The neuroscience behind pain
A straight forward, laymans explanation of the neuroscience behind pain - both short term and long term (chronic) pain.
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Pain Management
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Introduction
Introduction
Pain is a common part of hypermobility syndromes, and can vary a lot between individuals.
Pain can have a a variety of causes in symptomatic hypermobility, so different techniques might help at different times or with different types of pain.
Below are some suggestions that may help you manage some of your hypermobility related 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. Understanding your body and using 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.
Pain management techniques
General Pain Management Techniques
Medications
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
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.
Local Heat
The application of local heat may be soothing. Some methods include:
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Hot water bottles
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Baths
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Heat rub creams
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Heat lamps
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Ice gels
Relaxation
Daily sessions of muscle relaxation should help. If you feel that you might need help with relaxing, ask your physiotherapist to teach you some of the techniques, or members can have a look at the relaxations session videos in the members area.
Self Mobilisation
Performing self mobilisation techniques. These must be smooth and rhythmic.
Magnet Plasters / Bracelets
Magnet Plasters and bracelets help relieve pain for some people.
TENS
TENS units are useful for pain relief in many areas.
Movement and relaxation related pain management tips
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.
Joint position
Repeatedly realign hypermobile joints. Tune into your joints. Keep them in the neutral range (for example, don't sit with any joints resting at the end of their range, and make sure limbs are in a good position before picking anything up).
Stretching
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.
Ensure that you breathe with your diaphragm. It is important that you oxygenate your body maximally to keep the tissues healthy and energetic. The diaphragm is the most energy efficient muscle of respiration.
Exercise
Isometric / static strengthening exercises should be done to stabilise the joints.
Balance education and proprioceptive improvement exercises should be encouraged too.
Abdominal muscle strengthening exercises are important. 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.
Keep your joints moving without overstretching - Yoga (focused on strengthening and control rather than increasing flexibility), Pilates exercises, and Tai Chi are worth trying.
Movement and exercise
Pacing
Pacing
Have a daily programme of management; pace your activities, avoid repetitive tasks and fixed positions,
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.
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.
There may be a need to support the flat foot with insoles and a referral to a podiatrist or physiotherapist may be indicated.
Change your way of life:
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Move frequently
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Correct your posture and and joint positions
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Take rest breaks
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Listen to your body.
Aids and appliances
Supports, aids and appliances
Spints and supports
Splints, clasps and supports can help to provide relief for elbows, knees etc.
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.
Lumbar Spine
'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
There may be a need to support the flat foot with insoles and a referral to a podiatrist or physiotherapist may be indicated.
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
Reviewed June 2021
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