Kathleen Zonarich, PT

EDNF 2011 Conference

Initial Considerations:Get approval from your doctor or physical therapist

before starting any exercise program.This presentation is meant for those with Classic or

Hypermobility EDS (HEDS). If there are any cardiac/vascular issues, please discuss appropriate exercise levels with your doctor, specific to you.

This presentation is only meant to serve as a general template for an Individual Exercise Program. The specific exercises mentioned are not intended to be used by everyone. (consult your PT/doctor)

Benefits of Exercise for the General Population:

Combats chronic diseases such as:OsteoporosisDiabetesHypertensionHigh cholesterol

Maintains weightIncreases energy levels

Benefits of Exercise for the General Population (cont.):

Improves moodBetter sleepFunDecreases stressBoosts immune systemEnhances physical relationships

Benefits of Exercise for the General Population also apply to the EDS Population!

Recommendations for the General Population:

Aerobic Exercise:2 hours and 30 minutes per week of moderate

intensity aerobic exercise ; or1 hour and 15 minutes per week of vigorous

aerobic exercise

ANDMuscle Toning/Strengthening:

2 or more days a week

(Landr0, 2010)

Exercise Guidelines for the Disabled Population:

Research (Lee, 2003) indicates that individuals with disabilities may have benefits from as little as 30 minutes of slow exercise per day/ 5 days a week

Start out slowly, build your program at your own pace

Over time your body will adapt to your exercise routine, therefore you need to change your program to continue to challenge yourself

(Lee, 2003)

Overall Exercise Goals for the EDS Population:

Increase Function

Limit Disability

Use Appropriate Pacing /Sequencing

Follow “Success before progress” model

(Kerr, 2004)

Specific Goals for Exercising in the EDS Population:

Maintain/Regain normal range of motion

Correct and prevent movement dysfunction by re-training of:Postural controlPostural alignmentProprioceptionBalance

(Kerr, 2004)

Specific Goals of Exercising in the EDS Population (cont):

Achieving joint stability:Neutral joint position is most stable Core stability needs to be developed firstProximal to distal stability should follow

Create and Follow an Individualized Exercise Program

(Kerr, 2004)

Basic forms of muscle action:

Isometric

Istonic

Isokinetic

Types of Exercise:

AerobicAnerobicResistive

Against gravityFree weightsTherabandsBody weight

Components of a Balanced Exercise Program for the EDS Population:

Warm upStrengtheningROM/FlexibilityCardioBalanceProprioceptionCoordinationCool Down

Types of exercise that work well for the EDS population:

Aquatic- warm water better (90 degrees)Tai ChiLow- impact Cardio (aerobic)PilatesYogaWii

Exercise guidelines related to EDS:

Get approval from your doctor/therapist to start a “normal exercise program”

Normal ROM- perform exercise in normal range of motion. AVOID: hyperextension

Resistive exercises- can make joint instability more severe

Isometric ex- if too much force is applied, it can be bad for hypermobile joints

High impact- not recommendedProper form/body mechanics are essential

(Levy, 2010)

Tips for successful exercising:

Do the exercises in front of a mirrorProgress when you have success with current

level“No pain, no gain” – NOT for EDS Okay to have muscle soreness up to two days

after exercise, but you should not feel new pain or an increase in pain

Slow and steady wins the raceHave control throughout movement; if

something doesn’t feel right, stop

Exercise Program Sample 1 (HEDS – 12 year old girl)

12 year old girlNo Physical Education in schoolFrequent joint dislocations, especially at kneesWeak core musclesSevere pronation of feetVarying joint pain throughout body on daily

basis

Exercise Program 1: GuidelinesBegin with no resistance due to joint instability

and frequent dislocationsCore exercise to be the main focus, then

develop exercise for extremitiesLow reps to begin, progress to higher reps

then drop reps down and increase resistance slightly, build back up to higher reps

Focus to be in this order:StabilizationProximalDistal

(Tinkle,2010)

Exercise Program 1: Core(start with 5 reps each)

Pelvic tiltAbdominal crunches with arms crossed over

chestRotational abdominal crunches with arms

crossed over chestProne leg liftsProne opposite leg/arm liftsProne supermanProne plank - 10 secondsSide plank - 10 seconds

Exercise Program 1: Legs(start with 5 reps each)

Short arc quadsWall squatsStraight leg raise (supine)Standing exercises (hold on to kitchen sink as

needed)Hip flexionHip abductionHip extensionHam curlsHeel raises

Exercise Program 1: Arms(Start with 5 reps each)

Standing PositionArm circlesWall push upsBall exercises: (small light weight playground

ball)RowingCircles (clockwise and counter clockwise)Push ball up over headPush ball out in frontFull arc in front overhead and down to hipsBicep curls

Shoulder height abduction/adduction

Exercise Program 1: Balance(stand at kitchen sink/hold on as needed)

Start with 30 second holds if ableStand on one legStand on one leg with eyes closedStanding tree poseStar fish against the wallWarrior Raise up on toes

Exercise Program 1: FrequencyHow Often:

Cardio 2-3 days per weekExercises 3 times per week with one day rest

between each specific exercise type

General Considerations:Exercises do not have to be done in one block of

timeIf you are at a lower level, break up the exercises

throughout the day or alternate arms and legs on different days, etc.

