True Proprioception and Function

Proprioception could be looked at as one of the inner ‘controllers’ of our body!

You get great proprioceptive training for free if you do authentic Functional Exercise. Proprioceptors provide us with information about movement and the position of our head, limbs and body in time and space. Their aim is to protect our body from damage by using ‘stretch reflexes’ and these can restrict or limit our movement at times of need. Some of these sit in joints, some in our muscles and some in skin and fascia. In combination, proprioceptors give our body a supreme and enhanced awareness of our ‘whereabouts’.

You do need to proprioceptively train the body towards the function it so requires. Doing a ‘plank’ for example will not train your abdominals proprioceptively to protect you in upright function with lumbar spine extension and rotation. Squatting will not proprioceptively train your legs to run and that ‘static squat hold’ at 90 degrees that many are given, will certainly not protect your hips, knees and ankles while you ski.

Training proprioceptors effectively requires movement and often (although not always) it needs ground force reaction too! Increased effectiveness is achieved by using different tweaks or additions to our movement such as adaptations in speed, depth, height and angulation and this may involve using your head, limbs and body, all in 3 planes of motion. An INTEGRATED chain reaction is needed, nothing is ISOLATED.
Whatever sport or exercise you want to do, to become and stay good at it, your conditioning and rehabilitative training needs to look and smell like the sport you want to do!

If you need any help with Functional Training or need an injury treated, call us at Back to Back on 020 8605 2323

Functional Exercise and Training – The Why and the What!

Tri-Plane Movement and Functional Training, these are both current words used to describe movement and training by the personal training and allied health professions (osteopath, physiotherapist, exercise physiologist and chiropractor). The health and fitness industry is going through yet another change, just like the swiss ball was the man of the moment in the 90′s, pilates and the core were the trend of the early 2000′s, many trainers and health professionals are now focusing on training movement rather than muscle, training functional exercises rather than non functional exercises, training groups of muscles rather than muscles in isolation.

What this means in simplistic terms is that trainers and health professionals etc are now moving away from the body building approach to training and conditioning (that is isolated weight training) and moving towards training that integrates movement with resistance that mimics upright function such as gait and other movement patterns that we perform on a daily basis i.e. squat, sit to stand, step up and down, push, pull & rotate. Trying to use gravity as the driver by doing exercise on your feet or upright, rather than on your back or in a machine stimulates your proprioception much more effectively than fixing an area, therefore creating the correct chain reaction needed for full and appropriate muscle function.

This does not suggest that one training approach or philosophy is better than the other, it fundamentally comes down to what the specific individuals goal is. For a body builder looking to compete, then traditional weight lifting techniques that have been proven to produce muscle gain is required. For the olympic power lifter, olympic lifts are practiced. For the sporting indivdiual, there will be likely a combination of functional movement exercises as well as some strength, olympic and powerlifting techniques. For the individual wanting to improve their overall wellbeing, strength and mobility, there is also likely to be a combination of the above.

So what does Tri-plane movement, functional training etc etc mean. Tri-Plane movement simply refers to movement in the three planes (sagittal, frontal and transverse planes). If we look at the individual who is standing upright, the best way to describe movement in the sagittal plane is forwards and backwards movement. Movement in the the frontal plane refers to side to side movement (that is laterally stepping or performing a lateral lunge). Movement in the the transverse plane is when movement occurs with rotation. That is, whilst standing you twist and turn to move or lunge backwards and laterally. Everyday movement occurs in all three planes at a bone and joint level and this is why there is this growing change in the way that training is being carried out. Previously most gyms and training programs were focused on training muscles in machines and/or functional training was restricted to movement purely up and down i.e squat movement or forwards (anterior lunge). As our understanding of functional biomechanics and movement improves, so does our training approaches and philosophy. Now days we are seeing more and more clients perform movements that involve all three planes of movement, involving less equipment and with movements that mimic real life activity.

Functional Training is probably one of the biggest buzz words in the health and fitness industry at this particular moment. There are many indivdiuals out there claiming to provide functional training. Functional training is certaintly not something that is new, rather it has been around for many many years and simply relates to training that mimics how we function. How this training relates to how we function will depend totally upon what and why we are training. For an individual who sits for their job for their entire life and wants to improve this, then training should focus on improving their ability to sit whilst working. For those individuals who are wanting to improve their everyday movement, that is sit, stand, walk, step up and down, squat, lunge etc etc, then training should reflect this. For the sporting individual, the training should mimic the sporting requirements, movements or athletic components that are that sport. So functional training has many meanings and therefore can be interpreted in many different ways.

