I recently had an individual with low back pain for an evaluation who reported she has a history of being "hypermobile." Upon further questioning, she revealed a family history of Ehlers Danlos Syndrome (EDS). While the patient had never been diagnosed with any hypermobility disorder, I assessed her mobility using the Beighton Sign of 9, due to the genetic factor of EDS and the effect it has on collagen. For those of you unfamiliar with the Beighton scoring system, mobility is assessed at several different points (such as elbow extension, knee extension, lumbar flexion, etc.) for excessive motion. These patients will displays genu recurvatum, hyperextension of elbows, and hands flat on the floor with lumbar flexion. She was positive in all of the factors I assessed.
In hypermobile individuals, we should expect excessive mobility in all directions for each joint. When I looked at my patient's lumbar mobility, she had what would appear to be "normal" or a mild loss of mobility in each direction. Without knowledge of the presence of hypermobility, we might develop an inappropriate plan of care. Typically, when we think of people with hypermobility, we immediately assume we have to assign these individuals to a stability-type program. However, patients generally with hypermobility can present with relative hypomobility following an injury. My particular patient had a traumatic even at work and met most of the criteria in the lumbar mobility treatment-based classification. I initiated lumbar mobilization and AROM exercises with some repeated motions for HEP. She has shown significant improvement thus far with the emphasis on restoring her to her "normal" hypermobility.
That is not to say she doesn't require any form of stability training. Once this patient's mobility has normalized, I will redirect my plan of care to retraining movement patterns and building strength and power on them to help build her functional stability. The primary take away is that, given the circumstances, any individuals can fall into a mobility treatment plan, even hypermobile patients.
-Dr. Chris Fox, PT, DPT, OCS
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