Pain Management for Joint Hypermobility Syndrome
Below are some suggestions that may help you manage some of your hypermobility pain. There is some general advice and then suggestions as to some of the aids you may use to support various parts of your body.
Self Management of hypermobility pain, stiffness and muscle fatigue.
Understanding the condition and doing self-help techniques will help you to become independent of your doctor or therapist and will help you control the condition, not it control you. Re-educate your mind to repeatedly realign hypermobile joints. Tune into your joints. Keep them in the neutral range.
Relief of Severe Pain
Take strong enough analgesia to relieve pain and muscle spasm. Non steroidal anti-inflammatory drugs can be very effective, as long as you do not suffer from stomach ulcers as well. Panadol is effective in relieving post treatment pain. A very small dose of a muscle relaxant (such as Valium), can be helpful in the early stages of an acute episode of pain with marked muscle spasm. Discuss with your GP
Antidepressants can be effective for their muscle relaxant property and can promote good sleep.
Hydrocortisone Injections and Physiotherapy
For very severe, painful episodes, hydrocortisone injections and intensive physiotherapy, in the first 24 hours may be necessary.
The application of local heat (hot water bottles, baths, heat rub creams, heat lamps, ice gels) maybe soothing.
Performing specific local stretch techniques.
Performing self mobilisation techniques. These must be smooth and rhythmic.
Magnet Plasters / Bracelets
Magnet Plasters and bracelets help relieve pain for some people.
Splints / Clasps and Supports
Splints, clasps and supports can help to provide relief for elbows, knees etc.
TENS units are useful for pain relief in many areas.
Relief of Chronic Pain, Muscle Stiffness and Fatigue
Even if the person with hypermobile joints is pain free and leads a normal life, it is essential that full movement through their joint range is maintained.
Daily stretches are of paramount importance. The thoracic spine is the first place to stiffen in adolescents and 90° trunk rotation should be encouraged. To ensure 90° rotation to both sides, try sitting in a dining chair and twisting around to hold the back of the chair, so that your shoulders are at right angles to your pelvis. Repeat to the opposite direction. Do this once a day.
It is important that daily sessions of muscle relaxation should also occur. If you feel that you might need help with relaxing, ask your physiotherapist to teach you some of the techniques.
Ensure that you breathe with your diaphragm. It is important that you oxygenate your bodt maximally to keep the tissues healthy and energetic. The diaphragm is the most energy efficient muscle of respiration.
Isometric / static strengthening exercises should be done to stabilise the joints.
Balance education and proprioceptive improvement exercises should be encouraged too.
There may be a need to support the flat foot with insoles and a referral to a podiatrist or physiotherapist may be indicated.
Abdominal muscle strengthening exercises are important too. Prior to any movement of the upper or lower limbs, the trunk is stabilised by the automatic contraction of the abdominal muscles. When the abdominals are weak, the trunk, which includes the back, is less stable, limb movements are less co-ordinated and back injury more likely. Practise pulling in the low abdominal muscles and pelvic floor as you continue to breath normally and as you perform everyday activities.
Lying for 5 minutes daily, on your side or back, with your legs curled up, helps the discs imbibe water, thereby improving their hydration and shock absorbing properties.
Good hydration of body tissues is an essential factor in protection, repair and maintenance. Drinking plenty, (preferably water) before and after sport, is vital for healthy tissues.
Participating in racket sport has been found to significantly increase upper trunk strength and reduce the incidence of neck and shoulder pain.
Make sure you rest your joints each day. This does not mean that you must lie down and sleep but ensure you avoid fixed positions. FIDGET!! Only stay at one task or in any one position for a maximum of half an hour.
Have a daily programme of management; pace your activities, avoid repetitive tasks and fixed positions, keep your joints moving without overstretching, try taking up Yoga or Pilates exercise.
Change your way of life – the way you move; when to exercise; continually correct your posture; take rest times
Become a problem solver by managing daily tasks to suit your body. Look at ways of changing your environment so that, for example, work surfaces are at the correct height, avoid continually bending. Provide cushioning between your body and the world with softening aids, adaptations of your environment. These could include self help tchniques such as wedge cushions, strapping to prevent over movement of vulnerable joints, muscle and nerve mobilising exercises, massage and treatment of tender trigger points.
Head and Neck
Pillows: These come in a variety of shapes, degrees of softness and price. Car pillows help to support your neck, especially if you fall asleep. Desk slope (or ring binder files) help when you are writing.
Thoracic Spine and Shoulders
Gentle vibrating massagers can provide relief for stiff achy muscles.
‘Sitfit’ cushions, seat wedges, lumbar rolls, car support back rests, car seat wedges, mattress overlays, pillows laid lengthways in the bed to support your back and hips, big exercise balls or swiss balls (to help re-educate balance), kneeler chairs.
There are all sorts of aids to encourage good posture with computer use: shaped keyboards, paper holders, arm supports etc.
Knees, Hips, Feet and Heels
Shooting stick type seats to take on long walks, taking a second pair of shoes to work (with a different heel height), shock absorbing insoles and heel pads, pillows between the knees to sleep, metatarsal domes, support insoles (AOL / Formthotics).
Hands and Arms
Wide grip and light weight pens (Dr Grip), small bags that can be carried across the shoulders, back packs with wide cushioned straps and slings with velcro, front fastenings
Sharon Peck, Physiotherapist
To read more about aspects of the management of hypermobility syndrome, including exercise and health, osteopathy, occupational therapy why not take a look at the HMSA booklet “A Guide to Living with Hypermobility Syndrome” available alongside other booklets and books in the HMSA Shop