Welcome to the Bendy Club blog! This week, we’re delving into the crucial role of physical therapy in managing hypermobility. Whether you have Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (EDS), a tailored physical therapy program can help you build strength, improve stability, and enhance your quality of life.
The Importance of Physical Therapy
Physical therapy is a cornerstone of managing hypermobility. It helps strengthen muscles, protect joints, and prevent injuries. A well-designed program can significantly reduce pain and improve daily functioning.
Best Practices for Physical Therapy for Hypermobility
- Find the Right Therapist: You need to work with a physical therapist experienced in treating hypermobility. They will understand your unique needs and how to avoid exercises that might cause harm. So many patients have worked with physical therapists in the past and actually felt worse after. Someone experienced with hypermobility will know how to scale back and start with the basics.
- Start Slow and Steady: Begin with low-impact exercises to build a solid foundation. Gradually increase intensity as your strength improves. Many patients need to start with exercises all supine (laying on your back) because they don’t have the core stability and proprioception needed to perform upright movements.
- Focus on Stabilization: Exercises that enhance joint stability are crucial. This includes core strengthening and proprioceptive training. All exercises should be focused on strength and stability. Going to a therapist and getting manual therapy, heat/cold packs, and E-stim may make you feel better in that moment, but it won’t help you the next day or next month. You need to get stronger.
- Avoid Overstretching: While stretching can be beneficial for some people, those with EDS and HSD should avoid stretching as it can worsen hypermobility symptoms. Most people with hypermobility have more than enough range of motion in their joints. Again stretching may improve symptoms very temporarily, but it likely won’t make you feel better long term. Better to focus on controlled movements in a more neutral range of motion.
- Incorporate Strength Training: Building muscle strength around hypermobile joints provides better support and reduces the risk of dislocations and injuries. Most individuals with hypermobility are seriously lacking in muscle due to chronic pain, injuries, lack of exercise, and poor diet. Having more muscle mass will decrease pain and improve function in almost all hypermobile individuals.
Key Goals for Hypermobile Individuals – all exercises would be best started with a 1 on 1 session with a physical therapist or trainer with experience treating hypermobile patients.
- Correct Postural Faults: Most people with hypermobility lack proprioception meaning they don’t know where their body is positioned. For example the average person with HSD/EDS will hyperextend their knees when standing. This puts extra strain on the knees causing pain overtime. These postural faults are a great place to start with any PT program.
- Strengthen The Core: Having a strong stable core will not only protect the spine but also improve your ability to sit and stand upright without pain. Exercises like Planks, bridges, and even just standing with the abdominal muscles activated can help stabilize your core, supporting overall stability.
- Improve Proprioception: Balance exercises, such as standing on one leg or using a balance board, enhance joint awareness and stability. They also help to make weak areas more noticeable. For example if you knee collapses in (knee valgus) when trying to balance on a single leg than the therapist will know to work on hip abduction strengthening.
- Increase Strength: The more muscle you have the more stable your joints will be. Focus on controlled exercises with bodyweight, low weights, or resistance bands to build muscle strength around your joints.All exercises should be performed with smaller ranges of motion and potentially even supported i.e. laying supine for those just starting out.
- Increase Cardiovascular Endurance: Improving strength is important but your heart and lungs need to be strong too if you want to be able to perform at any level. Activities like swimming, cycling, and walking improve cardiovascular health without putting too much strain on your joints. For more information I recommend looking into Zone 2 cardio to better explain the benefits and how to perform these exercises.
Real-Life Insight
One of my patients, Alex, struggled with chronic joint pain especially in his ankles and frequent injuries. By working with a physical therapist experienced in hypermobility, Alex developed a tailored exercise program. Over time, his strength and stability improved significantly, reducing his pain and preventing further injury. Alex’s journey underscores the transformative impact of targeted physical therapy for hypermobility.
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Thank you for being part of the Bendy Club. Together, we can make a difference!
Warm regards,
The Hypermobile Solutions Team
References
The Ehlers-Danlos Society. Physical Therapy for Hypermobile EDS https://www.ehlers-danlos.com/physical-therapy/
Russek LN, Stott P, Simmonds J. Recognizing and Effectively Managing Hypermobility-Related Conditions. Phys Ther. 2019 Sep 1;99(9):1189-1200. doi: 10.1093/ptj/pzz078. PMID: 31158283. https://pubmed.ncbi.nlm.nih.gov/31158283/
Home. The Ehlers Danlos Society. https://www.ehlers-danlos.com/
What is HSD?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-hsd/
What is eds?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/
Jovin, D., Atwal, P., Herman, K., Block, N., Maxwell, A. J., Mitakides, J., Maitland, A. M., Saperstein, D., Hamilton, M., Schofield, J., Koby, M., Klinge, P., McElroy, A., Bluestein, L., Chopra, P., Tishler, J., Pocinki, A. G., Varga, J., Dempsey, T., … Lane, K. (2020). Disjointed: Navigating the diagnosis and management of Hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Hidden Stripes Publications, Inc.
Smith, C., & Wicks, D. (2017). Understanding Hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder: (previously known as Ehlers-Danlos Syndrome Hypermobility Type & Joint Hypermobility Syndrome, respectively). Redcliff-House Publications.
Cox, C. (2022). Holding it all together when you’re Hypermobile. Journey2Joy
Disclaimer
This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.