For the general public, when we look at the body and how it functions, the most common movements or positions we are in involve walking (gait), sitting, standing, squatting, lunging, stepping up and down, single leg balancing, pushing, pulling and twisting. All of these movements are impacted by gravity and ground reaction force and these are two other factors that should be taken into consideration when prescribing a program. Gravity is something that we are always working against to remain upright. Therefore gravity is something that can easily be used to increase or decrease the degree of difficulty of an exercise. Ground reaction force relates to Newton’s laws and how force in one direction results in an equal and opposite amount of force in the opposite direction. This can be related to jumping and landing on the ground whereby an amount of force is exerted downwards and then the force will be transferred back into the legs and must be either shifted or absorbed by the body. So when it comes to functional training and tri-plane movement training, hopefully now you will have a little bit more of an understanding of what, why and how this might be prescribed in relation to yours or anyone else’s training program.

In our opinion, functional exercise should be used more and more when rehabilitating injuries or with patients post surgery. The more you get patient’s bodies working proprioceptively and in 3 planes, their bodies can start to ‘switch on’ to allow them to recover better and stronger.

To find out more about changing your training program, making it a little bit more functional in relation to your specific goals, incorporating exercises that involve training in all three planes, then contact Back to Back – The Earlsfield Osteopath on 020 8605 2323 or click here

Adductor Function

I just LOVE this muscle!

It does most things other than adduct your hip!! If you lie on the ground on your side and lift you lower leg… sure… your adductors adduct your hip…..BUT during function, it does a fabulous job at not adducting your hip.

They are the adductor brevis, longus, magnus oblique and magnus vertical. The brevis and longus attach onto the posterior medial part of the femur, not just on the medial part as most people talk about.

A great and massively overlooked thing about this group of muscles is that they work with their opposite adductors. The right and left adductors are turned on in gait (differently) but at the same time.

If the right leg is forward the right adductors are stretched in the sagittal plane and they slow hip flexion. They are lengthened in the transverse plane (TP) and they help to internally rotate the femur. They are also shortened in the frontal plane (FP) with hip adduction.

As we walk, and as the left leg swings forward, the right leg becomes the back leg and the right adductors are lengthened by hip extension (posterior medial attachment). They are then lengthened in the FP by the pelvis leaning towards to the left leg causing hip adduction. It is then shortened in the TP are they externally rotate the femur. The facilitates top-down external rotation of the tibia and calcaneal inversion…. and locks out the mid tarsals ready for push off!

As I have said – both sets of adductors work as a pair…. The right adductor works with the left adductor to slow the movement of the pelvis to the left and visa versa. If the adductors and tight in any plane, they will inhibit other planes.

But they can also be responsible for other dysfunction. If the adductors are short or not permitting good function, your pelvis will be unable to move correctly in 3 planes of motion and so your lower back, mid back or neck may take the hit instead. You might end up seeing someone for your back pain all because of you adductors. This is why it is SO important to not always treat the symptom, but to go to the cause!!

If you have just injured yourself (especially after the marathon) or need to be assessed for injury or need treating, do give us a call at Back to Back on

Gastrocnemius function – How it assists in knee extension

Gastrocnemius function – How it assists in knee extension

This attaches above the knee into the femur and into the achilles tendon. It acts in a similar way to soleus, but as it attaches to the femur, its influence on the proximal joints and structures is more significant.

Gastrocnemius decelerates internal rotation of the femur when the foot is on the ground, but it is lengthened at both ends. One end in the frontal plane, the other end in the transverse plane. In the sagittal plane, it controls ankle dorsiflexion.

The knee flexion is transformed into knee extension by a number of muscles along with mass and momentum. As the front leg in gait is moving through towards swing phase, the tibia is slowed down by eccentric lengthening of the gastrocnemius and a number of other calf muscles. This slowing along with the momentum of the body creates knee extension as it pulls back on the distal femur as ankle dorsiflexion is decelerated.

So in function and gait…. the Gastrocnemius are a powerful knee extensor!

