Benign Joint Hypermobility Syndrome: What Women Need to Know - Part 2

Following on from our recent discussion regarding BHJS, this blog intends to enlighten you with a more complete picture of the symptoms and signs which present in this condition and how we can assist you.

Patients suffering from BHJS are known to suffer muscle cramps, tendonitis, headaches and a range of autonomic symptoms, which further indicate such a diagnosis.

Any relationship to bone mass?

Patients with benign hypermobility syndrome have significantly lowered t-scores referring to bone density, bone structure, and bone strength data, although never reach the threshold criterium for osteoporosis as proposed by the World Health Organisation.

So what exercises would I be benefiting from?

Among exercises, lower back stabilisation and closed kinetic chain exercises are most useful in improving joint stability and proprioception. For example, performing the push up reduces the amount of control needed compared to lying on your back pushing up dumbbells, whereby your hands (weights) are free to move and in the presence of laxity and impaired proprioception, may result in joint instability and injury.

Is there a link between BJHS and digestion?

It has been shown that those with BJHS have impaired propulsion of bowel contents demonstrable on GI physiological investigations. Because our digestive tract is also made up of connective tissue and contributes significantly to the passive mechanical properties of the gut wall, changes in the rate or degree of deformation/stretch in the gut wall are likely to influence the function of the bowel potentially leading to malabsorption issues. Unexplained abdominal pain is a very common complaint, seen in up to 86% of patients with BHS. Both Autonomic nervous system dysregulation and laxity in collagen comprising the gastrointestinal tract, may underlie increased pain generation.

How common are headaches in those with BHS?

Headache is a particularly troublesome symptom experienced by patients with joint hypermobility syndrome, with 75% of female patients suffering from migraines. Furthermore there is a strong association between benign joint hypermobility and temporomandibular (jaw) joint disease.

Is the nervous system involved?

About 75% of patients with joint hypermobility syndrome appear to have impaired autonomic reflexes. Although previously underappreciated, the decreased quality of life due to severe dysautonomia can be as high as in patients with congestive heart failure. Evidence suggests that there is increased sympathetic tone but decreased sympathetic reactivity to stimuli. As a result, patients tend to have Orthostatic hypotension (dizziness upon standing), gastrointestinal discomfort (such as early satiety, bloating, postprandial nausea/vomiting), and secretomotor complaints, including Raynaud phenomenon and abnormal sweating.

So, what can be done for the management of your symptoms?

No evidence is available regarding the use of opioids for the treatment of chronic pain due to hypermobility. Because the pathogenesis of pain in hypermobility relates more to chronic stresses, it does not stand to reason that opioids will help promote long-term alleviation of pain. Moreover, because opioid medications carry very significant risks, including the development of central pain sensitization, dependency, and the potential for abuse, these should not substitute for physical therapy and lifestyle modification all of which we provide at The Chiro Hub.

A potential link between Fibromyalgia, cardiac valve prolapses and BHS?

There is even evidence to suggest a link between those with BHS and chronic pain conditions such as fibromyalgia and cardiac valve defects. So, if you score 4 or higher on the Beighton 9-point scoring system, it may well be wise to have a cardiovascular examination in particular those with a family history of cardiac valve defects/abnormalities.

So, what’s the fuss? Just make me feel better Doc!

Whilst improving your symptoms and functioning, I would rather you be informed of the process that is happening within your body, rather than be treated the same way each time despite receiving positive relief. We must understand that the ambiguity of our complaints can surely lead to greater perceptions of fear, agoraphobia and panic disorders, and this (surprise surprise!) has been shown in those with BJHS. This ultimately can contribute to the pain experience.

Furthermore, it is important for those with hypermobility syndromes to understand that having the neck placed at the end range of its motion under long duration holds is deemed to be very risky and should be avoided.

Ensure that your clinician has examined your connective tissue quality and status!

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