Exercise as it relates to Disease/Exercise and hypermobility syndrome

Hypermobility syndrome also called Ehlers-Danlos Syndrome Type III is a disorder that is quite common yet doesn't have a lot of research. Hypermobility syndrome is strongly inherited and more common in females. People with hypermobility are born with a higher range of motion in their joints caused by a heritable collagen defect. There are other types of Ehlers-Danlos Syndrome so it is important to rule these out before to avoid the complications of that specific type, these include :

Someone with hypermobility can become flexible much quicker than the average person. This move which can take a normal person months can be achieved in days to weeks for someone with hypermobility

Type I & II: elastic skin slight hypermobility	Type IV: thin skin, possible organ failure, only the fingers are hypermobile
Type V: linked to a single family, unknown facts	Type VI: joint laxity and severe muscle weakness
Type VII A & B: congenital hip dislocation & severe joint laxity	Type VIIC: severely fragile skin

Symptoms

-Bruising	-Delayed motor development
-Excessive joint motion	-Flat feet
-Fractures	-Gaining flexibility quicker than the average person
-Higher chance of scoliosis	-More prone to joint injuries such as dislocations and sprains
-Nerve compression disorders	-Osteoarthritis
-Painful joints	-Soft tissue rheumatism

Diagnoses

Beighton Score test

Beighton score over 4 is considered Hypermobility

• Touching thumb to wrist (1 point per side)
• Little finger goes beyond 90 degrees (1 point per side)
• Hyperextension of the knee (1 point per side)
• Hyperextension of the elbow (1 point per side)
• Touching the floor with hands flat and legs straight (1 point)

Treatment

General

Short term solutions	Long term solutions
-Analgesics such as NSAIDS	-Education
-Compression	-Keeping weight at the lower end of a healthy BMI
-Taping	-Physical activity
	-Physiotherapy

Exercise

Life long commitment to exercise can lower the discomfort associated with hypermobility syndrome. As with all recommendations it is best to live an active life so aim for 30 minutes a day of light to moderate exercise. Exercises should be gentle and pain free. These include:

-Cycling	-Light strength training	-Pilates
-Rowing	-Some forms of dance	-Some forms of yoga
-Swimming	-Tai Chi	-Walking
-Core exercises	-Balancing on one leg	-resistance bands

However there are exercises that should be avoided these include:

• Exercise that includes excessive stretching
• Sports with high collision risks such as hockey and football
• It is best to avoid breast stroke as it may cause hip pain

Further reading

• http://hypermobility.org/
• http://www.lifewitheds.com/
• http://www.ednf.org/
• http://edsaus.ning.com/
• Pain diary
• Exercises by a woman suffering with hypermobility syndrome

References

1. Chelsea. What is HMS?. Available: http://hypermobilityhope.blogspot.com.au/p/what-is-hms.html. Last accessed 23rd Oct 2013.
2. HMSA. (2013). Genes & Inheritance. Available: http://hypermobility.org/help-advice/genes-inheritance/. Last accessed 23rd Oct 2013.
3. Ehlers-Danlos National Foundation . What are the types of EDS?. Available: http://www.ednf.org/index.php?option=com_content&task=view&id=1348&Itemid=88888969. Last accessed 23rd Oct 2013.
4. William C. Shiel Jr., MD, FACP, FACR. (2011). Hypermobility Syndrome. Available: http://www.medicinenet.com/hypermobility_syndrome/page2.htm. Last accessed 21 Oct 2013.
5. MAJ Michael R. Simpson, DO, MC, USA. (2006). Benign Joint Hypermobility Syndrome: Evaluation, Diagnosis, and Management. The Journal of the American Osteopathic Association. 106 (9), 531-536.
6. Dr A J Hakim MA FRCP. (2013). Clinician’s Guide to JHS. Available: http://hypermobility.org/help-advice/hypermobility-syndromes/jhseds-hm-clinicians-guide/. Last accessed 23rd Oct 2013.
7. Arthritis Research UK (2011). Condition: Joint Hypermobility. UK: Arthritis Research UK. 1 - 24.
8. Robyn Hickmott . (2013). Joint hypermobility syndrome. Available: http://www.medicalobserver.com.au/news/joint-hypermobility-syndrome. Last accessed 23rd Oct 2013.
9. Adam. (2012). Hypermobility and Sport. Available: http://thesportsphysio.wordpress.com/2012/08/19/hypermobility-and-sport/. Last accessed 23rd Oct 2013.