TL:DR hypermobility sucks more than you think, I am the pun queen, muscle energy technique is the bomb, double joints aren’t a thing.
I have one client I see on a regular basis, and the way she lets me know she needs treatment is leaping into my path from around the corner saying Go Go Gadget Arm! while awkwardly swinging her forearm around her elbow joint in a way no human should be able to. Upon hearing the SNAP! echo through the empty hallway, followed by my audible cringe, I promptly open my laptop and get her booked in for a treatment.
Gross.
There’s something about orthopedics that makes me absolutely love it and absolutely cringe all the way down to my own bones… Go watch some “orthopedic sports injuries”, you’ll see what I mean.
This guy is exceptionally dope 👏.
Anyway, hypermobility is a pretty big umbrella term. It can encompass diseases and conditions ranging from Ehlers-Danlos Syndromes, Marfan Syndrome, autonomic and/or gastrointestinal dysfunction, and general joint hypermobility/hyperflexibility. This is very much a spectrum disorder, a wide, wiiiide spectrum with an almost innumerable number of complications.
In the realm of massage therapy, we not only need to be on the lookout for people with possible symptoms along said spectrum, but to also be flexible in our treatment approach. Flexible… I know that joke is a stretch… You’ll bend to my puns eventually.
Of course not everyone experiences the same set of symptoms when it comes to hypermobile issues, but through the massage therapy lens, there seems to be a number of commonalities we see:
- Muscle tension, tightness
- Recurrent musculoskeletal injuries/irritations
- Joint pain
- Chronic generalized pain
- Quick to an inflammatory response
- Neuropathic symptoms
Massage therapy can help to reduce all of those things.
But like I said earlier, sometimes we need to adjust our approach. Often we’re trying to lengthen contracted muscles in our patients, but in a case of hypermobility, think about it, my gosh that would just make everything so much worse. I’ll admit too, it’s a bit counter-intuitive to think about shortening a tense muscle, but if said tension is the result of a muscle that’s too long, well, how is making it longer going to help?
In the therapist’s comfort mind-set, pain reduction is obviously the top priority, and considering the reactive similarities of hypermobile patients, heavier techniques may not be as effective. Reducing your patient’s chronic pain from their hypermobility issues is integral to their quality of life. Gentle fascial work can be particularly effective.
In the therapist’s functional mind-set, it makes sense to shorten the set-point of the muscle length, especially in an agonist-antagonist balance situation we want to bring as equal as possible muscle length to each of the opposing muscles (personally I use a slightly modified form of muscle-energy technique – it’s my gentle power-move when it comes to hypermobility.) This is a deep rabbit hole — we’re talking resetting muscle spindles, playing with golgi tendon organs, it’s an anatomy dork’s dream.
Honestly, this topic is so rich in knowledge and complexity I could write about it all day, and I’m the only nerd here who would actually read all that.
So, if anything I’ve said tickles a nerve with you, make sure to not only read everything you can, but also talk to your primary healthcare practitioner about any concerns you might have. This is worth looking into if your Stretchy-Sense is tingling.
For any fellow RMTs who may be reading, here is the epitome of knowledge in the realm of hypermobility. I took it earlier this year. Highly recommend. Instructor is a legend.
And for those of you who think being double jointed is a thing – stop it. That is not a thing. It never was. The only way you’d have a total of 4 knee joints is if you had four legs. Now THAT would get my attention in the super-gross orthopedics world. Ew.
More helpful links:
https://www.physio-pedia.com/Hypermobility_Syndrome