Have you ever walked across a bridge made from wooden planks and rope? I can assure you it is an unsettling experience. It bows and swings requiring steady steps and measured pace to traverse without incident to you or anyone ahead or behind you. The amount of muscle tension you recruit is immeasurably more than you would use walking across a concrete bridge.
In our body, the wooden planks represent the dense bones and the ropes are the connective tissues. No one would expect that bridge to withstand the weight of a car or truck or even too many people at one time before the “connective tissues,” the ropes somewhere along the way, would yield. And, if they did withstand a load for a while, eventually they would yield as the seasons pass and they age.
Historically, training in kinesiology, the study of movement, held that the prime movers in human locomotion were bones, muscles, tendons, and ligaments. This flawed concept, also assumed that each person possessed fully functioning bones, muscles tendons and ligaments. Not so.
In the past four decades an ever-increasing body of science is confirming the tremendous role fascia plays not only in locomotion, but life. I often refer to fascia as “Saran Wrap” that envelops EVERYTHING in the body. Participation on a team of researchers doing fascia dissecting on fresh cadavers, proved this to me. From the layers immediately beneath our skin to that wrapping all our internal organs down to the brain and spinal cord. Every bone is wrapped in fascia. Every muscle is wrapped in fascia and, that fascia links one muscles to the next, literally connecting the bottom of the foot to the eyebrow.
Inherent in all these connective tissues is a protein called collagen. Collagen is the ESSENTIAL ingredient required to develop and sustain ALL connective tissues. Think of it as water for fish or the egg for the cake. Each human has a genetic code or blueprint directing the constant replenishment of collagen for each specific tissue. Genes are not self-determinant i.e. just because you have a gene doesn’t mean it will automatically express itself, for collagen or cancer. Genes are influenced by their environment. The science of epi-genetics confirms some genes can be turned on or turned off by our internal environment.
People with multiple genetic disorders cannot make collagen and consequently never stand or move normally. The most severe cases of Ehlers Danlos Syndrome are wheelchair bound. Luckily, there are many categories of connective tissue disorders that allow people to live essentially normal lives, but not without compromise and the development of pain.
In my clinical experience, people living with excess or hyper mobility are conducting fairly normal lives and often see little association between their “condition” and their neuro-musculo-skeletal pain patterns. To make matters MUCH worse, many primary care medical physicians, specialist in orthopedics and neurology, physical therapist and chiropractors dismiss or discount this physical finding as an untreatable. I have not found this to be the case.
In spite of what I am calling a genetic pre-disposition in the collagen genes, science has established specific nutrients essential for collagen replication.
Simple lab test and in-office test can reveal deficiencies or, arbitrarily prescribing three key formulas to a person living with hypermobility will help many individuals. The bases of these formulas, all from Biotics Research Corp, are Chondroitin Sulfate, Glucosamine, Manganese, Zinc and Vitamin C.
Hypermobility can elude an unsuspecting clinician by existing in hands and feet but not the shoulders and hips. It can manifest in the spine alone. I concur with the literature that it is far more prevalent in women than in men but, when men have it that usually relate to me that their mother or sister has it worse.
The clinical pitfall hypermobility presents is the upset it has on the innate and integral “tensegrity” fascia, tendons, ligaments and muscle exert on one another throughout the entire body. For example; in a person possessing compromised connective tissue the load placed on the foot during ordinary walking will cause the ankle to shift inward, flattening the arch, rotating the shin, straining the knee, pushing the hip socket out and pulling the muscles across the pelvic floor and into the large pelvic joints. All these structural adaptations continue up the spine and I can attest to the fact that many people with hypermobility and foot/ankle issues have low back pain and headaches.
Sadly, many people presenting to me relate stories of chronic pain, multiple back surgeries and drug abuse because no one they have consulted respected the underlying situation and made the fundamental mistake of treating pain without reaching a proper diagnosis of hyper mobility.
The supplemental regimen described above often results in change within days to weeks not months. The person typically describes a “tightening” in their joints. Some say they can no longer, “pop their joints.” Unfortunately, at this point in my understanding and experience, people with this condition have to continue taking the nutritional regimen. Comorbidities vary from person to person but nearly all have them. Consequently, any time a comorbidity can be addressed physically, chemically or emotionally, it is, whether it is in my office or a referral to another professional is made.
A safe and effective and inexpensive temporary modality is the administration of Kinesio Tape. This serves as a limiting factor in knee/elbow hyper extension, hip capsule strain sprain and erector spinae tone in the upper thoracic spine as well as the core.
Without exception we use Aetrex orthotics to the exclusion of all other due to their ankle “posting” design. Their medial arch support is moved posterior-ward a few millimeters to preclude excess migration of the tibia on the talus, thereby improving/preserving the integrity of the medial arch and mitigating elongation of the plantar fascia.
People living with hypermobile joints are at risk of chronic pain, premature and accelerated degeneration and manifold limitations in activities or daily living as the years go by. Every clinician treating neuro-musculo-skeletal complaints will serve their patient better if they understand, identify and properly manage these individuals.