It has recently come to my attention that there is somewhat of a correlation between hypermobility (excess flexibility) and pelvic floor dysfunction. This led me down a path of discovery that has been really helpful for my clients. It has allowed me to better help them move forward out of this chronic cycle of pelvic pain
Hypermobile Spectrum Disorders
Hypermobility is a broad topic in itself, but more specifically I want to discuss Hypermobile Ehlers Danlos Syndrome (H-EDS) and other Hypermobility Spectrum Disorders (HSD). H-EDS is a subtype of EDS and it is a disorder of the connective tissue, our body’s passive support system. This includes ligaments, joint capsules, fascia, etc.
Hypermobile EDS is one of the most common subtypes of EDS, but unfortunately does not have a clear genetic marker like other forms of EDS. Once the checkboxes for H-EDS have been met and all other connective tissue disorders have been ruled out, a patient will then be diagnosed with H-EDS.
HSD on the other hand, is diagnosed when someone does not check all of the boxes for H-EDS and other connective tissue disorders are ruled out.
Medical Limitations for Hypermobility Disorders
One of the major problems in treating these two is that the patient will often be sent to multiple providers in an attempt to treat the symptoms, not solving the true cause of the problem. There also tends to be a dismissal of symptoms with these patients because of medical providers’ limited understanding.
Screening for Hypermobile Disorders
When screening for these disorders within my practice, I use the Beighton Scale that includes tests such as:
Touch your palms to the floor without bending your knees
Observe for elbow hyperextension
Observe for knee hyperextension
Can they bend their little finger past 90 degrees
Can they touch their thumb to their forearm
The patient gets a point for each of the activities they complete, helping to indicate if hypermobility is present.
Another test I do is called the Five Point Questionnaire. This test takes into consideration not just where a patient is at today, but if they were able to do any of the tasks as a child. This allows us to be aware of previous hypermobility that may be a driving factor for the patient’s current symptoms.
Learn more about what to expect at a pelvic floor physical therapy appointment here.
Disability in the Hypermobile Population
These patients typically experience repeated joint dislocation/subluxation, chronic pain around the joints, history of labral tears, and repeated sprains and strains. Chronic headaches and migraines are also common. Pelvic dysfunction with these patients that I see in the clinic include prolapse, pelvic pain, pain with intercourse, chronic constipation, heavy periods, painful periods, and infertility.
Nervous System Deficits
These patients will also have what’s called dysautonomia, or difficulty regulating heart rate and blood pressure, resulting in difficulty regulating their “fight or flight” and “rest and digest” responses.
A more specific disorder in this category of dysautonomia is called POTS, or Postural Orthostatic Tachycardia Syndrome. POTS patients will have an elevated heart rate upon standing and symptoms of heart palpitations, dizziness, passing out, exercise intolerance, brain fog, or excessive fatigue. In terms of correlation, about 70% of people struggling with hypermobility will also be diagnosed with POTS.
Mental Health Struggles
Mental health disorders also can come into play with this population. These patients experience increased anxiety after years of searching for answers, symptoms of chronic fatigue, chronic pain, and an overactive sympathetic nervous system. Because of an overactive sympathetic nervous system, they may also struggle with Attention Deficit Hyperactivity Disorder.
Proprioception Impairments
Patients with hypermobility will also have impaired proprioception, or the awareness of their body in space. They may report feeling clumsy or “floppy” because their tissues don’t pick up the same sensory stimulation. Someone who is hypermobile does not have the same sensory response and can take their joints to an extreme position without pain or discomfort, resulting in injury.
You’ll also see these patients experience chronic muscle tension and pain likely drawing them to practice yoga. They choose yoga because they feel they need to stretch tight muscles, but in reality, this may do more harm than good.
Chronic Pain Syndromes
This overcompensation of the muscular system can oftentimes lead to tense, tight, and overworked muscles resulting in muscle fatigue and pain, often resulting in the diagnosis of fibromyalgia.
Fibromyalgia is widespread tenderness throughout the body and it is also often associated with fatigue and difficulty sleeping. This happens when the nervous system starts to generate pain responses, even when they’re not warranted.
Chronic fatigue syndrome is also another common diagnosis within the hypermobile population, characterized by extreme fatigue greater than 6 months in chronicity that is not relieved by rest and cannot be explained by any other medical condition.
Mast Cell Activation Disorder is an autoimmune disorder that impacts the mast cells of a person’s immune system, often affecting this population. Mast cells are one of the first lines of defense for immunity, but in this dysfunction, mast cells release their inflammatory molecules when not warranted. This often occurs in response to stress, anxiety, exercise, and extreme temperatures.
Learn about the impact of chronic stress on our bodies in my blog post here.
Hypermobility individuals often also have digestive issues like Irritable Bowel Syndrome, leaky gut, and chronic constipation. You might see them have food sensitivities and be on a restrictive diet because of these sensitivities.
Want a more holistic approach to addressing gut health? Check out my blog post here.
Taking a Holistic Approach
Sometimes a patient may be hypermobile and not have any of these chronic conditions. Knowing that they are hypermobile may help to explain some of their chronic symptoms and put them on a path to successful recovery. Knowing this information, we are better equipped to modify exercises and make referrals when necessary.
Without taking into consideration the full picture of the patient, we can sometimes get stuck in a rut and not be able to solve the problem. My goal with this information is to bring awareness to clinicians and patients. If a patient in front of you is struggling with these symptoms without reprieve, consider these disorders as a possibility.
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If you’re interested in learning more about this topic or have questions, feel free to reach out to us at 502-939-8564 or request a consultation here.