Hypermobility amd massage

Joint Hypermobility is a condition characterised by the movement of joints within the body beyond a normal range of motion. There are many types of hypermobility, with a wide range of severity, from trivial flexibility (often referred to as being “double-jointed”) all the way to full-blown genetic disorders of the connective tissue with many serious medical consequences. The condition affects 10% to 25% of the population, and there are many undiagnosed people out there who know something is wrong in their bodies but can’t work out what it is. I have a personal interest in the condition, being hypermobile in my knees, wrists and elbows.

Many hypermobile people live quite happily without any associated health problems, but those with the more severe forms can experience fatigue, muscle pain, severe joint pain, early onset osteoarthritis, clicking joints, frequent dislocations, and an increased risk of injury, including whiplash. Joint hypermobility can be a stand-alone phenomenon or part of a broader syndrome.

• Generalised Joint Hypermobility (GJH) is characterised by multiple joints having an extended range of motion. GJH can increase the risk of joint instability, pain, and injury.

• Hypermobility Spectrum Disorders (HSD) is a range of conditions that feature joint hypermobility and other associated symptoms but do not meet the full diagnostic criteria for hEDS (Hypermobile Ehlers-Danlos Syndrome).

• Ehlers-Danlos Syndrome (EDS) is a group of genetic disorders that affect the body’s connective tissues. The hypermobile type (hEDS) is characterised by joint hypermobility, soft and stretchy skin, and widespread pain.

Hypermobility is strongly associated with ADHD, autism, dyspraxia, fibromyalgia, IBS, hereditary connective tissue disorders and anxiety disorders. Symptoms can also be exacerbated during pregnancy when relaxin and other hormones alter ligament physiology to accommodate fetal growth. There’s a lot of overlap with myofascial pain syndromeas well.

What causes it?
Hypermobility is primarily caused by inherited variations in collagen (the protein that gives connective tissues like ligaments strength). Other factors include bone shape, reduced muscle tone, genetics, and trauma. Hypermobility often passes from one generation to the next. It has been suggested, but never studied, that hypermobility could be one of the systemic issues that drives the formation of trigger points, perhaps just due to the exhaustion caused by constantly striving to stabilise joints, or just a neurological response to pain arising from other sources. People who have hypermobility often suffer from increased levels of muscle fatigue, as their muscles have to work harder to compensate for weakness in the ligaments that support the joints.

Can it be treated?
The simple answer is no, but there is a lot that be done to help protect the joints and learning skills to manage pain. I believe that developing good body awareness and understanding how your joints work is key. Improving bodily awareness can be done through bodywork and movement such as somatics. Wearing supportive footwear can be helpful, as can maintaining a regular but gentle exercise routine. Strength training is also good to help the muscles surrounding the joints to support them.

How can massage help
Regular massage can give people struggling with joint hypermobility many benefits, including aiding in pain management and reduction, reducing muscle tension, improving proprioception, and enhancing overall well-being. However, not all bodywork techniques are suitable for hypermobility sufferers, and a therapists' understanding of the condition and ability to work carefully and intuitively is important.

Particle and full dislocations are a risk, especially if working with someone with HDS or EDS. People with hypermobility do not need to have their joints stretched, and if there is to be movement of any joint, it needs to be done mindfully, gently and with a lot of support.

People who are hypermobile often have altered pain perception and poor proprioception, meaning that they may not respond to discomfort in a typical manner. Clean communication between the therapist and client is important to ensure that the client isn’t taken to any place that is painful. Proprioception can be developed through massage sessions and is a key part of protecting the joints.

Hypermobility can result in certain muscles being overworked while others are underused, leading to muscle imbalance. A tailored massage treatment will involve assessment of the whole body and whole person so that any work undertaken aims to restore balance overall.

A gentle, responsive type of massage is generally more beneficial than deeper approaches, which may potentially be too much for a client's nervous system to process and lead to more pain. Evaluating the state of inflammatory and nervous system responses must be a priority after each session, so that both the client and the therapist can determine what is tolerated and beneficial to the client's body.

References

Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175(1):148-157. doi: 10.1002/ajmg.c.31539.

Bravo JF, Wolff C. Clinical study of hereditary disorders of connective tissues in a Chilean population: joint hypermobility syndrome and vascular Ehlers-Danlos syndrome. Arthritis Rheum. 2006;54(2):515-523. doi: 10.1002/art.21568.

Doyle T.A, Halverson C.M.E, Use of complementary and alternative medicine by patients with hypermobile Ehlers-Danlos Syndrome: A qualitative study. Front Med (Lausanne). 2022 Dec 14;9:1056438. doi: 10.3389/fmed.2022.1056438. PMID: 36590929; PMCID: PMC9794619

Rombaut L, Malfait F, De Paepe A, et al. Impairment and impact of pain in female patients with Ehlers-Danlos syndrome: a comparative study with fibromyalgia and rheumatoid arthritis. Arthritis Rheum. 2011;63(7):1979-1987. doi: 10.1002/art.30337.

Remvig L, Engelbert RH, Berglund B, Bulbena A, Grahame R. Need for a consensus on the semeiology and terminology of pathophysiological phenomena of joint hypermobility. Eur J Pediatr. 2015;174(6):791-796. doi: 10.1007/s00431-014-2437-5.

Engelbert R.H, Juul-Kristensen B, Pacey V, et al. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. Am J Med Genet C Semin Med Genet. 2017;175(1):158-167. doi: 10.1002/ajmg.c.31545.