EDS Series Part II: Physical Therapy for Hypermobility

Manual Therapy

Manual therapy is a broad term that describes the use of specialized, hands-on treatment to manipulate joints and soft tissue. These techniques help to improve range of motion and tissue mobility, control pain, reduce soft tissue swelling, inflammation, and restriction, and facilitate relaxation. There are a few techniques I’ve found helpful for the EDS/HSD population:

• Soft Tissue Mobilization introduces varying pressures to muscles, fascia, tendons, and ligaments to improve blood flow, induce relaxation, decrease inflammation, break up scar tissue and rigid muscle tissue, and induce healing. Muscles in EDS/HSD often tighten up and spasm to provide stability to overly loose joints. Sometimes, certain muscles are tighter than others. Much like a tug-of-war battle, the tighter muscles “win” and pull joints into painful positions that are not ideal for proper function. By using soft tissue mobilization techniques to relax tense muscles, joints can more easily settle into a proper position. This can significantly improve pain symptoms and muscle function.
• Trigger Point Release uses deeper pressure on trigger points (taut bands of muscles often referred to as “knots” or spasms) to help them relax. Trigger points often refer pain to other areas of the body, known as referral patterns. Trigger points are deprived of oxygen, which leads to a buildup of metabolic waste and pain. By adding pressure and input to the areas, the body directs blood flow to these “knots” and helps to oxygenate the area. This can help decrease pain in local and referred pain areas as well as decrease the intensity of these spasms. Want to learn more about trigger points and referral patterns? Check out this interactive website or ask your PT to learn more.
• Joint Mobilizations use passive, gentle pressure on joints to assist in decreasing pain and improving joint positioning and mobility. In EDS/HSD, joints are particularly mobile and often move partially out of place (aka a subluxation). Ensuring that joints are in a proper position prior to adding strengthening and stability exercises is key to proper recovery. We want to strengthen joints while they’re in the proper position to help them function to the best of their ability.

Dry Needling

Dry needling is a technique used to decrease pain and improve muscle function. In my practice, I use a thin acupuncture needle and insert it into trigger points and connective tissues (think scar tissue, tendons, fascial adhesions, and more) based on what my patient may benefit from most. Typically, the needle is inserted to elicit a twitch response, which is a brisk contraction of the muscle fibers, usually around a trigger point. This has been shown to decrease pain and improve a muscle’s ability to function properly, though the mechanism behind it isn’t fully understood.

Dry needling can be uncomfortable, but if it’s the right treatment technique for you, it can make a huge difference in your pain and function. Typical side effects of dry needling can include soreness of the needled area, bruising, and redness. At SetPT, we use sterile techniques to avoid any risk of infection and are trained thoroughly to needle safely.

Dry Cupping

Cupping involves creating suction on the skin using a glass, plastic, or ceramic cup. At SetPT, we use suction devices to remove air from the cup to create the intended effect, known as dry cupping. We do not perform wet cupping, which involves piercing the skin to induce blood flow into the cup. 

Cupping can help to reduce pain and inflammation, improve blood flow to the treatment area, promote relaxation, improve nervous system function, and facilitate healing. It is considered a safe and non-invasive treatment technique and can be helpful for fascial restrictions or those who are too sensitive to tolerate dry needling or trigger point release therapy. Side effects are temporary and can include bruising or skin discoloration, increased sensitivity of the treatment area, and lightheadedness, dizziness, or nausea.

Splinting and Bracing

Because individuals with EDS/HSD have hypermobile joints, the use of splints or braces can be helpful to provide stability and decrease pain. Strengthening hypermobile joints to the point that they’re stable and controllable requires months of dedicated exercise, so we often seek assistance from stability devices to help prevent injury during this process.

To determine if a joint may benefit from a splint or brace, I perform a:

• subjective assessment, including a patient’s history of pain, joint subluxations or dislocations, and everyday activities that may require assistance
• hands-on assessment of the joint’s level of hypermobility and strength 
• visual assessment of how the joint functions with activities such as walking, navigating stairs, gripping objects, changing positions, and more. 

I have recommended splints and braces for the sacroiliac joint (SIJ), low back, knees, ankles, shoulders, neck, elbows, wrists, and more. In some cases, I will measure joints for custom-made splints that fit your needs. At this time, I am measuring individuals with HSD/EDS for ring splints, which provide stability to hypermobile finger and thumb joints. 

Some individuals with EDS/HSD may benefit from bracing beyond my abilities, and I will often recommend they see an experienced practitioner for custom foot orthoses or body compression suits, such as DMO suits.

Keep an eye out for Part III of this series for specific bracing and splinting product recommendations!

Taping

Taping is an invaluable technique used to relieve pain, improve joint stability, improve proprioception (the ability to feel where your limbs and joints are in space), facilitate or inhibit the activation of particular muscles, correct poor biomechanics, and prevent injury. 

In the EDS/HSD population, I often tape to inhibit overactive, painful muscles such as those pesky neck and shoulder muscles called the upper trapezius and levator scapulae. I also use tape on back muscles to “cue” the body to improve posture. One of the most helpful taping techniques I use, however, is to help provide stability and security to particularly hypermobile joints such as the shoulders and knees. 

The only drawback to taping is the risk of skin irritation. Those with EDS/HSD often deal with increased skin sensitivity due to Mast Cell Activation Disease (MCAD) or Syndrome (MCAS), which causes heightened allergic reactions to different stimuli. The adhesive on different types of tape can cause reactions such as redness, irritation, itching, blisters, or skin tearing. In my treatments, I will often use a skin prep wipe to create a skin barrier which can help decrease or eliminate this reaction. It often takes some trial and error, and ultimately, taping may not be the appropriate treatment technique for you if repeated irritation occurs.

Exercise, exercise, exercise

Exercise is the gold standard for treating EDS/HSD in physical therapy. Ligaments and other connective tissues are typically responsible for preventing joints from moving beyond their normal position. In EDS/HSD, these tissues are too stretchy, leaving the joints to move excessively. Unfortunately, we can’t fix these things in physical therapy, so we focus instead on what we can control: muscles. Muscles are the body’s secondary form of joint control. They allow us to move, lift, lower, pull, push, jump, sit, breathe, bend, and more. They also provide much-needed stability to joints when strengthened and trained appropriately.