Having my final placement at B3 Therapy has opened my eyes to the many different opportunities physiotherapy can offer!
I’ve learned so much about both vestibular and orthopaedic rehabilitation. I’m excited to learn more about what contributes to dizziness and hope to even practice as a vestibular therapist myself! Haley has offered me a great foundation for vestibular rehabilitation, and I cannot wait to learn more once I get into my own practice. Catherine has also been fantastic at providing me opportunities to learn, practice and hone in on my manual therapy and orthopaedic physiotherapy skills!
Through my time with Catherine, we have noticed some cases of individuals with hypermobility reporting more chronic pain than those without hypermobility. This prompted me to look into the research to determine if there was a link and, if so, what that link is. Though this area of research is relatively new there are some contributing factors.
What is chronic pain in adolescents (ages 10-19 years old)?
The prevalence of chronic musculoskeletal (muscle, tendon, ligament, or bone) pain in school-aged children and adolescents can range from 4-40% globally. Chronic pain is pain that lasts longer than three months and can be due to muscular, ligamentous, or bony structures. This can have a lasting impact on physical functioning and activities (such as participation in sports or hobbies), mood (feeling down or different due to the pain) and social life and reduce the overall quality of life of adolescents.
What is generalized joint hypermobility?
Generalized joint hypermobility is a condition that results in an increased range of motion in one or more joints in the body (i.e., increased flexibility).
This can result in:
- Soft tissue injury (muscle strains or ligament sprains)
- Joint instability (dislocations or feelings of being unstable)
- And/or chronic musculoskeletal pain
When these signs and symptoms are present, this is known as joint hypermobility syndrome.
So, why do individuals with joint hypermobility experience chronic pain?
When individuals have chronic pain, there are one of two things that can happen.
- Pain can be interpreted by the brain as non-threatening and a part of the life experience.
- This gives us important information on how far to push ourselves.
- The individual will then continue performing activities as usual, interpret the pain as non-harmful, and maintain regular activities and hobbies.
2. Pain can be interpreted is that it is seen as threatening and a warning to stop doing activities.
- This can lead to avoidance of activities we once enjoyed, which can result in weakness of muscles (due to not using them) and even mental health concerns.
- These all play a role in the decrease of an individual’s pain tolerance, therefore creating a cycle in which pain causes individuals to continue to avoid movement.
- This can lead to fear around movements, which is very common in individuals with hypermobility.
Many other factors also contribute to why individuals with hypermobility experience chronic pain, such as:
Injury:
Individuals with hypermobility disorders are at higher risk of injuries such as muscle sprains, tendon injuries, or dislocations when compared to non-hypermobile individuals. Micro-traumas to the joints due to repetitive injuries on the joint surface can lead to joint instability or connective tissue fragility. This can cause compensations resulting in overloading of other joints and muscles, or leading to more pain. Individuals with hypermobility also tend to require more time for recovery between injuries, which can prolong the pain experience.
Pain Experience:
Joint and muscle pain is the most common complaint amongst individuals with hypermobility disorders, with the most common areas being:
- Neck
- Shoulders
- Knees
- Ankles
Individuals with hypermobility are also at increased risk of having hyperalgesia (increased sensitivity or pain response). This means that individuals might experience increased pain even from a non-harmful stimulus (such as when you lightly bump into a doorway with your shoulder and it causes excruciating pain). This can increase the risk of developing persistent or chronic musculoskeletal pain.
Avoidance Behaviours and Disuse:
Avoidance behaviour is when an individual puts off performing a particular activity or task. Individuals tend to do this to potentially reduce the risk of experiencing pain. Those who are avoiding certain activities are often influenced by the beliefs of recommendations of healthcare providers or those around you.
Pain, fatigue, and fear of injury are common barriers reported by individuals with hypermobility to participate in physical activity and exercise. Adolescents with hypermobility tend to avoid more dynamic exercises (like sports) that require more balance and put stress on ligamentous tissues compared to static activities (like cycling and walking). In addition, children and adolescents with hypermobility tend to withdraw from gym class and avoid sports. This often results in de-conditioning and reduced social time with friends. Overall, this can significantly impact the quality of life for children.
Reduced Proprioception:
Research has shown that individuals with hypermobility tend to experience decreased joint proprioception. Proprioception is information from the joints, muscles, and nerves about where our body is in space. Due to hypermobility, this input is altered creating poor body awareness that can increase the risk of injuries.
How can physiotherapy help?
With physio we can work collaboratively with you to create goals regarding the things that mean the most to you! Whether that’s playing with friends or getting back into sports!
Physiotherapy can help through:
- Pain science education
- Muscle endurance & strength training
- Proprioceptive (body awareness) & balance exercises
- Help you reach your goals, get back to the things you LOVE & NEED to do!
This can help reduce the risk of dislocations, increase proprioception, decrease the intensity and frequency of pain, and return you to the things you love!
References
1. van Meulenbroek T, Huijnen IPJ, Simons LE, Conijn AEA, Engelbert RHH, Verbunt JA. Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain. 2021;21(1):22–31. Available from: https://doi.org/10.1515/sjpain-2020-0023
2. Reychler G, De Backer MM, Piraux E, Poncin W, Caty G. Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review. Am J Med Genet A [Internet]. 2021 Oct 1;185(10):2986–94. Available from: https://doi.org/10.1002/ajmg.a.62393
3. Scheper MC, De Vries JE, Verbunt J, Engelbert RHH. Chronic pain in hypermobility syndrome and ehlers-danlos syndrome (Hypermobility type): It is a challenge. Vol. 8, Journal of Pain Research. Dove Medical Press Ltd.; 2015. p. 591–601.
4. Baeza-Velasco C, Cohen D, Hamonet C, Vlamynck E, Diaz L, Cravero C, et al. Autism, Joint Hypermobility-Related Disorders and Pain. Vol. 9, Frontiers in Psychiatry. Frontiers Media S.A.; 2018.5. Karagiannopoulos C, Griech SF. Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults. Journal of Hand Therapy [Internet]. 2024; Available from: https://www.sciencedirect.com/science/article/pii/S0894113023001618