Joint hypermobility syndrome (JHS) is commonly seen in my clinics, either as a feature observed or as a problem in itself – see previous blog. Commonly people desecribe pain, poor spatial awareness (so-called clumsiness), flat-footedness, problems with walking and controlling movement. What can we do about these problems? Firstly, understanding the neuroscience of movement and pain really helps the individual to engage in the training process to craft change and improve pain and performance. Applying what we know from contemporary neuroscience allows us to create individual treatment programmes that tackle the problems at source.
Spatial awareness and motor control
Traditionally the training to improve spatial awareness and motor control in joint hypermobility syndrome (JHS) involves proprioceptive tasks (balancing in a variety of formats). Undoubtedly this is a vital part of the programme. However, whether this shouild be the start point or a stage to be progressed to depends upon the assessment findings. Clearly there are a number of people who are hypermobile who can actually balance extremely well – dancers and gymnasts of course. However, they are often subject to many aches and pains put down to injury and repetive straining of the tissues beyind the normal range. This can be true. Just returning to a piece of research that found incongruence to cause pain and altered sensation, we know that there are other forces at play, those of the brain. How can we detect what is going on?
In recent times there has been an increase in studies looking at the adaptations that occur in the brain and how these manifest. Certainly we know about changes in two point discrimination that relate to plastic adaptations in the nervous system and in the ability to recognise left and right images of different body regions. Both of these offer assessment that moves beyond the tissues and into the underpinning mechanisms behind altered movement, sense of self and pain – all of which we have identified as features of hypermobility.
Training: I would start the individual upon tactile discrimination training, recalling that normal sensory information is sent to the brain to maintain and integrated view of the body that is vital for the control of movement. If left/right recognition is either slow or inaccurate, or both, the Recognise training will also be commenced, targeting the early mechanisms of movement (the planning phase – an actual movement can only be as good as the plan). From here we progress to specific motor control and proprioceptive exercises with an emphasis upon quality of movement and feedback.
Strength
Strength is very important and often found lacking in hypermobility. On a day-to-day basis it may not be too obvious that there is a strength deficit, however on testing the reality is different. Interestingly, a study looked at the effects of a home based strengthening programme and found that as well as strength gains, proprioception improved as did pain. The nerve endings in muscles and tendons send a great deal of information to the brain about movement and tension that could explain the improved sense. The increase in capillaries within the muscles as a result of exercising will improve the blood and oxygen supply thereby nourishing the tissues.
Training: From a baseline the resistence is gradually increased using body weight and hand-held weights, targeting both individual muscles and groups of muscles that work functionally together.
Pain
Reducing the pain and sensitivity is always a goal of the treatment programme. This is both directly with therapies targeting the pain mechanism(s) and by training the brain.
We know that from modern neuroscience research that pain is a brain experience 100% of the time and that the feeling of pain is allocated a location in the body, therefore targeting the brain as well as the health of the tissues is vital. This includes developing a good understanding of your pain and the influences upon it. Lifestyle (e.g./ diet & exercise, work habits), stress, fatigue, mood and emotional state all play a significant role in the sensitivity of the nervous system. We address all of these factors to provide a comprehensive treatment programme that is designed for you to reach your goals.
Summary
To deal with the problems that can arise in association with hypermobility takes a rounded approach with a solid neuroscience backing that recognises the individual. This is in fact the same approach for any persisting or more complex pain case. We must look at the problems and concerns and subsequently deliver treatment and therapy that is tailored in order to reduce the sensitivity, increase confidence, promote healthy habits and restore desirable activity levels.
For further details please see our website: www.specialistpainphysio.com
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Richmond
Richmond Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist Specialist Pain Physio Clinics | Harley Street | Chelsea | Temple | New Malden Richmond is a Chartered Physiotherapist with a background in pain science. He specialises in the treatment of pain and injury using the latest model of care (biopsychosocial) and sciences to optimise individual performance and living. Commonly, individuals with complex and persisting pain problems visit the clinics for this modern approach that offers contemporary treatments that address the sources and influences upon pain. Richmond has a strong interest in pain education and writes several blogs on the subject of pain to help individuals understand their pain, the underlying mechanisms and treatment approaches. Additionally he is currently writing articles for scientific publication and a book. www.specialistpainphysio.com www.crpsuk.com
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