If you type the word ‘contortionist’ into google search you are presented with many images of people with legs wrapped around their heads or completing the ‘splits’ . If youve ever been told that this is the result of practice then think again such feats of flexibility are part of a phenomena termed hypermobility, however in some cases it is extreme.
General hypermobility is common , children are commonly observed to have increased mobility,this usually reduces with age. Also increased ranges of mobility are observed in pregnancy due the influence of hormones. We treat many vegetarians , as we have many links with yoga practitioners in Birmingham they prefer to follow a “no meat “ diet ethically and for general health . As an observation at spinalsolutions Osteopathic Clinic I have observed that this client group tend to have greater joint laxity this is probably due to some change in the collagen or based on reduced protein levels, certainlyI have observed improvement if the diet is adjusted for a higher level of dietary protein.
However outside of the normal and general presentations of hypermobility there are levels of laxity that increase potential for joint damage and those that are known pathologies which may also affect arteries and viscera.
When forces are applied to ligaments either ‘sudden’, through sustained elongation, traction or repetitive force there is injury but also a process of deformation ,the response is time dependant. Loading Ligaments results in increased heat and plastic deformation known as creep . Recovery from deformation is possible, and in normal subjects may occur after a rest period of 25 to 50 minutes. In addition if these ligaments tear they heal by replacement with scar tissue which does’nt have the same elastic properties. Ligaments can only handle around a 10 % change in legnth before undergoing permanent damage.
Trauma to a previously normal joint can lead to ‘local hypermobility’ of the damaged area, this is especially the case in the ankle and the knee which have a great range of motion in certain planes . We tend to see this type of injury in footballers as the knee is exposed to twisting and shearing forces , through the action of kicking and sharp changes of direction that occur during “dribbling” . Generally we see these injuries reported as an anterior cruciate or posterior cruciate ligament . These ligaments crossover through the joint articulation .When examining joint movement passively ,one can appreciate 2 barriers , the physiological barrier which is the soft tissues and ligaments and the anatomical barrier usually based on the shape of the bones making up the articulating surfaces or at the point of extreme compression of the joint . These restrictions make up what is described as ‘The range of Motion’. Some ligaments make up a supportive structure for organs however they have a different function to those contributing to joint support and movement.
Joint hypermobility is often hereditary (runs in families). One of the main causes of joint hypermobility is thought to be genetically-determined changes to the collagen that makes up the ligaments. As mentioned above, Collagen is found throughout the body – for example, in skin and ligaments (the tough bands that link two bones together at a joint).If collagen is weaker than it should be, tissues in the body will be fragile. This can make ligaments and joints particularly loose and stretchy. As a result, the joints can extend further than usual.
Most cases of joint hypermobility are thought to be linked toEhlers-Danlos syndrome hypermobility type, which is a group of inherited conditions that affect collagen proteins in the body.
Occasionally, joint hypermobility may be part of a rare and more serious condition such as:
- osteogenesis imperfecta – a condition that affects the bones
- Marfan syndrome – a condition that affects the blood vessels, eyes and skeleton
- Ehlers-Danlos syndrome vascular type – a condition that can cause the arteries, bowel or womb (in pregnant women) to rupture (split)
How common is joint hypermobility?
It is not clear how many people in the UK have joint hypermobility. There are estimates that up to 3 in 10 people may be affected to some degree.
In many children, the joints become stiffer by the time they reach adulthood, although in some people, joint hypermobility and its associated symptoms continue into adult life.
Certainly hypermobility should be considered in any presentation of musculoskeletal pain , simple testing of ranges of motion around the body and feeling ‘the nature’ of the tissues may lead one to conclude hypermobility. A referral to the clients GP will then eliminate or confirm some of the pathologies mentioned above. However if negative, care will still need to be taken to ensure that joints are not overworked in the treatment process. In extreme cases it always a case of developing the treatment with the client , in some cases Osteopathic treatment may be unsuccessful or inappropriate.
Solomonow, M. Ligaments: A source of musculoskeletal disorders. Anatomy, physiology, pathophysiology review. Journal of Bodywork and Movement Therapies 2009 (13):136-154.
Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column. Spine. 1982 Mar-Apr; 7(2):116-2