Hypermobility: Getting Healthy, Improving Function & Strength · 1. Squat to lift and lower. Do ....
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Hypermobility: Getting Healthy, Improving Function & Strength
Transcript of Hypermobility: Getting Healthy, Improving Function & Strength · 1. Squat to lift and lower. Do ....
Hypermobility: Getting Healthy,
Improving Function & Strength
Objectives
Review the function of collagen and muscle
Apply principles of motor control and learn to maximize joint stability
Identify various approaches to increase physical activity and fitness with Joint Hypermobility Syndrome (JHS) and Ehlers Danlos Syndrome (EDS)
Describe intervention techniques to control pain and minimize debility
What is Collagen & Why We Need It
Is the most abundant protein in our body
Provides ultrastructure for cartilage, ligaments and tendons
Sparsely vascularized
Ineffective vascular supply + genetic collagen dysfunction potentially = a weakened joint
Presenter
Presentation Notes
Basic pathology is the involvement of collagen tissue with decrease in tonus of body elastic tissue With loss of soft tissue strength, we have unstable joint with laxity , loss of proprioception, tendency for traumatic injuries. So, why do patients with jhs have joint pain esp in the knee ? Thought to have excessive joint laxity which leads to wear and tear on jt surfaces and strains or fatigues the soft tissue surrounding these jts. Studies show there is proproceptive ( impaired sensory feedback) impairment which also leads to excessive jt trauma .
Factors That Contribute to Joint
Stability
Static Contributors: bone, capsule (fluid filled sack surrounding the joint) and ligaments
Dynamic Contributors: muscles, tendons and the nervous system which controls movement of the muscles
Presenter
Presentation Notes
Factors are two fold: static (stationary) and dynamic (moveable) . Physical activity and exercise increased the strength of ligaments , tendons, mm’s and improve efficient activation of mm’s; therefore, contributing to the joints and body as a whole. Mechanoreceptors enable us monitor position of our joints, mm’s , and bones when touch, pressure or stretch is applied.
Symptoms associated with
JHS Pain
Fatigue
Weakness
Early degenerative joint disease
Decreased bone density
Recurrent sprains, subluxations, dislocations
Headaches
Poor Sleep
Dizziness/vertigo/POTS
Nerve compression disorders
Temporomandibular joint dysfunction
Urogenital conditions
Best Interventions in Managing and Treating JHS
Education is the most important aspect of managing JHS.
For example, symptoms associated with spinal/wrist hypermobility can improve with education in ergonomics and body mechanics as can joint protection can decrease pain/traumatic injury.
The selection of jobs, sports and recreational activities is important to lessen exacerbation of condition.
Presenter
Presentation Notes
Effective treatment may be accomplished with lifestyle modification (pacing), altering pt’s exercise regimen, jt protection and proper body mechanics.
Sitting
1. Squat to lift and lower. Do not bend at the waist.
2.Keep your lower back bowed in while bending over
3.Keep the weight as close to you as possible
4.Bow your back in and raise up with your head first
5.If you must turn, turn with your feet- not your body.
6. Never jerk or twist
• Put the weight down by keeping your lower back bowed in
• Keep your feet apart, staggered if possible
• Wear shoes with non-slip soles.
Proper lifting Techniques
Best Interventions in Managing and Treating JHS
Exercise
Functional stability re-training for controlling mechanical dysfunction
Strengthening and Proprioceptive exercises surrounding affected joints
Joint Stress During Activity
Activities Hips Knees Ankles Shoulders Hands
Walking • • • Swimming • • Running •• ••• ••• Rowing • •• • •• ••
Climbing stairs ••• ••• •
Cycling(sta) • •• • Tennis/ Racquet ••• ••• ••• ••• •••
Low impact aerobics •• •• •• •
Why should you exercise?
• Strengthens muscles, ligaments and tendons which increases support
• Increases aerobic capacity/endurance
• Increases bone density
• Reduces dementia
• Reduces pain
• Increase balance and proprioception
• Reduces blood lipids
• Improve GI motility
• Increase metabolic rate
• Decrease depression and improve mood
• Improve self confidence and quality of life
Presenter
Presentation Notes
We know certain meds can help us with pain but the effectiveness is short-lived, whereas, benefits of exercise can remain present up to 8 months.