Exercise Program Sample 2 (HEDS – 40 year old female)

40 year old femaleChronic dislocations of hipsBilateral knee painPronation of both feetUpper extremity weaknessSub-luxing right shoulderDesk jobUnsuccessful attempts to exercise in the past

with increased pain

Exercise Program 2: GuidelinesBegin with no resistance due to joint instability

and frequent dislocationsCore exercise to be the main focus, then

develop exercise for extremitiesLow reps to begin, progress to higher reps,

then drop reps down and increase resistance slightly, build back up to higher reps. Begin with 5 reps.

Focus to in this order:StabilizeProximalDistal (Tinkle, 2010)

Exercise Program 2: Core

SupinePelvic tiltBridgingKnee rollArm reach between kneesArm reach to opposite knee

Exercise Program 2: LegsSupine

Quad setsHam setsGlut setsHeel slidesHooklying hip abduction/adductionHip abduction

ProneKnee flexion

SidelyingHip extension

Exercise Program 2: ArmsSupine

Shoulder FlexionShoulder abductionBicep curlsInternal/external rotationHorizontal shoulder abduct/adduction

Sitting Same as above will make it more challengingBall catch (closer to center of body is easier)

Prone Elbow extension with arm hanging off bed

Exercise Program 2: BalanceSitting balance unsupported

Balloon tossBall toss (more challenging)

Standing balance (holding on to sink as needed)Static stand

Eyes open/closedUnilateral stand

Eyes open/closedLow level yoga pose

Standing tree with toe on floor rather than at knee

Exercise Program 2: FrequencyHow Often:

Cardio: 2-3 days per weekExercises: 3 day per week with 1 day of rest

between each specific exercise type

General Considerations:Exercising does not have to be done in one block

of timeIf you are at a lower level, break up the

exercises throughout the day or alternate arms and legs on different days, etc.

General Exercise Progression Guidelines: (in order of easiest to hardest)

AbdominalsSitting on ball or chair reclinedOn floor against gravity

Arms crossed over chest Arms at side of head Arms over head extended Medicine ball at chest Medicine ball with extended arms

General Exercise Progression Guidelines: (in order of easiest to hardest)

Arms/LegsSupported by surface (gravity eliminated)

Partial range of motion Full range of motion

Against gravity range of motionUse of body weight for resistanceLight weight resistance Heavier weight resistanceMachines

General Exercise Progression Guidelines: (in order of easiest to hardest)Balance

Sitting Sitting balance supported Sitting balance unsupported Dynamic sitting balance

Standing Static

Supported Unsupported Hard surface to soft surface

Dynamic Hard surface to soft surface Bilateral to unilateral

Resources on the Internet

Exerciseismedicine.orgProvides exercise videos and self assessment

tool for individuals with diseasesHealth.gov/paguidelines

2008 Physical Activity Guidelines for Americanswww.myrafitkit.com

Provides personalized exercise program with demonstration (For the EDS population- flexibility should be only within normal range)

Questions???

now or later…..

kathleenzonarich@gmail.com

Works Cited: Kerr, PT, Rosemary. "Management of the Joint Hypermobility Syndrome: the

Therapist's Contribution." Jointandbone.org. Joint and Bone: Musculoskeletal Disease Online, 30 Sept. 2004. Web. 3 July 2011. <http://www.reumatologia-dr-bravo.cl/para%20medicos/HIPERLAXITUD/www_jointandbone_org_RODGRAH.htm>.

Landro, Laura. "The Hidden Benefits of Exercise - WSJ.com." Business News & Financial News - The Wall Street Journal - Wsj.com. Wall Street Jounal, 5 Jan. 2010. Web. 03 July 2011. <http://online.wsj.com/article/SB10001424052748704350304574638331243027174.html>.

Lee, Thomas, and P. Skerrett. "ViewNewsletter." Harvard Heart Letter. Harvard Health Publication Newsletter, 15 Aug. 2003. Web. 03 July 2011. <http://harvardhealth.staywell.com/viewNewsletter.aspx?NLID=2>.

Levy, MD, Howard. "Ehlers-Danlos Syndrome, Hypermobility Type - GeneReviews - NCBI Bookshelf." Ncbi.nlm.nih.gov. National Center Biotechnology Institute: National Institute of Health, 14 Dec. 2010. Web. 03 July 2011. <http://www.ncbi.nlm.nih.gov/books/NBK1279/>.

Tinkle, Brad T. Joint Hypermobility Handbook: a Guide for the Issues & Management of Ehlers-Danlos Syndrome Hypermobility Type and the Hypermobility Syndrome. Greens Fork, IN: Left Paw, 2010. 94+. Print.

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