S E5: Ep 5 – Are you “Double jointed” with lots of aches and pains?

Hello and welcome to the Pain Free Living Podcast.

My name's Bob Allen and my aim is to help you to live pain free.

Let's begin.

I'm an osteopath.

And Louise is not an osteopath.

So I am a change coach and consultant.

So I help businesses and people to navigate change.

And as part of that, I like asking questions.

Yes, you do like asking questions, don't you?

And this is why Louise is here.

She is the voice of the people.

So what we're talking about today, Louise.

We are going to be talking about hypermobility, which I didn't realize affects 30% of the population.

Yes, it does.

So Bob, tell us a bit more about hypermobility.

Okay, so we'll start off with what hypermobility is.

And it's, it's what people call double jointed.

It's where people have different little party pieces.

And when I was training as an osteopath, one of my tutors said that, yeah, hypermobility is people being double jointed and they generally have really weird party pieces that they can do.

And he loved to tell a story of one guy who used to be able to get his fist in his mouth and that was his party piece.

Except that one day he did it and his jaw locked and it meant going down to ae.

So if you're double jointed and if you have a little party piece.

Yeah, don't do that.

It's.

There's a.

There's a good chance it could go wrong.

And if it goes wrong, yeah, it may well be a trip to A E for you as well.

I was always jealous of people that had a party piece doing that.

Not putting the fist in.

I've never seen that.

But yeah, people that could, like do various things double jointed.

But I'm sure we'll come on that in a minute.

Yes.

Yeah, we can.

That's the common, that's a common name for it.

Hypermobility is being double jointed.

What, what hypermobility actually means is that the, the joints are.

Help.

Excuse me.

Joints are held together by ligaments and tendons, and if you are hypermobile, those ligaments and tendons are not doing the job they're supposed to do or not as well as they're supposed to.

So you can actually get a bigger range of move movement in your joints than 70% of the rest of the population.

So, yeah, that's what hypermobility is.

And Is it genetic?

Is there an ethnicity link?

It depends because there are people that have got some, some double jointedness, for want of a better word.

They are, they have a little bit of hypermobility.

And there are some people that are very hypermobile because it's.

So there's different classifications.

Yes, it can be genet, certain conditions can be genetic.

And yes, they found that the proportion of the population of Asian or Afro Caribbean descent are more likely to be hypermobile than the rest of the population.

Why?

I don't know.

Potentially it's because where things are more specific to different groups, different ethnic groups, for example, it's because they, they can confer some advantage, not a mass advantage, that's some advantage.

So they tend to stay, to stay within a population.

It's a bit like with sickle cell anemia.

So there are Afro Caribbean populations which are African populations who have sickle cell anemia because it confers a small immunity to malaria.

So if you have sickle cell, you tend to be less prone to malaria.

Not significantly so.

And there are so many downsides to having sickle cell that it's a very small advantage.

But it's one of the reasons why in populations in Africa the trait hasn't died out.

Okay, so given that it's 30% of the population, how often do you see clients who are hypermobile?

I do see a few people who are hypermobile, but again it depends on scale of hypermobility.

So some people are very hypermob, some not so much.

It's one of those things where it's useful to know but you can't cure hypermobility.

Will everybody know if they are hypermobile or how do you identify it?

Yeah, that's a good question.

And the answer is most people don't know about hypermobility.

They'll know.

They'll know if they've got flexible joints because like I said, they'll have a party piece.

They'll often have a party piece that they do.

So they'll notice they've got flexible joints.

But again there's this scale.

So the scale goes from you can have flexible elbow joints or flexible knees.

So that's kind of lower end of the scale up to the you sneeze and you dislocate rib, you get out of a chair and you dislocate a hip.

So there are extremes, but the majority of people are at the lower end of the scale of hypermobility.

So they don't even know they've got it.

Right.

So how do you then identify Hypermobility.

Well, there's.

There's a test called the Beighton scale, which is kind of like the gold standard for identifying whether people are hypermobile or not.

So looks at flexibility in certain joints, and the more mobile certain joints are, the higher the score on the scale, as a couple of simple examples.

And some people can do, some people can't.

So one example is, can you get your thumb to touch your forearm?

So wrist is flexed.

Can you get your thumb on your forearm?

Basically, you're not far off.

I am quite mobile.

I'd probably be on the low end of the hypermobility spectrum.

So that's one measure, another.

So if I can do that with both arms, then that's two points.

So if I extend my arm out, so as you can see, it's kind of fairly straight.

Yeah, yeah.

If I was hypermobile, then there'd be more of a bend that way.

So elbows hyperextend.

If I could do that on both elbows, that's another two points.

