Following on from our recent discussion regarding BHJS, this blog intends to enlighten you with a more complete picture of the symptoms and signs which present in this condition and how we can assist you.
Patients suffering from BHJS are known to suffer muscle cramps, tendonitis, headaches and a range of autonomic symptoms, which further indicate such a diagnosis.
Any relationship to bone mass?
Patients with benign hypermobility syndrome have significantly lowered t-scores referring to bone density, bone structure, and bone strength data, although never reach the threshold criterium for osteoporosis as proposed by the World Health Organisation.
So what exercises would I be benefiting from?
Among exercises, lower back stabilisation and closed kinetic chain exercises are most useful in improving joint stability and proprioception. For example, performing the push up reduces the amount of control needed compared to lying on your back pushing up dumbbells, whereby your hands (weights) are free to move and in the presence of laxity and impaired proprioception, may result in joint instability and injury.
Is there a link between BJHS and digestion?
It has been shown that those with BJHS have impaired propulsion of bowel contents demonstrable on GI physiological investigations. Because our digestive tract is also made up of connective tissue and contributes significantly to the passive mechanical properties of the gut wall, changes in the rate or degree of deformation/stretch in the gut wall are likely to influence the function of the bowel potentially leading to malabsorption issues. Unexplained abdominal pain is a very common complaint, seen in up to 86% of patients with BHS. Both Autonomic nervous system dysregulation and laxity in collagen comprising the gastrointestinal tract, may underlie increased pain generation.
How common are headaches in those with BHS?
Headache is a particularly troublesome symptom experienced by patients with joint hypermobility syndrome, with 75% of female patients suffering from migraines. Furthermore there is a strong association between benign joint hypermobility and temporomandibular (jaw) joint disease.
Is the nervous system involved?
About 75% of patients with joint hypermobility syndrome appear to have impaired autonomic reflexes. Although previously underappreciated, the decreased quality of life due to severe dysautonomia can be as high as in patients with congestive heart failure. Evidence suggests that there is increased sympathetic tone but decreased sympathetic reactivity to stimuli. As a result, patients tend to have Orthostatic hypotension (dizziness upon standing), gastrointestinal discomfort (such as early satiety, bloating, postprandial nausea/vomiting), and secretomotor complaints, including Raynaud phenomenon and abnormal sweating.
So, what can be done for the management of your symptoms?
No evidence is available regarding the use of opioids for the treatment of chronic pain due to hypermobility. Because the pathogenesis of pain in hypermobility relates more to chronic stresses, it does not stand to reason that opioids will help promote long-term alleviation of pain. Moreover, because opioid medications carry very significant risks, including the development of central pain sensitization, dependency, and the potential for abuse, these should not substitute for physical therapy and lifestyle modification all of which we provide at our Sydney Chiropractic Centre, The Chiro Hub.
A potential link between Fibromyalgia, cardiac valve prolapses and BHS?
There is even evidence to suggest a link between those with BHS and chronic pain conditions such as fibromyalgia and cardiac valve defects. So, if you score 4 or higher on the Beighton 9-point scoring system, it may well be wise to have a cardiovascular examination in particular those with a family history of cardiac valve defects/abnormalities.
So, what’s the fuss? Just make me feel better Doc!
Whilst improving your symptoms and functioning, I would rather you be informed of the process that is happening within your body, rather than be treated the same way each time despite receiving positive relief. We must understand that the ambiguity of our complaints can surely lead to greater perceptions of fear, agoraphobia and panic disorders, and this (surprise surprise!) has been shown in those with BJHS. This ultimately can contribute to the pain experience.
Furthermore, it is important for those with hypermobility syndromes to understand that having the neck placed at the end range of its motion under long duration holds is deemed to be very risky and should be avoided.
Ensure that your clinician or Chiropractor Sydney has examined your connective tissue quality and status!!
References:
1: Albayrak İ, Yilmaz H, Akkurt HE, Salli A, Karaca G. Is pain the only symptom
in patients with benign joint hypermobility syndrome? Clin Rheumatol. 2015
Sep;34(9):1613-9. doi: 10.1007/s10067-014-2610-6. Epub 2014 Apr 18. PubMed PMID:
24744155. Done
2: Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor AJ. The
relationship between benign joint hypermobility syndrome and psychological
distress: a systematic review and meta-analysis. Rheumatology (Oxford). 2014
Jan;53(1):114-22. doi: 10.1093/rheumatology/ket317. Epub 2013 Sep 29. Review.
