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Hypermobility Syndromes

Joint Hypermobility Syndromes

The term Joint Hypermobility Syndromes, JHS, refers to the condition where a person’s joints are unstable because their ligaments are weak and loose (‘hyperlaxity’) and they may have poor muscle tone.  This means that joints tend to bend beyond the typical movement range. The Alexander Technique can help people with this and many of the other problems associated with joint hypermobility syndromes.

There are a number of diagnostic terms used to describe the various manifestations of the condition.  For these terms and further information on joint hypermobility syndromes visit the Hypermobility Syndromes Association, HMSA

Joint hypermobility can be a heritable disorder.  It can also develop through repetitive stretching as can be seen in dance, yoga and athletics training.

Asymptomatic Hypermobility

Roughly 1 in 10 people have some level of hypermobility but only some would call themselves  ‘double-jointed’.    Like many conditions, hypermobility syndromes come over a wide spectrum, from minimal to severe enough to be disabling.  However, most people experience very few problems and they have ‘asymptomatic hypermobility’.

This child’s arm shows classic signs of hypermobility in her elbow joint

Several members of her family are also hypermobile.

Symptomatic Hypermobility

A smaller number of people have ‘symptomatic hypermobility’.  Symptoms include:

  • Joint instability and hyper extension. This can lead to subluxations and even dislocations
  • Constant pain, with a tendency towards sprains and strains
  • Poor proprioception, balance and coordination. People often have flat feet and feel rather clumsy
  • Thin, stretchy skin that bruises easily and takes a while to heal
  • Bowel and bladder problems
  • Autonomic disfunction with dizziness and fainting, particularly when standing up quickly. (PoTS) . they may also have poor temperature regulation
  • Chronic fatigue

Some Signs of Joint Hypermobility

This photo shows some mild joint hypermobility in the shoulders, elbows and thumbs

Hypermobility Syndromes and the Alexander Technique

Alexander lessons can help many people with hypermobility issues, particularly those to do with proprioception.  Gaining more sense of where our body is in space can help improve our coordination, balance and confidence. Learning how to reduce tension can also reduce our pain and help improve energy levels.

I personally have taught many pupils with general hypermobility syndrome. One pupil could stand with his body facing me but have his toes pointing behind him! An interesting example of unstable joints and hyperlaxity.  I have also taught clients with Ehlers Danlers Syndrome, EDS, and Marfan Syndrome, MFS, which are two of the more severe forms of JHS conditions.

The NHS Consultant Rheumatologist Dr Philip Bull FRCP, who is on the HMSA Medical Advisory Board, is a great advocate of using Alexander Technique lessons for hypermobility patients, often alongside Physiotherapy.  He has seen how hypermobility syndrome patients are helped by learning the Alexander Technique and has written articles on the topic. Dr Bull states that ‘patients with hypermobility found it particularly helpful; some even life changing’ .

You may read and download Dr Bull’s article about Hypermobility Syndromes and the Alexander Technique  here.

 

 

Crepitus

Crepitus comes from the Latin for ‘a crackling or rattling sound‘ and it is a medical term that refers to all those little clicks, cracks, pops and grating crunchy noises that can be experienced when we move around. 

Crepitus can occur when bones in our joints rub together as a result of damage to the cartilage, to the bone itself as in osteoarthritis, or sometimes when there is damage to an intervertebral disc which could result in the vertebrae rubbing against each other. It is possible to hear these noises, the grating can very often be felt internally and may or may not be associated with pain. An audible sound of crepitus can be one of the symptoms of bone fracture.

It is also possible to have little popping noises occurring in our lungs or soft tissues when there is an abnormal area of air or gas under the skin. This type of crepitus does not concern us here as it tends to occur in various severe conditions that require medical intervention, which is not the remit of the Alexander Technique. 

However, the crunches that are experienced in our joints are very relevant to Alexander lessons. If we contract our muscles and increase the tension around our joints with our habits of contracting down into ourselves with mis-use, then crepitus is more likely to occur. Also, when we hear those crunchings, they can be a useful reminder and warning that we need to allow our muscles to unwind and free up. If crepitus is persistent or severe, it may be wise to seek a medical diagnosis as to the cause.

When we can learn how to allow our musculature to be more elastic and freely lengthening, it is possible to reduce the pressure around our joints so that the bones are less pushed together. This process can allow the joints to move more freely, which often reduces the crepitus and helps us to avoid creating further damage to our bones and joints. 

