Loose Joints

Pain & Rehab Forum [Moderated]
1

I would love some suggestions for someone with hyper mobility.

I am hyper mobile in certain joints and that make things, well, difficult and I have been having a really hard time finding good exercises to stabilize my joints or know what else to do about it.

Wrists: pretty much all Bodyweight work with my hands holding my weight gives me acute wrist pain and trying to “brace” my hand by pushing hard into the floor to hold my wrists slightly straighter is extremely fatiguing and doesn’t work well.

Ankles: I get ankle pain while running. resistance bands and balance work doesn’t seem to make a difference

Knees: this one is weird. Example of something that happened today: I was napping on the couch and when I went to get up, my left knee did not want to hold any sort of weight and I have to lift my whole leg and put it on the floor carefully. I had a secondary spasm when putting too much weight on the knee and I almost fell over. I fear that I slept on it “wrong” and the knee joint became off centre or something like that.

Back: I have been reading a lot about how pain can be created and perpetuated without any injury or problem, but my current theory is my low back pain is because I have (anterior) pelvic tilt and my back easily scrunches up and compresses itself. I have the most pain when lying on my back (I have to hold my hips down with my muscles otherwise it feels like my lower back arched way too much and it pinches) and toss and turn all night as there is no comfortable position. Driving a lot also causes pain for days after. I am trying my best with stretches and strengthening my abs, hams and glutes but I feel like this is not making any sort of headway. It feels like the only way to solve my pain is to push my hips down, consciously, 24/7 when I am sitting or walking or standing.

My current activitity level: I do barbell training 2-3 times a week on my own and otherwise work in a sedentary job.

2

Hey,

Thanks for the questions.

How old are you?

How long have these issues been ongoing?

Any recent traumas?

Why do you think you have hypermobilie joints (i.e. where did this narrative come from)?

Any prior history of partial or complete dislocation?

There appear to be two discussions going on here, one of hypermobility and one regarding stability.

Stability is well defined in the research literature as the ability to resist perturbation.
I like Reeves’s definition:
“To discuss stability of a system, whether it is in equilibrium (static) or changing with time (dynamic), we must give a small perturbation and observe the new behavior. If the new behavior is approximately the same as the old, qualitatively speaking, the system is stable. If the changed behavior becomes indistinguishable from the old behavior, returning to its original position or trajectory after a sufficiently long time, the system is asymptotically stable. Finally, if the disturbed behavior differs significantly from the old behavior, the system is unstable.”

Improving stability is task specific, example: if you want to be better at balancing on a bosu ball while juggling flaming chainsaws then that’s what we need to practice. If you want to be able to hold a plank better, then that also needs to be practiced.

Stability as it relates to joints is discussed from a standpoint of dislocation (luxation) and partial dislocation (sub-luxation – no, not the one chiros talk about). If a joint is deemed unstable, that means it either has previously partially or completely dislocated or we are concerned it may. Typically we do find issues with joint stability from contact/trauma based injuries acutely damaging the joint or genetically as connective tissue dysfunction in Ehlers-Danlos syndrome – which requires a consultation for diagnosis. We also can have patients present with chronic multidirectional instability to say the shoulder. Most of these scenarios are accompanied with a prior history of dislocation/subluxation.

If we want to improve stability of a joint, it is task specific, and I am a biased fan of strengthening surrounding structures via resistance training (bands and bodyweight may be a starting point but we need to quickly increase intensity to tolerance via other implements – barbells, dumbbells, kettlebells, etc.).
Regarding the pain you are experiencing, even in the scenarios described above – it is difficult to correlate pain to perceived instability or hypermobility. Meaning, a person may very well have hypermobility, but that does not mean they will have pain and/or dysfunction. Make sense?

I encourage you to check out some of the youtube videos and articles Barbell Medicine and I have put out regarding pain.

Ausitn Baraki’s discussion on pain: https://startingstrength.com/article/aches-and-pains

My article on pain: Loading...

Podcast on pain: https://itunes.apple.com/us/podcast/clinicalathlete/id1253517238?mt=2&i=1000417390904

BBM youtube page: https://www.youtube.com/watch?v=9FXOcnJ1klI

3

Hi Michael,

I have been having random pain problems for most of my adult life and I am 29 now.

It is is possible I am just overly sensitive, I have considered this before but it gives me no reassurance. I perceive pain disproportionately to any real world signs like swelling or anything like that. I am very sensitive to bodily changes like I get really bad reactions to low blood sugar even though I am very insulin sensitive and of overall good health. I am a normal weight.

I have tried to work on various theories on my own because when I go to the doctor they tell me to suck it up (gotta love dealing with military doctors!). One of them said it’s kust because I was not active as a kid and it’s normal. So no formal diagnoses of anything. But also no support from professionals because if I can work that’s all that really matters.

i have received some very disappointing PT for my back pain and foot pain (I get plantar fasciitis flare ups on occasion when I have to stand for too long). I actually ended up having to treat my plantar fasciitis myself and I found using minimalist footwear helped improve my foot’s posture, so to speak, and the flare ups are now a rare occurrence and do not render me limping since I taught myself to stand better. But I have no had success in finding any similar type of changes to make my back cease complaining or my ankles when I run. Or anything else that tends to bug me.

So I have tried to work this out on my own. I have reached for hyper mobility because the pain is in my joints and the pain occurs when the joints tend to be pushed together (hence wrist pain when I lean on my hands, ankle pain when I land on my foot while running). I do score a few points on the Beighton scale, around 4-5 I think. I must admit I am trying to “find a reason” because so far doctors, PTs and my own blood sweat and tears has made little headway into reducing my pain issues.

Maybe stabiltiy would be a better way to define my problems?

I actually started barbell training to see if I could just get stronger and these issues would go away. I definitely am stronger now and my confidence and self esteem is higher but the pain still lingers. I will watch those videos right now.

4

So I have done some reading and I am understanding this more but I still don’t know what I should do.

I am the problem, and all the articles and podcasts talks about it from the doctor/trainer side. I am the patient and I need to treat myself. There is no one here qualified like you guys are that could help me.

I guess I can just resolve to try and keep my stress low, I can keep up my meditation practice and hope it helps me de personalize the pain. But it is still really hard fighting your instincts. And my issue is so broad… I get loads of different problems, it’s not just my back. Sometimes I feel really useless. I am perfectly capable of pushing through pain, but my current experience is pain simply begets more pain. I have pushed through pain running numerous times and have ended up in agony. Or on the other side, going easy means I spin my wheels and get nowhere.

If I go to the doctor and try and talk to them about this they will give me a blank stare and refer me to psych. These doctors aren’t really that intuitive or up to date on the latest literature. They will think I’m trying to get out of work. I don’t want to be a hypochondriac. I don’t want to be pathetic. I am very strong minded but my body fights me at every turn. It complains to me about everything.

Sorry if this seems a little desperate but I have been fighting this battle for many years and have made very little progress. It is very wearying. Endlessly frustrating.

5

Have you considered a consult with one of us at Barbell Medicine? Contact Us | Barbell Medicine

I understand all of this can be overwhelming and leave you feeling helpless but the first step in the process is acceptance, and then realizing you do have control. We’d be happy to guide the process for you via remote consultation.

There’s also a new app on the market called Curable. You may find benefit from this app for managing recurrent and persistent pain symptoms. https://www.curablehealth.com/

6

Thanks Michael.

This is a complicated issue for me since it isn’t just one thing. I will try that app and maybe I can get a consult sometime too. Wish me luck.

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