Hypermobility part 2 (March 2012)

Hypermobility Syndrome – part 2

James Dodd

Part 1 of this article looked at giving readers a better understanding of Hypermobility Syndrome (HMS) and the implications it may have on the musculoskeletal system. Having a greater understanding of the common problems associated with hypermobility syndrome, how it is diagnosed and its relationship to other connective tissues disorders provides us with a solid base by which we can then go about developing a corrective exercise program. Part 2 aims to provide a more extensive look at assessing the hypermobile patient and taking a region specific approach to training. A detailed case history and screening process should alert you to any problematic areas or regions which may be predisposing, maintaining or aggravating your patient’s musculoskeletal problems. Static observation will help you to define any asymmetries in posture. Observation from all three views (frontal, lateral and posterior) will help you focus on areas of possible dysfunction. Functional testing in sagittal, frontal and transverse planes may highlight other areas of dysfunction

Muscle and Movement Testing

Carry out stretches and tests to identify weak, tight and shortened muscles. Take particular care in the hypermobile patient as range of movement may be much greater than expected. They are also good at ‘cheating’ to hide a dysfunctional area.

Assess functional activities such as gait, step up/down, lunge, squat, one leg stand and reach, anterior reach, posterior reach and push up for functional capability. Look for asymmetries, imbalances and glitches within the movement patterns to alert you to potential areas of dysfunction. Common causes of dysfunctional movements could be inhibited/over facilitated muscle activity in agonist/antagonist or synergistic muscles, tight and short or weak and lengthened muscles, hypo/hypermobile joints or body regions and balance, proprioception and coordination problems.

Always remember to seek advice from your patient’s general practitioner, osteopath or physiotherapist if you suspect any serious possible musculoskeletal problems or red flags.

A Regional Approach to Training the Hypermobile Patient

Common presenting features in the hypermobile patient include the following:

Shoulder, hip, neck, lower back, knee and foot pain

Poor body awareness, balance and proprioception

Flat, pronated feet

Hyperextended knees

Anterior pelvis

Clicking/popping joints

Hyperkyphotic or reduced movement in the thoracic spine. This could also be chronic muscle spasm

Tight and shortened hamstrings, gastrocnemius, iliotibial band, tensor fascia lata, pectoralis major/minor muscles

Weak anterior deep neck muscles, iliopsoas, core stabilizers and gluteals

Poor core stability

Upper rib breathing and poor diaphragmatic breathing

A good case history, observation and assessment should highlight any areas of dysfunction and will help you to focus on devising a program that will help restore optimal health and posture. Foam rollers, static stretching, active stretching and Muscle Energy Techniques (MET) are treatment strategies that can help stretch, activate and restore muscle balance. Remember to train the patient as a whole. The body works as one, and all systems are connected. Therefore, any one problem or area can predispose to a dysfunction elsewhere. The tissues are generally weaker and more vulnerable to injury than the non-hypermobile patient.

Hypermobility and the Lower Back

Poor overall functional stability is common among those individuals with lower back pain. In conjunction with poor stability, the hypermobile patient may also have poor kinesthesia and proprioception.

Focus training on:

Improving body awareness (anterior and posterior tilting of the pelvis)

Finding neutral spine

Teaching diaphragmatic breathing

Activating core muscles

Incorporating core muscle activation into functional activities

Balance, proprioception and coordination

Look for an ability to activate the core muscles:

Without co-contraction of more global muscles such as the rectus abdominis and external oblique muscles

Independently breathing

Diaphragmatic breathing? (often you will observe upper chest breathing)

Exercises that will be useful for the patient with core stability issues include:

Anterior and posterior tilting of the pelvis (standing, supine).

Core muscle activation (supine, prone, side-lying and four-point kneel).

Core muscle activation standing, seated.

Remember to isolate muscle activation and then integrate into functional activities.

Hypermobility and the Neck

Hypermobile patients may present with a history of neck complaints, ranging from the acute ‘wry’ neck to chronic neck pain. Individuals may present with an upper crossed syndrome pattern, which could be predisposed, maintained and aggravated by hypermobility, work and lifestyle postures such as sitting and slouching.

