Some people use braces, splints, and mobility aids to help them better live with a type of Ehlers-Danlos syndrome (EDS) or hypermobility spectrum disorder (HSD). Many kinds of supports are available, which should be recommended by a healthcare professional based on each person’s specific needs. Braces, splints, and mobility aids may be used short-term, long-term, or even situationally, depending on an individual’s needs.
It is important to continue to perform appropriate exercise alongside the use of these supports to ensure that the muscles continue to be used. Exercise helps prevent deconditioning, which refers to changes in the body that occur during periods of inactivity. Deconditioning can worsen a person’s symptoms and make it even harder to function and be active.
Signs of deconditioning include:
- Weakness
- Tiredness
- Pain with activity
- Shortness of breath
- Increased heart rate
- Difficulty performing usual activities and exercise
Signs of deconditioning include:
- Weakness
- Tiredness
- Pain with activity
- Shortness of breath
- Increased heart rate
- Difficulty performing usual activities and exercises
A knowledgeable physical therapist (PT), occupational therapist (OT), podiatrist, orthotist, or physiatrist (also known as physical medicine and rehabilitation or PM&R doctor) can help determine which type of brace or splint is best for you. You can read about different types of braces, splints, and mobility aids below.
Braces and splints
Braces and splints are sometimes recommended when a part of the body requires extra support. In general, three categories of braces and splints can be used.
Proprioceptive braces and supports
Proprioception is the ability to sense the body’s position and movement. Research shows that people with EDS and HSD have decreased proprioception compared to people without these conditions.
Proprioceptive braces and supports aim to improve body awareness through pressure on the skin. These braces provide light compression and may reduce pain. Proprioceptive braces are made of flexible material, such as neoprene, and may have straps made of elastic. These braces do not necessarily restrict joint range of motion, making muscle loss less likely.
Proprioceptive braces can be worn daily or for specific sports or work activities. These types of braces are generally very safe to wear. However, it is important to monitor skin color changes, which might indicate that the brace is too tight.
Kinesiology tape can also provide proprioceptive support and decrease pain, but skin fragility and sensitivity should be considered in people with EDS and HSD.
Functional non-immobilizing splints and braces
Functional non-immobilizing splints and braces allow movement through a controlled range of motion. This is especially helpful for functional activities, such as writing and gripping (for example, ring splints for the fingers) and walking (for example, Richie brace for the ankle).
These types of supports are used to correct movement patterns and reduce overload injuries to the joint and soft tissues. They may also reduce pain. Functional non-immobilizing splints and braces can be worn daily or as needed and should not lead to muscle loss.
Resting splints and braces
Resting splints and braces are made of rigid materials. They are used for protection and pain reduction when there is considerable joint instability and pain (such as after a joint dislocation). They can also help when muscle activity is affected by nerve damage (for example, foot drop).
Resting braces and splints are sometimes prescribed for nighttime use to prevent injury and maintain alignment. If rigid braces are used for extended periods of time while awake, muscle wasting is likely to occur. For this reason, these types of supports should be used with careful consideration.
Crutches, walkers, canes, and other mobility aids
Mobility aids can help people who have issues moving around. They may reduce limitations and allow people to engage in activities longer. People who use mobility aids should still do consistent joint-friendly exercise to maintain muscle tone and general health.
You can discuss mobility aids with your healthcare providers to learn if this is an option for you. It is always best to consult a physical or occupational therapist about which mobility aids fit your specific needs and functional capacity. Mobility aids may need to be customized to meet your needs.
Wheelchairs
A small percentage of people who have EDS or HSD need to use a wheelchair because of their condition. Wheelchairs are not recommended as standard practice. However, a wheelchair may be considered when a person cannot move around or engage in daily activities due to joint instability, pain, deconditioning, or comorbidities. The decision to use a wheelchair should be made in consultation with your doctor and a therapist experienced in wheelchair prescription.
Consideration should always be given to whether using a wheelchair will make symptoms worse. Deconditioning occurs quickly when we stop moving. Limiting or removing walking from daily life can weaken the trunk and leg muscles. This can worsen joint instability and could potentially worsen a person’s overall condition to the point of being unable to walk. Deconditioning can also impact other symptoms and comorbidities, such as POTS. It is important to continue to perform appropriate exercises alongside the use of wheelchairs and other supports to ensure that the muscles continue to be used so their strength is maintained.
Wheelchairs can be used part-time, full-time, or situationally, depending on the individual’s needs. Wheelchairs, like all mobility aids, are tools that can help people feel and function better. Mobility aids, including wheelchairs, are appropriate to use when they can help someone turn a “no” into a “yes.” Wheelchair use can enable participation in preferred activities, increasing quality of life, engagement, and productivity. Wheelchairs should be considered as part of an overall management plan if and when required.
There is no one “best” wheelchair for people with EDS or HSD. If someone uses a wheelchair frequently, it should be customized to help them move around without injuring other parts of their body. Many people with EDS or HSD find self-propelling wheelchairs challenging to manage independently. In these cases, a power assist device or power wheelchair may be more appropriate. Each type of wheelchair comes with its own unique challenges, including transportation and cost.
In-shoe orthotics
Some people with EDS and HSD benefit from in-shoe orthotics. Many different types of orthotics can be inserted into the shoes to provide support. When worn, orthotics provide support and help the feet move better by changing the pressure that goes through them.
Everyone’s feet are different and need different support. This means some people might benefit from hard orthotics, while others prefer soft orthotics. Soft orthotics, also called insoles, can often be purchased from shoe stores and pharmacies if you feel you need extra cushioning inside your shoe. Health professionals, such as podiatrists or orthotists, can recommend personalized soft or hard orthotics if you have specific concerns about your feet or walking.
Ring splints
Ring splints can help to limit hyperextension, instability, and associated pain in the finger and thumb joints. They can also help with daily activities by increasing proprioception, or awareness of joint position and movement.
Ideally, ring splints should be measured and ordered by an occupational therapist, physical therapist, or Certified Hand Therapist. They come in a wide price range depending on the type of material used and its longevity. Ring splints made of plastic are often the least expensive and may offer a starting place to see if ring splints are right for you. However, plastic splints may not last as long or be as comfortable as ring splints made from metal. Some brands require splints to be ordered by a therapist to maintain standards and ensure appropriate use of splints.