If I can keep my legs straight, get my palms flat down on the floor, that's another point.

And then you look at the knees, and there's a couple of other tests as well.

So the higher the score, the more you score on the Beighton scale.

If people score highly on the Beighton scale, then they may go on to do other tests.

They will look at the history.

Other indications of hypermobility are whether as a child they used to suffer from lots of muscle and joint pains, aches and pains.

If they're older, they will look at this things like what we call pots, which is postural orthostatic tachycardia syndrome.

Remember that?

Or that.

Or do they have a history of stomach and bowel issues?

Do they have a history of muscle joint issues?

So again, they will look at those different things and they will say, okay, yes, this person warrants investigation.

Then we need to give them additional support.

So from what you're saying there.

Then there are some other conditions that are associated with hypermobility?

Yes, there are.

I mean, the most common ones that I'm likely to see, I don't see many of them, to be honest.

But the most common ones are what we call Ehlers Danlos syndrome, which is a hereditary genetic issue.

And it affects the connect.

It affects the collagen.

So collagen is found in joints and ligaments and tendons, and they are what give joints their integrity.

They are what gives joints that restriction.

So a laptop, I can do that because the ligaments and tendons stop it from going any further.

If you've got Ehlers Danlos, and there's another condition called Marfan syndrome, which is also a genetic condition.

If you've got issues with the connective tissue, your joints tend to be a more flexible and a lot more mobile.

So although they can't cure the conditions, they can help to manage them.

One of the big issues with it is that if you are hypermobile, then the medical profession tends to be quite poor at picking it up and they don't generally pick it up until quite late.

Where they pick it up earlier is if you're at the extreme end of the scale and you're.

And you're having a number of history of dislocations, ankle sprains, lots of muscle and joint issues, then they could potentially investigate.

They won't necessarily.

If you have high joint mobility, but you also have a history of stomach problems, or you also have a history of what we call dysregulated heart rate.

So one minute's quite low, then the next minute it's up through the roof.

It causes you dizziness, can cause fainting, those sorts of things.

That's pots.

So that's an indication that there's potentially hypermobility there.

If you have bowel issues and you have regular bowel issues, but there's no obvious explanation, then that is another potential indication of, you know, hypermobility.

There's things that you wouldn't naturally associate.

No.

And this is the problem.

And this is why it tends to be.

It tends to be missed, because if you have joint and muscle issues, you're going to go to an orthopedic.

If your GP thinks it's serious enough, he'll refer you to an orthopaedic surgeon or a rheumatologist.

If you have bowel and gut issues, they'll send you to gastroenterology.

If you have heart issues, they'll send you to a cardiologist.

So you could potentially have lots of different experts all looking at something that has a common cause.

But because they're different experts and because they tend to be quite siloed and they tend not to talk to each other so much, it tends to get missed.

Now, although you can't fix, you can't fix hypermobility, you can't fix Ehlers Danlos, you can't fix Marfans.

What you can do is you can help manage the condition, but you have to recognize it's there first.

And that's the challenge.

What can trigger an episode or the symptoms of hypermobility?

Yeah, it's a tricky one.

Sometimes it's pregnancy.

So because there's hormones changing and joints tend to become lax anyway because it's all about accommodating the baby ready for birth.

That can be a trigger for it, or a traumatic incident can be a trigger for it.

It's one of those things, like I said, it's one of those things that's quite hard to diagnose unless you build a full case history of what's going on.

And then if it's something you suspect, you can then look at the genetic component.

You can look at the parents.

Did they used to have lots of muscle and joint issues, and you build up a picture of what's going on.

One of the advantages of being an osteopathical physical therapist is that I can get the whole picture.

I can look at, you know, part of the case history that I do is going to talk about whether they have any gut or bowel issues.

I will look at, you know, how's your heart working?

Do you have any issues with that?

And I can look at medication I can look at.

I can get.

I can build a full picture.

So, yeah, and again, although you can't fix it, you can manage it, but you have to have it identified in the first place.

Let's talk about helping to manage it then, because I guess there's a range of things that you're able to do.

Yeah, yeah, there is.

I mean, one of the things that can happen with hypermobility is that lots of muscle and joint aches.

Now, the muscle and joint aches are because the muscles are trying to do the job that the ligaments and tendons can't do.

So ligaments and tendons being loose means that.

Say again, let's go with the elbow ligaments and joints that are loose in the elbow means that the elbow might hyperextend, which then puts more tension in the elbow joint.

Now, because the ligaments and tendons can't do it, you build up the strength in the muscles.

So one of the issues that can cause the muscle tension, the muscle pain, is the fact that the muscles are overworking.

They're constantly trying to stabilize a joint which is unstable.