Look for:

Forward head posture (chin poking forwards)

Increased kyphosis (rounding) through the thoracic spine and Cervico-Thoracic C7/T1 region (base of the neck)

Reduced mobility through the thoracic and cervical spine

Tight upper trapezius, levator scapular, pectoral minor, sternocleidomastoid and scalene muscles

Weak rhomboids, lower trapezius and deep anterior neck flexors

Winging, elevated or protracted scapulars. Look for asymmetries in static

observation, movement and muscle weakness in shoulder stabilizers

Focus training on:

Lengthening short and tightened muscles

Strengthening weak muscles

Activating inhibited and de-facilitating over active muscles

Balance, proprioception and coordination

Exercises that will be useful for the patient with upper crossed syndrome and neck pain include:

Scapular retraction and setting

Ys and Ts exercise

Other useful exercises that aim to improve mobility of the neck, strengthen deep anterior neck flexors and increase body awareness include:

Chin tucks (similar to an emu neck movement)

Isometric neck flexion (using soft ball to push head against)

Isometric lateral neck flexion (using soft ball to push head against)

Pulling shoulder blades backwards and down, whilst lifting sternum to the roof

For more information on isometric neck exercises, see Paul Chek’s “How to Eat, Move and Be Healthy!”

Hypermobility and the Shoulder

The shoulder is the most unstable joint in the body, and often the hypermobile person will have a glenohumeral joint and/or scapulothoracic joint dysfunction. Problems may develop due to poor neuromuscular control, increased laxity of the capsule and rotator cuff weakness. Individuals may also present with subacromial impingement signs and symptoms. In some circumstances, your patient may require referral to an osteopath or physiotherapist to rehabilitate and teach correct scapulothoracic setting and glenohumeral positioning before commencing an exercise program. Focus training on:

Scapulothoracic setting

Rotator cuff strengthening

Stretching tight and shortened muscles i.e. pectoralis major and minor

Strengthening weak muscles i.e. serratus anterior, rhomboids, lower trapezius

Training functional exercises which address adjacent areas (cervical, thoracics, lumbars and hip/pelvis), muscular slings, synergistic and agonist/antagonist muscles

Hypermobility and the Hip

Like the shoulder, the hip is a ball and socket joint that has a large range of movement. It is essential that the neuromuscular, active and passive systems are working effectively to allow adequate movement and yet stabilize the region sufficiently. The hypermobile person is more likely to suffer from clicking/popping hip. The exact cause of this could vary from an intra to extra articular causes such as a tight iliopsoas to a labral tear or loose body. It may or may not be associated with pain. In those individuals presenting with extreme or constant pain, refer them off to the GP, sports medical doctor, osteopath or physiotherapist for further assessment. Typically, hypermobile patients will have poor control of their hip, pelvic and lumbar regions, and these often need to be addressed to correct any imbalances and prevent further problems developing.

Focus training on:

Lumbar (lower back) stability

Hip stability

Weak iliopsoas

Weak gluteus medius and maximus

Tight hamstrings, iliotibial band, tensor fascia lata

Balance, proprioception and coordination

Hypermobility and the Knee

Patellofemoral problems are common in hypermobile individuals. The cause of patellofemoral problems can be both structural and non-structural related. Common causes include a variable Q angle, genu varum, increased foot pronation and biomechanical and muscle imbalances.

Focus training on:

Tight iliotibial band, tensor fascia lata, hamstrings, gastrocnemius

Weak vastus medialis, gluteal muscles

Pronation and supination foot

Balance, coordination and proprioception

Exercises that will be useful for the client include:

Seated heel presses (helps to activate vastus medialis)

Foam rolling ITB and quadriceps muscles

Exercises that will be useful for the patient include:

Seated heel press (helps to activate vastus medialis)

Lunge – Forward

Lunge – Multiplanar

Squat – Against Wall with SB

Squat Touchdown – 1 Leg

Step Up to Balance – Frontal Plane

Hypermobility and the Foot

Pronated (flat) feet is common in the hypermobile patient. Over pronating can lead to problems with the subtalar joint, mid and forefoot, possibly causing plantar fasciitis and other problems up the biomechanical chain. Over pronation will cause internal rotation of the tibia and fibula, therefore potentially creating dysfunctions further up the chain at the knee, hip/pelvis and lower back. Individuals with flat feet may benefit from an exercise program or orthotics prescription.