Orthostatic or Postural Hypotension

Orthostatic Hypotension or Postural Hypotension

Orthostatic Hypotension is the somewhat uncomfortable dizziness or ‘head rush’ sensations some people experience upon standing up.

When we move into an upright position too quickly, our blood can remain pooled in the lower part of the body, so there is not enough blood being pumped up to the brain, making us experience dizziness and other symptoms, usually on a temporary basis. 

Mild symptoms of Postural Hypotension often happen when people stand up abruptly and this is caused by a temporary drop in their blood pressure. It is more common in the elderly, in someone with low blood pressure, or possibly as a side effect of drugs but it can also be present in certain illnesses and physiological conditions that may need treatment.

If you experience symptoms of Postural Hypotension on a regular basis, this indicates that you need to visit a doctor in order to have your blood pressure checked and to see if there is an underlying condition which may be contributing to the problem. 

Postural Hypotension Symptoms are variable : 

Dizziness; Faintness; Nausia; Visual disturbances.

Shock

Similar symptoms may be experienced with shock, so it may be necessary to diagnose the cause of the symptoms if they are experienced strongly or frequently. Physiological shock can be life threatening and needs immediate treatment.  Profound psychological shock can leave us with symptoms that are experienced for some years, for instance in Post Traumatic Stress Disorder (PTSD). 

Light-headedness

Less worrying and more common is the light-headedness and occasional other temporary symptoms, that can sometimes happen if people get up too quickly, for instance after practising the AT lying down procedure – so it is important to remember not to end gain and rush into getting up but to bring yourself back up to standing in a measured and thoughtful manner. If you are concerned about frequent dizziness or other symptoms, do visit your doctor.

Text Neck

Text Neck 

Text Neck is a buzz word used to define the syndrome that causes pain in the head, neck and shoulders, which is brought on because of the over-use and mis-use of smart phones, tablets, laptops and suchlike.

People often use this type of equipment on their laps, so they habitually pull right down towards the screen in order to use them. This means the heavy weight of the head is dragging down and over-stretching the muscles in the neck and shoulders, often for long periods of time. This strains the muscles and interferes with the finely-tuned balance of the head and the neck, which results in pain.

Unfortunately many young children have already been diagnosed with having painful Text Neck and this could continue to cause problems later in life if not addressed. However, if these unhelpful habits are recognised, altered and people can learn how to let go of them, then they can begin to reduce and even stop the pain.

Torticollis or Wryneck

Torticollis – Wryneck is a form of Cervical Dystonia

Torticollis is a condition where a person’s head and neck are constantly twisted by spasms in their neck muscles. These contract down towards one side all the time, often with abnormal rigidity. This old Private Eye cartoon says it all! Torticollis may develop gradually or suddenly and babies may be born with Congenital Muscular Torticollis.

Acute Torticollis or Wryneck

This is the term given when the condition arrives suddenly. For instance a person may wake up to find they slept in a distorted position and have such a stiff neck that they cannot move their head from side to side. This problem often resolves itself fairly quickly.  But a wise person would ask themselves what they might have been doing to bring it on and then find a way of avoiding it happening again.

Diagnosis

When severe, torticollis may be associated with damage to the cervical vertebrae and discs. Diagnosis is essential when there are symptoms such as chronic neck pain with numbness in the hands and arms. This numbness not only poses a threat to many careers but indicates an underlying problem where the nerves are being irritated.  The cause needs to be known, to check for a prolapsed disc and to rule out illnesses such as meningitis, particularly if the person has a fever.

Causes and Development of Neck Pain

Torticollis can be caused by accidents, injuries, tissue scarring and shrinkage.  It can also be brought about by mental states such as anxiety and habitual patterns of poor body use, as in the image above.

Poor posture and long-term mis-use of the body, that disturbs the natural muscle balance in the neck, can lead to the gradual development of torticollis. Unfortunately, many children hunch over school books, holding the pen in a contracted, twisted manner whilst writing. This is a habit they often take into adulthood and then gradually develop neck pain – unless they learn to let go of the habit. Also babies whose heads are left lolling down to one side as they sleep in pushchairs, must be vulnerable to wryneck developing. Over time the neck muscles can get used to being contracted in this way and they become fixed so that torticollis can develop.

