on what normal range of movement of certain joints is. What a complete waste of time that is! Everyone is so massively different. Should we compare contortionists and gymnasts as shown in the picture to big burly rugby players?
To give you an example we regularly see people with perfectly functional hamstring whose range of movement barely gets to 30 degrees. Equally we see dancers and gymnasts who have a range of movement in excess of 160 degrees. I’ve even seen one lady who can get her leg past horizontal going beyond 180 degrees. Technically this is the definition of hyper-mobile. Did it give her any physical problems, no. Her body had simply adapted to the needs of her profession.
Do The Joints Wear Out?
In a word no. Let’s dis-spell a few myths again. Firstly wear and tear on the cartilage within your joints doesn’t necessarily have to be painful. Cartilage in itself is very poorly innervated by nerves and therefore, by definition, cannot feel much pain. We talk in much more detail about this idea in our previous post Does Arthritis Really Exist. We also talk about more recent research which has shown that the amount of wear and tear on your joints is NOT a predictor for the amount of pain that you feel.
A lovely practical example of that is a client I have been seeing for the last month who has been told by an orthopaedic surgeon that he needs two knee replacements immediately due to the state of his cartilage. 4 treatments in and he’s walking about town pain free and I’m harbouring ambitions that I’ll get him skiing again! Have I changed the cartilage? No. Have I improved the muscle control that gives stability to the joint? Yes.
We can glean further reassurance for another large study which concluded that most wear and tear in joints happens in elite athletes and the morbidly obese. So the rest of us in between should have relatively minimal wear and tear in the grand scheme of things. And even if we’re not, and we have considerable wear and tear on the joints, that in and of itself is not necessarily the cause of our pain.
So coming back to hyper-mobility, even in the most of silly mobile joints even if that does lead to some wear and tear on the cartilage because the joint is literally going too far – it’s still not necessarily the excessive movement in the joint that is holey responsible for your pain experience.
In fact what you choose to believe is more important than what is happening physically. Such is the power of the mind! If you’ve been told by someone in a position of power, say a doctor, surgeon, physiotherapist, sports therapist, anyone that you trust. If they tell you it’s the hyper-mobility that is the problem and there’s nothing that can be done. You believe them and that alters your behaviour to being defensive of the joint or joints which alters your movement patterns which makes things worse.We explore this idea in more detail in our Blog on the psychology of pain – 50 Shades of Pain.
One of our biggest challenges as therapists is to change people’s beliefs. We try to do this with our actions and our techniques which show that change can come about quicker than you’d previously thought possible. We also go to great lengths not to make sweeping statements about conditions. So what if you’re hyper-mobile. The key question is what can we do to help you feel less pain?
What Can Be Done About It?
Hopefully you’re with me now in understanding that just because you’re extra flexible in some joints it’s not enough to say that is the sole cause of your pain.
If we go back to our original definition of hyper-mobility we see that it talks about excessive range of movement caused by laxity of soft tissues. Remember soft tissues relating to joints are ligaments, tendons, joint capsules, fascia and muscles. Now what out of that list can we affect?
Ligaments – Traditional wisdom suggests once they’re floppy they’re floppy! Either from previous injury or genetics. One exception is pregnancy, ladies ligaments loosen especially around the time of birth – for obvious reasons. Then become more rigid again in the months after child birth. However, with the world of physiotherapy and bio-mechanics opening itself to the fascia revolution we can argue here that the fact that all ligaments (apart from the cruciate ligaments in the knee) are entirely invested within the fascia and therefore if we affect muscle and fascia we can affect control of the ligaments – let’s not get too involved in this one today or we’ll be here for a while!
Tendons – again very hard to specifically train and strengthen – just speak to someone with a genuine (which is rare) Achilles tendon problem. But again maybe we can affect their function by improving the muscles and fascia to which they belong.
Muscles and Fascia – I’ve grouped these 2 bad boys together because if we affect fascia we affect muscles and vice versa. It is the length-tension relationship of the muscles and fascia that control the positioning in space of the joints. If we can better control the muscles that act across the joint we therefore better control the joint. Hyper-mobile or not. If we can improve function of the muscles and fascia using our box of magic tricks that we use at the clinic then we invariably see a massive change in people’s pain. Have we reduced the range of movement in the joint? No. Have we improved the muscle control around hyper-mobile joints? Probably. Have we removed the pain? Yes.
Whilst all of this is not an exact science this approach works in the vast majority of cases. Whilst I concede that in rare cases the excessive hyper-mobility of a joint or joints can cause problems in our experience hyper-mobility is massively over diagnosed as the source of people’s pain and in approximately 90% of cases this can easily be remedied with the right course of treatment.
If you’re struggling with an issue you or anyone else has put down to hyper-mobility, or any other condition for that matter, and you’d like to know if we’d be able to help you please give us a call to discuss your condition on 01793 613352 or mail at info@SwindonSportsTherapy.co.uk. We’d love to be able to help get you pain free again!