Focus training on:

Tight plantar fascia, gastrocnemius and soleus muscles

Activation and control of tibialis anterior, peroneal muscles

Tight iliotibial band and weak gluteal muscles

Balance, coordination and proprioception

Exercises that will be useful for the patient include:

Active plantarflexion and dorsiflexion of the foot

Rolling feet inwards (pronation) and outwards (supination)

Single leg balance (stable to labile surface i.e. wobble board, bosu ball)

Swiss ball squat with ball between the knees finishing with standing on toes

Exercises that will be useful for the patient include:

Side to Side Hip Swing (Hip)

Balance Hold 1 Leg – Overhead Anterior Reach

Balance Hold 1 Leg – Overhead Posterior Reach

Hypermobility and Balance and Proprioception

Hypermobile individuals are likely to have poor balance, proprioception and kinesthesia. Exercises that challenge these components will translate over to improvement of general daily activities and reduce the likelihood of injury.

Exercises that will be useful for the patient include:

1 Leg Balance

1 Leg Balance Reach (anterior, posterior, lateral)

Balance Hold 1 Leg – Overhead Anterior Reach

Balance Hold 1 Leg – Overhead Lateral Reach

Step Up to Balance – Frontal Plane

Equipment such as wobble boards, Bosu Balls, cones, Airex Balance Pad, Swiss ball, Theraband, etc. can be added to further challenge balance and proprioception.

References:

Cook, G. Athletic Body in Balance, Human Kinetics, USA, 2003.

Gray, G. Functional Video Digest Series

Gray, G. Total Body Functional Profile, Wynn Marketing, 2001.

Janda, V. Muscle Function Testing, Butterworths, London, 1983.

Keer, R. & Grahame, R. Hypermobility Syndrome, Recognition and Management for Physiotherapists, Butterworth/Heinemann, 2003.

Kendall, F et al. Muscle Testing and Function with Posture and Pain, Lippincott Williams & Wilkins, 5th Edition, USA, 2005.

Murtagh, J. General Practice, McGraw Hill, 3rd Edition, Sydney, 2003.

Osar, E. Complete Hip & Lower Extremity Conditioning.

Osar, E. Complete Shoulder & Upper Extremity Conditioning.

Petty, N.J & Moore, A.P. Principles of Neuromusculoskeletal Treatment and Management, Churchill Livingstone, London, 2004.

Santana, J.C. Functional Training: Breaking the Bonds of Traditionalism

Wolf, C. Human Motion: A Pictorial Guide to Functional Integrated Movement Patterns. Human Motion Associates.

Resources:

www.ehlers-danlos.org <http://www.ehlers-danlos.org>

www.hypermobility.org <http://www.hypermobility.org>

www.marfan.org <http://www.marfan.org>

www.marfanssyndrome.net <http://www.marfanssyndrome.net>

www.medicinenet.com/hypermobility_syndrome <http://www.medicinenet.com/hypermobility_syndrome>

http://medlineplus.gov/

www.oif.org <http://www.oif.org> (Osteogenesis Imperfecta)

www.nlm.nih.gov/medlineplus/osteogenesisimperfecta.html <http://www.nlm.nih.gov/medlineplus/osteogenesisimperfecta.html>

Important Disclaimer:

No express or implied warranty (whether of merchantability, fitness for a particular purpose, or otherwise) or other guaranty is made as to the accuracy or completeness of any of the information or content contained in any of the pages in this web site or otherwise provided by personal training on the net. No responsibility is accepted and all responsibility is hereby disclaimed for any loss or damage suffered as a result of the use or misuse of any information or content or any reliance thereon. It is the responsibility of all users of this website to satisfy themselves as to the medical and physical condition of themselves and their clients in determining whether or not to use or adapt the information or content provided in each circumstance. Notwithstanding the medical or physical condition of each user, no responsibility or liability is accepted and all responsibility and liability is hereby disclaimed for any loss or damage suffered by any person as a result of the use or misuse of any of the information or content in this website, and any and all liability for incidental and consequential damages is hereby expressly excluded.

Hypermobility pt 1 (January 2012)

Hypermobility Syndrome – part 1

James Dodd

There is Hypermobility and Hypermobility Syndrome (HMS). Hypermobility syndrome is the hypermobile patient with symptoms. Not all hypermobile patients are, or ever become symptomatic. HMS is a condition many individuals often experience their entire lives without ever having it diagnosed and managed correctly. Hypermobility has certain implications for the joint itself, as well as the surrounding ligaments, bones, joint capsules, muscles and tendons. It is important for a hypermobile patient’s well-being that they have effective neuromuscular control and active and passive systems that can support the joints in the body. Hypermobile joints by definition are those “displaying a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual.” Hypermobility Syndrome, also known as Joint Hypermobility Syndrome or Benign Hypermobility Syndrome, is defined as ‘generalized joint laxity with associated musculoskeletal complaints in the absence of any systemic disease’. HMS is an inherited form of a connective tissue disorder. Those with Hypermobility Syndrome are believed to experience pain as a result of joint microtrauma, which has been caused by overuse and/or misuse of the tissues in which there is an inherent weakness in the collagen.

