A Note About Hypermobility - Dr. Rob Pape

Originally posted December 13, 2016 to www.nycbodymechanic.com

A Note About Hypermobility Syndrome

Are you double jointed? Can you hyper-extend your elbows, knees or other joints? You may be "hypermobile."

One of the most challenging of all patients to help in practice is the hypermobile patient. This is because hypermobility can lead to Hypermobility Syndrome (HMS). HMS tends to affect many parts of the body and mind. Anxiety, digestive issues, hypersensitivity to light or sound, and chronic muscle and joint pain are regular features of HMS. And these are often the tip of the iceberg.

Super flexible pretty much everywhere, with muscle pain that seems impervious to the deepest of deep tissue work, the hypermobile patient can be a big challenge. After struggling with these cases early on in practice, and not being able to provide a long term solution, I started studying the similarities and came up with a new theory (to me, anyways) about how HSM works. It is centered around two concepts: the Joint By Joint Theory, and Hyper-Sympathetic Nervous System Tone.

The Joint By Joint Theory postulates that the muscle and joints of the body need equal amounts of mobility and stability to function properly. Each region of the body, and the body as a whole, should have a 50/50 mobility to stability ratio. 

Obviously, the HMS person is going to upset that ratio from go. Being super flexible in multiple areas, mobility/stability might be 80/20 in the neck, hips, shoulders and other joints. The body tries to balance this ratio by creating stability in the place structurally built to absorb it: the rib cage and mid back. 

The mid back and rib cage become highly fixated and stiff in the HMS person, even while they are super flexible everywhere else. This fixation of the rib cage and mid back leads us to the second concept, Hyper Sympathetic Tone.

You have heard of the Fight or Flight part of our nervous system. It kicks into gear when we have a stressor. It is designed to help us flee from danger. The sympathetics are the fight or flight nervous system, and are built for short bursts of intense activity. The sympathetics are in a constant tug of war for control of our bodies with the parasympathetics, which we refer to as the Rest and Digest part of our nervous system. The parasympathetics are in charge of, you guessed it, rest and digestion! And we want balance between these two parts of our nervous system. Neither side should dominate in this tug of war.

So here's the connection: the sympathetics are located in the spine at the same levels as the rib cage and mid back. The increased fixation of this area leads, theoretically, to a constant stimulation of the sympathetics, as if someone turned the volume up on a radio to 10 and left it there. This allows the sympathetics to run wild, completely dominating the parasympathetics in their ongoing tug of war. Which, theoretically, leads to the constellation of symptoms we see in the HSM person: chronic pain, irritable bowel syndrome, anxiety, hypersensitivity, among many others.

We have been working on new treatment protocols to address this imbalance in our NYC and Oakland offices. My colleagues and I are combining forces to comanage the HMS population with this new theory in mind. We are seeing promising results.

For more information on HMS, please check out http://hypermobility.org. For more information about what we are doing in Oakland, don't hesitate to contact us at chirofitnessoakland@mac.com.

Posted on March 26, 2017 .