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Hypermobility Syndrome
Too Loose Can Be Too Painful
I have often had
requests to discuss my thoughts about hypermobility syndrome with respect to
causing chronic pain.
Hypermobility syndrome, for the most part, occurs when an individual's
connective tissue (muscles, ligaments or tendons) are simply looser or more
easily stretched than what is considered normal. The result is that the bones in
and around a joint are more mobile and likely to move off track, or partially or
completely dislocate from the joint. The result can be damaging to the cartilage
of the joint, the muscles and tendons around the bone and joint or the ligaments
that attach bony parts together.
Connective tissue diseases, of which are rare, but of many types, can be a major
cause of hypermobility syndrome. Often, these diseases are associated with
serious complications and require close monitoring by several specialist groups
(rheumatologist, nephrologist, opthomologist, etc.). More often, I see
individuals who have not yet met with a diagnosis of a connective tissue
disease, but clearly are hypermobile. Classically, They present in my office
with a diagnosis of Fibromyalgia syndrome (FMS), and are quite young with no
history of
trauma, or a good explanation for the pain syndrome. They are often female (but
some were male), and there physical exam exhibits an individual who has
extraordinary flexibility, especially given the pain syndrome (typically FMS is
associated with reduced range of motion). Typically, the few I have diagnosed,
had exaggerated range of motion of the shoulders, elbows, writs and good or
great range of the low back and hips. However, many had poor range of certain
spinal
segments (neck, mid back and some in low back) consistent with specific regional
spinal segment injuries.
My thoughts are
that the injuries occurred as a result of excessive spinal segment mobility
causing injury to muscles, disks, facet joints of the specific spinal segments.
If these injuries occur in enough spinal segments, then a fibromyalgic picture
can arise (much like in a
classical FMS). The red herring, so to speak, is that range of motion is
maintained throwing the examining physician off the scent.
I have treated a small number of these individuals, and had some success in
some. In the ones that had improvement, the treatment often included specific
deep spinal injections of the affected levels (dry needling with some nerve
blockade/cortisone), inversion therapy or traction of the neck or low back, and
stretching of muscles that were evidently inflexible/unstretched. Unfortunately,
not all have responded, but about half had good benefit.
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