It’s signs and symptoms are so often missed and so it goes undiagnosed and so is mismanaged. This means the suffering patient can go on suffering unnecessarily.

Common Features of Hypermobility

•Females are often more mobile than males.

•Mobility varies amongst ethnicity (Asian populations seem to be more affected than European populations).

•Mobility decreases with age.

•Hypermobility can be inherited or acquired i.e. repeated subluxation of the shoulder joint.

•Hypermobility Syndrome is typically determined by the genetic make up of the individual, in particular the genes causing hypermobility are those that are responsible for the production of collagen, elastin, fibrillin and tenascin.

•Certain sports and activities (i.e., gymnastics, ballet dancing, swimming) have shown to have a greater number of individuals with hypermobility.

•Musculoskeletal regions commonly affected include the achilles tendon, patellofemoral joint, rotator cuff, carpal tunnel, cervical and lumbar spine (non specific lower back pain and medial and lateral epicondyles.

•Hypermobile individuals may suffer from clicking, spondylolithesis and pars fractures.

•Hypermobility is a risk factor for the development of early Osteoarthritis.

•Fibromyalgia is commonly diagnosed in individuals with Hypermobility Syndrome

Diagnosis

The Beigton Score System (below) is a 9-point scale originally introduced to recognize hypermobile patients within the population. Primary health care practitioners now use it as a common screening process to help determine whether an individual has hypermobility.

•Passively dorsiflex 5th metacarpophalangeal joint to > 90 degrees (2 points)

•Passively take thumb to forearm (2 points)

•Passive hyperextend the elbow to > 10 degrees (2 points)

•Passively hyperextend the knee to > 10 degrees (2 points)

•Actively place hands flat on floor without bending the knees (1 point)

There can be a total score of 9. The revised diagnostic criteria for hypermobility requires you to get a Beigton score of 4/9 and have arthralgia (joint pain) for longer than three months in more than four or more joints.

There is also the Brighton Criteria that aids in the diagnosis of Hypermobility Syndrome. These include:

Dislocation and/or subluxation in more than one joint and on one or more occasions.

Abnormal skin: striae, thin skin, increased stretch of skin.

Eye signs: drooping eyelid or myopia

Varicose veins, hernia, or uterine/rectal problems

Soft tissue rheumatism (i.e., epicondylitis, tenosynovitis, synovitis)

Hypermobility and Connective Tissue Disorders

Marfan’s Syndrome, Ehlers-Danlos Syndrome and Osteogenesis Imperfecta are each genetic disorders in which the connective tissue of the individual is affected. Each disorder is different in its epidemiology, incidence and clinical presentation. While it is beyond the realm of this article to discuss each of these conditions in detail, if you have a patient with one of these disorders, you should conduct further reading in order to gain a better understanding of the disorder, its implications and how you can alter your training program to better suit your patient.

Rehabilitation and Exercise Prescription

Management of the patient will largely depend upon his/her age, current physical condition, hypermobility state and personal goals. The primary aim of dealing with any hypermobile patient should be to reduce disability and increase function. This should incorporate a holistic approach which addresses not only the fitness components but also addresses dietary, work and other lifestyle components.

Hypermobility and Acute or Chronic Injury

The acute hypermobile client should be managed like any other acute musculoskeletal injury. During the acute stages, you should be aiming to reduce swelling, inflammation, pain and restrict any aggravating or maintaining factors. Always refer your patient to a medical practitioner or hospital if you suspect anything serious. In the sub-acute or chronic hypermobile patient, the aim should be to restore normal function and reduce pain to a comfortable level. This could range from prescribing an exercise program to referring your patient for specific treatment from a GP, Physiotherapist, Osteopath or Podiatrist. It is always best to seek treatment from a practitioner that that works with and understands the implications of HMS. Failing to correctly manage with your client’s sub-acute/chronic injury could result in the development of compensatory patterns, which in turn could lead to problems developing elsewhere.