The Minimum Effective Dose or Proper
Amount Needed to Cause Change
Intensity
Duration (reps)
Speed
Frequency
BORG Scale
Presenter
Presentation Notes
Mm power (force x by velocity) seems to have larger impact on functional abilities than mm strength. Young men had a significant loss of mm Type 2 after 10 day detraining after 3 mo of RT (art 33) Significant question is what is Min amt. We know the majority of strength gains are in the first 8 wks of beginning exercise that continues to improve over a 12 wk period with sustainablity for up to 8 months with one day a week workout using 8 to 12RM 1 set 1 x week. We know there is a direct relationship bet/w phys act and cardiorespiratory health and that fitness has a direct dose-response relation bet/w intensity, frequency, duration and volume.
Strength and Endurance Training
Endurance Training
3-5 days a week 60-70% 1RM
BORG level 12-13
12-15 reps 1-2 sets
Medium speed 30-60 sec rest
30-60 minutes
of moderate intensity
Walking Light cycling
Water aerobics
Strength Training
3 days a week 80-85% 1 RM BORG level:
14-15 6-8 reps 2-3 sets
Slow speed 60-90 sec rest
Switch between
upper and
lower body
Warm up training and cool
down
Presenter
Presentation Notes
CDC. Growing stronger:strength training for older adults.http://cdc.gov/physical activity/growingstronger/exercises/stage3.html. Updated February 24,2011. Accessed June 28, 2011. ACSM. ACSM’s. Guideline for exercise testing and prescription. 8th e.d. Philadelphia, PA:Lippincott, Williams & Wilkins:2009
Warm Up and Cool Down
Begin by warming up for 5-10 minutes
End by cooling down for another 5-10 minutes
Warming up pumps nutrient-rich, oxygenated blood to your muscles and raises your heart rate/breathing.
Cooling down slows breathing and heart rate bringing blood back into normal circulatory patterns. Prevents sudden drop in blood pressure causing dizziness
Presenter
Presentation Notes
Warm up ; march in place,swing your arms, exercise bicycle cool down slow gait or your movements until heart rate and breathing returns to normal.
Principles of Stability
Rehabilitation Control of Neutral Joint Position
Retrain tonic, low threshold activation to increase muscle stiffness by applying a consistent low force hold with activation throughout the range and into functional activities. This helps with recruitment of mechanoreceptor stimulation in a joint ligament
Transverse abdominus and lumbar multifidus
Presenter
Presentation Notes
We know with EDS and JHS, we have a dysfunction of the recruitment and motor control of the deep segmental stability system results in poor control of the neutral jt.position.If we don’t address this , we can have an increase in predisposition of recurrence and early progression of degenerative changes. All mm’s concentrically (shorten) and accelerate motion for mobility function and eccentrically lengthen or isometrically hold and decelerate motion for stability function and they must send this proproiceptive information back to the brain or CNS for coordination and regulator of mm function. So when we have regional pain or joint effusion it has been shown to alter the normal recruitment processors of the local stability mms around the joint.
Principles of Stability
Rehabilitation Motor control and recruitment are the priority and not strength and flexibility
Palpate for correct activation
No pain
Breathe/ no rigidity
Low force sustained hold with normal breathing (10 sec) and repeat (10 x’s)
No fatigue
Presenter
Presentation Notes
Principles of Stability
Retrain dynamic control of the direction of stability dysfunction
Low-load integration of local and global stabilizer recruitment with only moving through the range in which you have control.
Presenter
Presentation Notes
Key strategy to symptom management is to control directional stress and strain unloads mechanical provocation of pathology
Direction of stability
dysfunction
Slow, low-effort repetitions and movement only through the range that the dysfunction is controlled actively should be performed.
Clinical guide: Perform 15-20 slow repetitions until it starts to feel familiar and natural
Helps unload pathology and decrease mechanical provocation of pathology and assist in symptom management.
