Physical therapists (also called physiotherapists or PTs) can help people with the Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) in many ways, depending on the type of pain and other symptoms they have.
A physical therapist can:
- Prescribe appropriate exercises to reduce pain associated with joint instability, muscle spasms, strains, and sprains
- Provide education and tips on how to improve posture
- Advise on how to perform daily tasks in less painful ways
- Apply gentle manual therapy to reduce pain and help with joint instability
- Provide tips for managing joint instability at home
A physical therapist can also suggest other helpful pain management strategies, such as:
- Heat
- Ice
- Electrotherapy (such as TENS)
- Supportive taping
- Braces and splints
- Mobility aids
- Laser therapy
- Ultrasound
- Dry needling
Physical Therapy Techniques
Exercise is important for people with EDS and HSD because it improves muscle strength, which helps stabilize hypermobile joints. It can help reduce pain caused by muscle spasms that occur due to the muscles being too weak to stabilize the joints. Exercise can also help the body heal and ease pain from strains and sprains.
It is best to work with a physical therapist or exercise physiologist to determine the best exercises for you. Many exercises can be used for people with EDS and HSD, but exercises should be adapted based on each person’s abilities and limitations. It is also important to find exercises that you find enjoyable so you will be more likely to do them consistently.
Exercises that focus on movement control and strengthening the stabilizing muscles are generally suitable for people with EDS and HSD. Exercises with a low load on the joint are preferred. As a general rule, it is recommended to start low (with a low number of repetitions, low weight, short time exercising) and go slow (when you increase repetitions, increase weight, increase the amount of time you exercise).
People with unstable joints should avoid high-impact activities (such as running and jumping), combat sports, high-contact sports, and sports that focus on flexibility.
People with vascular EDS (vEDS) should only participate in exercise and sports at low intensity. They should avoid activities that cause blood pressure spikes and straining.
People with EDS and HSD often feel the need to stretch. Careful, gentle stretching of muscles can be helpful when muscles are tight. Overstretching beyond the normal range of motion can be harmful. It may lead to instability if the muscles are unable to stabilize the joint.
A PT can teach you to stretch safely and effectively and to know your limits when stretching. They can advise you on when to stretch, how often to stretch, and what types of stretches are appropriate for you.
It is important to target the correct areas when stretching because the areas that are already most flexible sometimes stretch more easily. The more flexible areas should be stabilized to target the muscles and tissues that are tight. For example, when the hamstring muscles are tight, and the lumbar spine is more flexible, the lumbar spine should be stabilized before the hamstring is gently stretched.
Sometimes, it feels like a muscle needs to be stretched because it is overworked or overactive. In these situations, you may need to do exercises to strengthen your muscles or make your movement pattern more efficient. A PT can help you do appropriate stretches correctly or recommend other exercises to target the problem.
Some PTs use gentle manual therapy. Manual therapies are hands-on techniques that PTs use to help reduce pain and improve functioning. There are many different types of manual therapy, including:
- Joint, muscle, and nerve mobilization
- Joint manipulation
- Myofascial release/soft tissue mobilization
- Trigger point therapy
- Strain counterstrain, or positional release therapy
Management of Joint Instability
Joint instability occurs when the bones of a joint aren’t held in place securely. This can lead to joint subluxations, dislocations, sprains, and other injuries. The terms dislocation and subluxation are often used interchangeably, but there are some key differences.
A dislocation is defined as “the displacement of a bone from its natural position in the joint.” This occurs when two bones at a joint completely separate and are no longer touching.
A subluxation is defined as “a partial dislocation.” This occurs when the two bones at a joint are out of place but are still touching each other.
Subluxations can be just as painful as dislocations but often resolve on their own or can be manipulated back into place at home. Dislocations often require attention from a doctor or PT to ensure the bones return to their correct positions without compromising surrounding structures. You can read about managing joint instability here.
Both subluxations and dislocations occur for similar reasons in people with hEDS and HSD. In addition to differences in the connective tissue, this can also include:
- Altered muscle tone
- Impaired proprioception
- Repeated or excessive stretching
- The shape of the joint surfaces
A physical or occupational therapist can help by:
- Providing advice about how to prevent future episodes
- Investigating the underlying cause(s) of the instability
- Suggesting management strategies (such as exercises or support braces)
FAQs
Resources
- The Evidence-Based Rationale for Physical Therapy Treatment
- Physical Therapy Management - Inge De Wandele and Leslie Russek
- The Role of Physiotherapy in Managing These Pains - Inge De Wandele
- The Role of Physical and Occupational Therapies in EDS and HSD - Dr. Lies Rombaut
- How To Appropriately Recondition The Hypermobile Body - Dr. Derik Anderson
- Managing Deconditioning - Dr. Leslie Russek
- New Insights in Physical Therapy - Prof. Jane Simmonds
- The Muldowney Protocol - Kevin & Kathleen Muldowney
- Keeping Children Active: Physical Therapy - Patricia Stott
- Considering physical therapy modalities with the highly sensitive patient - Dr. Patricia Stott