Program Design

Training the hypermobile patient requires special attention to certain training principles. You need to consider all joint, muscle and ligament actions when training, making sure that you train throughout the entire range of movement and training the muscles for isometric, isotonic, concentric and eccentric actions.

Stability of a joint is determined by the integrity of the musculoskeletal system (muscle, tendon, capsule, ligament and articular surfaces) and the neural control system (motor and sensory). It is important to address these aspects when devising a program in order to develop optimum function.

The key fitness components that need addressing in the hypermobile client include:

Proprioception

Balance

Coordination

Kinesthesia

Core stability

Endurance

Strength

Controlled flexibility

Cardiovascular fitness

Each of these fitness components requires extra attention in clients with Hypermobility Syndrome. However, each program will differ considerably depending upon each patient (i.e., client age, current physical state, hypermobility and goals). Programs could range from being as simple as improving one’s functional state (i.e., daily living activities such as walking, squatting, sitting up and down) to training elite athletes. Essentially, you will need to assess each case individually and design a program specific to the client’s needs.

Your program should try to:

Train function. Include functional activities such as push/pull, step up/down, squat, lunge and rotation exercises in your program.

Strengthen muscles equally and ensure there is a balance among agonist, antagonist and synergistic muscles.

Train movements rather than muscles, when possible.

Progress from slow to fast, stable to unstable, simple to complex, non weight bearing to weight bearing, closed chain to open chain, one plane to multi plane.

In Part 2 of this article, I will be taking a more in depth look at the individual assessment of the hypermobile patient and how we can deal with the common musculoskeletal issues one may have. The article has been divided into bodily regions, outlining what we should be looking for in the assessment, how this interacts with other regions of the body and how we can go about correcting these problems.

References:

Cook, G. Athletic Body in Balance, Human Kinetics, USA, 2003.

Gray, G. Functional Video Digest Series <http:> </http:>

Gray, G. Total Body Functional Profile, Wynn Marketing, 2001.

Janda, V. Muscle Function Testing, Butterworths, London, 1983.

Keer, R. & Grahame, R. Hypermobility Syndrome, Recognition and Management for Physiotherapists, Butterworth/Heinemann, 2003.

Kendall, F et al. Muscle Testing and Function with Posture and Pain, Lippincott Williams & Wilkins, 5th Edition, USA, 2005.

Murtagh, J. General Practice, McGraw Hill, 3rd Edition, Sydney, 2003.

Osar, E. Complete Hip & Lower Extremity Conditioning.

Osar, E. Complete Shoulder & Upper Extremity Conditioning.

Petty, N.J & Moore, A.P. Principles of Neuromusculoskeletal Treatment and Management, Churchill Livingstone, London, 2004.

Santana, J.C. Functional Training: Breaking the Bonds of Traditionalism <http:> .</http:>

Wolf, C. Human Motion: A Pictorial Guide to Functional Integrated Movement Patterns. Human Motion Associates.

Resources:

www.ehlers-danlos.org <http:> </http:>

www.hypermobility.org <http:> </http:>

www.marfan.org <http:> </http:>

www.marfanssyndrome.net <http:> </http:>

www.medicinenet.com/hypermobility_syndrome <http:> </http:>

http://medlineplus.gov/

www.oif.org <http:> (Osteogenesis Imperfecta)</http:>

www.nlm.nih.gov/medlineplus/osteogenesisimperfecta.html <http:></http:>

Important Disclaimer:

No express or implied warranty (whether of merchantability, fitness for a particular purpose, or otherwise) or other guaranty is made as to the accuracy or completeness of any of the information or content contained in any of the pages in this web site or otherwise provided by personal training on the net. No responsibility is accepted and all responsibility is hereby disclaimed for any loss or damage suffered as a result of the use or misuse of any information or content or any reliance thereon. It is the responsibility of all users of this website to satisfy themselves as to the medical and physical condition of themselves and their clients in determining whether or not to use or adapt the information or content provided in each circumstance. Notwithstanding the medical or physical condition of each user, no responsibility or liability is accepted and all responsibility and liability is hereby disclaimed for any loss or damage suffered by any person as a result of the use or misuse of any of the information or content in this website, and any and all liability for incidental and consequential damages is hereby expressly excluded.