PubMed PMID: 24080253.
3: Smith TO, Jerman E, Easton V, Bacon H, Armon K, Poland F, Macgregor AJ. Do
people with benign joint hypermobility syndrome (BJHS) have reduced joint
proprioception? A systematic review and meta-analysis. Rheumatol Int. 2013
Nov;33(11):2709-16. doi: 10.1007/s00296-013-2790-4. Epub 2013 Jun 1. Review.
PubMed PMID: 23728275.
4: Toprak Celenay S, Ozer Kaya D. Effects of spinal stabilization exercises in
women with benign joint hypermobility syndrome: a randomized controlled trial.
Rheumatol Int. 2017 Sep;37(9):1461-1468. doi: 10.1007/s00296-017-3713-6. Epub
2017 Mar 30. PubMed PMID: 28361275.
5: Kumar B, Lenert P. Joint Hypermobility Syndrome: Recognizing a Commonly
Overlooked Cause of Chronic Pain. Am J Med. 2017 Jun;130(6):640-647. doi:
10.1016/j.amjmed.2017.02.013. Epub 2017 Mar 10. Review. PubMed PMID: 28286166.
6: Kozanoglu E, Coskun Benlidayi I, Eker Akilli R, Tasal A. Is there any link
between joint hypermobility and mitral valve prolapse in patients with
fibromyalgia syndrome? Clin Rheumatol. 2016 Apr;35(4):1041-4. doi:
10.1007/s10067-015-3024-9. Epub 2015 Jul 28. PubMed PMID: 26216348.
7: Em S, Oktayoglu P, Bozkurt M, Caglayan M, Karakoc M, Ucar D, Verim S, Yildiz
I, Sariyildiz MA, Evliyaoglu O, Nas K. Serum relaxin levels in benign
hypermobility syndrome. J Back Musculoskelet Rehabil. 2015;28(3):473-9. doi:
10.3233/BMR-140543. PubMed PMID: 25322737.
8: Baeza-Velasco C, Gély-Nargeot MC, Bulbena Vilarrasa A, Bravo JF. Joint
hypermobility syndrome: problems that require psychological intervention.
Rheumatol Int. 2011 Sep;31(9):1131-6. doi: 10.1007/s00296-011-1839-5. Epub 2011
Mar 4. Review. PubMed PMID: 21373784.
9: Booshanam DS, Cherian B, Joseph CP, Mathew J, Thomas R. Evaluation of posture
and pain in persons with benign joint hypermobility syndrome. Rheumatol Int. 2011
Dec;31(12):1561-5. doi: 10.1007/s00296-010-1514-2. Epub 2010 May 20. PubMed PMID:
20490806.
10: Zarate N, Farmer AD, Grahame R, Mohammed SD, Knowles CH, Scott SM, Aziz Q.
Unexplained gastrointestinal symptoms and joint hypermobility: is connective
tissue the missing link? Neurogastroenterol Motil. 2010 Mar;22(3):252-e78. doi:
10.1111/j.1365-2982.2009.01421.x. Epub 2009 Oct 15. PubMed PMID: 19840271.
11: Sahin N, Baskent A, Ugurlu H, Berker E. Isokinetic evaluation of knee
extensor/flexor muscle strength in patients with hypermobility syndrome.
Rheumatol Int. 2008 May;28(7):643-8. Epub 2007 Nov 28. PubMed PMID: 18043921.
12: Gulbahar S, Sahin E, Baydar M, Bircan C, Kizil R, Manisali M, Akalin E, Peker
O. Hypermobility syndrome increases the risk for low bone mass. Clin Rheumatol.
2006 Jul;25(4):511-4. Epub 2005 Nov 26. PubMed PMID: 16311714.
13. Unexplained gastrointestinal symptoms and joint hypermobility: is connective
tissue the missing link? Neurogastroenterol Motil. 2010 Mar;22(3):252-e78. doi:
10.1111/j.1365-2982.2009.01421.x. Epub 2009 Oct 15. PubMed PMID: 19840271.
14. Are there early signs that predict development of temporomandibular joint disease? Fredricson A S, Khodabandehlou F, Weiner C K, Naimi-Akbar A, Adami J, Rosen A, J Oral Sci. 2017, Nov 22