Presenter
Presentation Notes
For ex. control of lumbo-pelvic control . Helps unload pathology and decrease mechanical provocation of pathology and assist in symptom management.
Presenter
Presentation Notes
Clam with rotational load
Active lengthening or inhibition of muscles
Employ this when there is a lack of extensibility due to overuse or adaptive shortening, compensatory overstrain to maintain function.
Clinical guide: sustain the correction for 20-30 seconds and repeat 3-5 times
Presenter
Presentation Notes
Support the arm to lessen activation of the upper trap and to engage their core. This can help with the functional task of reaching.
Key to Exercising
Control neutral joint position
I.D. abnormal resting positions
Example: hyperextending or locking out at the knees or elbows
Re-train dynamic control
Re-training of specific muscles to maintain joint position while moving adjacent joints
Example: move hip or march while keeping spine neutral
Equipment
Balance
Bosu, airex, dynadisc, balance board, exercise ball, balance stones
Resistance
Weight machine, elastic bands, exercise ball, cuff weights, body weight
Aerobic
Pedometer, elliptical, recumbent bicycle, treadmill
Classes
Swimming
Tai Chi
Pilates (reformer)
Yoga
Silver Sneakers
Presenter
Presentation Notes
Help with POTS, balance , core stab , breathing , movement
Splints, Braces and Taping
S3 brace
Kinesiotaping or McConnell taping
Foot orthotics
Compression wear
Medical supply companies
S3 Brace
Presenter
Presentation Notes
Use for stability and postural alignment, cervical (deep neck flexors. gently retracting the retracting and adducting the scapula and gently elongating the cervical spine muscles while helps us facitilitate the deep neck flexors mm performance. It also provides tactile feedback.
Kinesiotaping or McConnell Taping
Kinesiotaping or McConnell taping
Foot orthotics
Compression wear
Pes Planus
Medial knee strain and compression to the lateral portion of knee
Muscle tendon strain and compression to lateral ankle
Use foot orthotic
Bottom Line
30 minutes of moderate aerobic exercise at least 5 days/wk
2-3 sessions per/wk of strength training that works the major muscle groups of legs, trunk and arms and shoulders
5-10 minutes of warm-up and cool down periods of each exercise session.
Presenter
Presentation Notes
If you are just starting out set goals and increase weight by 5% after you complete 15 reps in 2 consecutive workouts. Increase walking by 20 % every 2 weeks.
Take-Home Message
Evidence supports the use of physical therapy and exercise of various types in reducing pain and disability in patients with EDS and JHS. Improvements were found with both supervised and unsupervised exercise programs.
As you make your way along life’s tumultuous
highways, its important to note, if you can’t
fly, run; if you can’t run, walk; if you can’t walk,
crawl, but by all means keep moving.
Martin Luther King Jr.
Websites
www.mypyramid.gov
www.realage.com
www.sparkpeople.com
www.mapmyrun.com
www.fitness.gov/fitness.htm
www.health.gov/paguidelines.com
www.justmove.org
www.arthritis.org
www.ednf.org
www.nof.org
www.arc.org.uk
www.hypermobility.org
www.fitday.com
www.shapeup.org
References
1. Lass P, Kaalund S, leFevere S. Arendt-Nielsen L, Sinkjaer T, Simonsen O, Muscle coordination following rupture of the anterior cruciate ligament: electromyography of 14 patient. Acta Orthop Scand 1991; 62:9-14
2. Henning C, Lynch M, Glick K. An in vivo strain gauge study of elongation of the anterior cruciate ligament. Am J Sports Med 1985;13:22-6.
3. Wood L. Ferrell WR. The response of slowly adapting articulra mechanoreceptors in the cat knee joint to alterations in intra-articular volume. Ann Rheum Dis 1984;43:327-32.
4. Ferrell WR, Tennant N, Sturrock R, Ashton L, Creed G, Brydson G, Rafferty D. Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility syndrome. Arthritis & Rheumatism, 2004; 50:3323-28.
5. Barton LM, Bird HA: Improving pain by the stabilization of hyperlax joints. J Orhtop Rheumatol, 1996; 9:46-51.