So what I would do with someone in that situation, first thing is, first thing to do would be to build the strength in the muscles.

We can't improve the strength or the stability in the ligaments and the tendons because they, you know, that's the genetic thing that we cannot control.

But what we can do is make the muscles stronger to be able to better support the ligaments and tendons.

So a strength program is a definite.

But there's a little caveat to that in that you can't go down the typical gym and go, okay, you've, you, you've had a hypermobility diagnosis.

You don't want to get stronger.

You need to find somebody that understands what hypermobility is so they can then do a proper assessment and then build the strength and the muscles that need to be strengthened around the joint.

It's not immediately obvious.

So if you went to your typical gym and tried to try to do that yourself, you know, you might think, okay, I'll strengthen the bicep and tricep.

And that's going to sort out.

Actually, there's a lot of muscles around the elbow joint, not just the bicep and tricep.

You've got all the flexors and extensors in the forearm as well.

All of those come across the elbow joint.

So you need to work on everything.

And also, if you start too heavy or you've got poor technique, that's potentially going to make things worse rather than better.

So if you're going to start a physical program, which is what I'd recommend, find somebody who knows what hypermobility is first.

So that's a conversation you need to have because if they don't understand what it is, they can potentially make things worse.

Yeah, those people do exist.

I have spoken to a few of them, but there's not many out there.

So, yeah, it needs to be careful who you choose.

And I guess there's a piece as well to supplement that around education, lifestyle awareness, information.

Absolutely.

Because, for example, IBS or irritable bowel disease is what they call it.

But IBS is all the same thing.

It's just, it's just a bucket term for people that have gut issues.

Yeah, yeah.

But, yeah, so, you know, feed the gut, but feed the gut the good stuff.

So fermented foods, avoid ultra processed food, you know, plenty of fruit, those sorts of things.

I'm not a nutritional therapist.

I would recommend going to a nutritional therapist.

If you don't know yet, you can find information on the Internet and there's a couple of really good sources of information, but generally speaking, again, find somebody who knows what they're doing and, and go and go to see them.

You mentioned about joint muscle pain.

What about pain management?

Are you able to help on that?

Yeah, I mean, one of the things about muscle and joint pain is.

Yes.

So again, we'll go back to the Elbow.

You get pain in the elbow because the lacks ligaments in, in the elbow joint.

So what I find is that somebody who has a lot of muscle aches and pains, it can come from the fact that you've got the wrong muscles trying to stabilize.

So as well as them going through a strength program to build the muscle to allow the joint to be more stable, there are muscles that are likely to be too tight because they're doing the wrong job.

So what I can do is I can work on those muscles, release the tension in those.

So you're strengthening the right muscles and you're releasing the tension in the muscles that are overworking, you know, soft tissue work, joint mobility work, that sort of thing.

Not stretching.

Again, you can.

There will be yoga instructors out there who will be able to give you advice on which muscles need to be stretched and which ones don't.

But you need to find somebody who understands what hypermobility is.

Great, thank you, Bob.

That's really interesting about hypermobility.

Good.

I genuinely didn't know that many people were affected by it.

Yeah, it's a big number.

But the thing is, a lot of them are symptomless.

They don't even know they've got it.

And that's great.

They don't need to know they've got it unless they start to have problems, in which case, yes, that needs to be investigated.

Things like Ellis Danlos and Marfans.

There are societies out there that are experts in managing those symptoms and giving them all the information they need.

You're not going to get that from this, you know, 15, 20 minute podcast.

But what I can do is I can put information in the show notes.

If you suspect that you have a problem, we can have a conversation and generally speaking, I can give you an idea of whether, yes, that needs further investigation or no, you're just being silly.

Nah, sort yourself out is something I would never say.

But yeah, all joking aside, if you suspect now that you know what hypermobility is, if you think that there is a problem, it needs to be looked at.

If it's Elizanos and Marfan's, you could have been spending years in pain and not known why and getting a diagnosis, okay, yes, it can't be fixed, but it gets you into the system and then you can find the right support.

But like I said, I'll put stuff in the show notes on where you can go to get more information on Ellis Danlos, Marfans and just general information around hypermobility and what it can cause.

So we can't finish this podcast, Bob, without hearing your tutor saying fat hypermobility.

Those words are still ringing in my ears.

Basically, what my tutor used to say was one man's party piece if another man's trip to A and E.

So if you have hypermobility and you can do lots of weird, strange, bendy things, just keep that in mind.

Be careful out there.

See?

Got it in.

Okay, we've come to the end of the episode.

Hope you enjoyed it, hope you learned a few things, and please tell all your friends like and subscribe and I'll see you next time.