HMS - hypermobility syndrome

[Lindawen]

Hello,

My first post on this board...

Got a patient with HMS. Starting with easy excercise, minimal weight. Had a shoulder luxation, wrist subluxation and is wearing a support brace for the wrist. Many sprains and inflammations. He is doing excercises at home and once a week at my practice for a few months now. But I don't see much strenght coming back. Muscle tone is sometimes extremely high. Muscle weakness at many places. He has difficulties with stability and 2 days muscle pain after training.
He is very driven to get better but it doesn't seem to work.

Has anybody any suggestions?? Other treatment? Referral back to the doc.?
This is my first patient with the hypermobility syndrome, more information about this is also welcome.

Excuses for my poor language...english it not my first..

Greetz Linda

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[Physiobase]

You mention

strength coming back

He might not have ever had strength. Can you tell us how old this client is and what their base level of fitness is as this might direct our starting point.

I suppose the high tone is perhaps due to weakness in other areas causing some increased activity in other areas. Look at what has higher tone and try to think logically what things might need strengthening in order to take "the pressure" off the over active area. Time would be better spent on address those areas (whether antagonisits or synergists) than on releasing higher tone structures that are likely to return to that state time and time again. We look forward to further comments. 8o

[alophysio]

Another possibility is "multi-Directional" instability pattern as described by Peter O'Sullivan.

See Grieve's Modern Manual Therapy 3rd ed...

I would type the info in but it is way too late!!!

[Lindawen]

Hi, thanks for the quick replies!

A bit more information: This patient is 25 years old. He did athletics in his youth but had to stop, due to pain and injuries. He had a car crash about 5 years ago with whiplash damage to the cervical region and lower back. He tried after that to pick up his exercises and a bit of fitness. But that also didn't work. So it sure looks like he never had much strength.
Now he works on his schoulder(s) the most, with stabilisationexerises and the weight we use is about 5 to 10 kilo's, but most is 5 kilo. Even then it is hard to repeat the 30 or 45 times.

Weak areas are the cervical and lower back region, upper extremities and ankles. He also has a kyphoscoliosis and a slight torticollis to the right (with soms restricted moving to the right). I ony try to take some pressure of the extremely high tone areas when he complains of severe pain. There are some major trigger points then. And this person doesn't complain...he is convinced there are people who are worse.. :rolleyes

Problem is that he says he doesn't otice when he has done too much. He says something is to heavy when he as already done it :\ When I look at this patient I sometimes think it
has got something to do with a collagen defect or connective tissue. Has anyone expirience with such things?
This has been one of the mt difficult patients to deal with over the last time. I am glad he is a friendly and patient person!

would this be enouh information or do you need more>?
Tanks very much!!