Top 5 Fridays! 5 Things You Need to Know Regarding Hypermobility | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Things You Need to Know Regarding Hypermobility

"You must unlearn what you have learned..." - Master Yoda

There are misconceptions about hypermobility in physical therapy just like manual therapy and biomechanics. Here are 5 Things You Need to Know Regarding Hypermobility

1) They often have the same Mobility issues as individuals with average mobility
  • I’ve been treating a lot of gymnasts lately at my daughters’ gymnastics facility
  • I was surprised to see as lax as they are, they often have the same areas of hypomobility as your “average” patient
  • meaning you’ll see mobility limitations (often severe) in
    • the thoracic spine
    • shoulders
    • hips (extension in particular)
    • ankles
2) You can’t “stabilize them”
  • they often do not need “stabilization” exercises for the reasons most people prescribe them
  • people who score 9/9 on the hypermobility scale are systemically hypermobile
  • you can’t make all their ligaments taut or give the system so much tone that they now have average mobility, that would be like changing their genetic disposition
  • these patients most likely need motor control strategies to help them control and move efficiently in a safe range
  • general strengthening and conditioning certainly helps as well, but “stabilization” is not really making them more “stable”
3) Manual Therapy is still helpful
  • as an extension of the last point, many schools of thought teach stabilize the hypermobiltiy and mobilize the hypomobility
  • however, anyone who is moving with altered motor control due to perceived threat can benefit from the modulation of non-threatening manual therapy
4) End Range Loading also works
  • don’t worry about end range loading, it still works in the hypermobile areas (like lumbar extension), you just have to make sure the patient gets to end range to get the same proprioception bombardment to the CNS for the reset
  • you can’t make them more lax, any more than you could make them less lax
  • you only reduce the threat associated with certain movements/activities, and give them control of those movements
5) Kinesiotape works wonders but you don’t need a pattern
  • most studies show sham taping patterns work just as well as the “real” patterns instructed in many courses
  • that’s because it’s just tape on skin, but those of you who perform IASTM know that skin stimulation is a very powerful modulator
  • if your patient is having difficulty with the motor control or end range loading strategy you educated them for homework, try kinesiotape for added proprioception
  • the bonus is that you can just try some taped pattern along the area that has perceived tightness or discomfort, and no pattern is needed
  • I ask them where they perceive the most discomfort or tightness, and that’s where I start
  • “tweak” taping, or using a small piece of tape as opposed to taping an entire “chain” also works well and is economical for both the patient and your practice
To sum it up, systemically hypermobile patients often have the same common mobility problems, end range loading still works (but they may need more cuing and convincing to get there), manual therapy is beneficial, and will not make them unstable.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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