There are also work situations which require a person to incline their head and body in one direction constantly. Radiologists for instance, or violinists, often resort to pulling their heads down to one side quite tensely in order to work or hold the violin in place. Dentists often lean down over patients at an angle and a twist – for hours on end all their working lives! If such activities are performed without looking after the head-neck-back relationship and general body use, then problems such as torticollis and neck pain are likely to develop.

Treatment 

In extreme cases, botulism can be injected into the muscle to stop the spasm for a few months. Surgery to partially cut and release the contracted muscle is sometimes used as a last resort.  Physiotherapy to help stretch out the muscles can be helpful.

Can the Alexander Technique help Torticollis?

Fortunately, it is possible to improve one’s body use by learning the Alexander Technique so we can avoid the habits of twisting and contracting that contribute to torticollis. Through the gentle guidance of the Alexander Teacher, it is possible to re-educate muscles so that they can relax and ease out of the neck spasm.  This puts less pressure onto vulnerable discs and nerves and begins to re-establish the natural head neck back relationship.

Many violinists for instance, have been saved from constant pain which could threaten their careers, by applying the Alexander Technique to playing.  They can learn to hold and play their instrument in a manner which does not cause them harm. When they learn how to maintain a freedom and resilient lengthening of their muscles, they can avoid going into spasm whilst playing.

Research into the Alexander Technique and Neck Pain

More generally, a major research study, the ATLAS Research Trial (2015) has shown that the Alexander Technique produced “clinically relevant reductions in neck pain and associated disability” for people with chronic non-specific neck pain.

http://annals.org/article.aspx?articleid=2467961 

If you would like to discover how the Alexander Technique can help you with neck pain and other conditions, you can contact me to arrange an Introductory Alexander Lesson:

Contact Hilary King

Stenosis

Stenosis is a term that comes from the Greek word that means ‘narrowing’

Stenosis is the abnormal narrowing of a tubular structure within the body, such as a duct or blood vessel. This narrowing to an internal passageway, usually creates some sort of blockage or pressure which causes problems and pain.

The condition that is frequently seen by Alexander Technique teachers and is therefore of more relevance to their work with their pupils, is spinal stenosis.

 

 

 

Spinal Stenosis

Spinal Stenosis is the narrowing of the spinal canal and can occur in the cervical, thoracic or lumbar areas of the spine – or sometimes in more than one area at the same time. This narrowing can be brought about by the degeneration of the vertebrae through conditions such as wear and tear from ageing or from general mis-use of the body which creates a continual downward compression through the spine. Other causes are tumours, osteoporosis and a number of pathological conditions. 

Spinal stenosis can also be created by a prolapsed or herniated spinal disc, which can bulge and get pushed out of place, narrowing the spinal canal,  thereby compressing and damaging the spinal cord and nerves. This can cause acute and sometimes chronic back pain. Gradually, if the problem is not addressed, the condition can also lead to numbness, weakness and sometimes a reduced ability to control limb movements, bowels or bladder.

As a final resort, decompressive surgery may be used to relieve the condition.

However, many people would prefer to avoid surgery if possible and it is at this point that they may start Alexander Technique lessons. Over the years, many pupils have indeed avoided having spinal surgery in this way.  

Someone learning the Technique can begin to use their bodies more freely and in a more aligned manner, so that their musculature can relax and begin to lengthen out again – rather than being tightly contracted and creating the downward pressure through their bodies that causes restriction and damages the spine and other parts of themselves as they move around.

Instead of this unhelpful way of using their bodies, pupils will learn to bring about a more buoyant and expansive way of moving around, so that they relieve the pressure on their discs and vertebrae. In this way their discs are often able to regenerate, at least to a degree, which allows the vertebrae to re-align enough to reduce the pressure on the spinal cord and spinal nerves.

Our spine is a little bit like a drinking straw in that if you push down onto a straw, it will buckle and in doing so will stop any fluid going through. If you lengthen the straw out again, fluid will once again be able to go through the gap in the middle.

If the spinal stenosis has been caused by something like a tumour, then it may be possible to use the Alexander Technique in the way outlined above, in order to minimise the discomfort and to stop any avoidable pain.  However, if the stenosis has mainly been brought about through the way that a person has been using their body as they sit, stand and move around, they can often reduce the pain almost entirely through using the Technique.

The fact that learning the Alexander Technique can help someone to reduce chronic back pain, which may have been brought about for a variety of reasons, has been supported by the ATEAM Research Trial, which was published by the BMJ in 2008.

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