Sjukgymnastik

Det finns bra böcker om behandling av smärtor vid hypermobilitetssyndromet men som också fungerar lika bra på EDS-III patienter.

Följande 2 böcker av bl a Rosemary Keer och Rodney Grahame finns att beställa på bokus för drygt 300 resp 400 SEK.
Hypermobility Syndrome. Recognition and Management for Physiotherapists.
hypermobility fibromyalgia and chronic pain (nyutgiven version)

Här en annan relativt ny bok av Brad Tinkle   (264:-)
Joint Hypermobility Handbook

Länk till artikel i en tidskrift för sjukgymnaster från 2000 som beskriver undersökning, utredning, diagnostik, prognos, behandling.
Examination and treatment of a patient with hypermobility syndrome
Här alternativ länk
Examination and Treatment of a Patient With Hypermobility Syndrome
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Hypermobility and the hypermobility syndrom – Masterclass

Jane V. Simmonds, Rosemary J. Keer, Hypermobility and the hypermobility syndrome, Manual Therapy, Volume 12, Issue 4, November 2007, Pages 298-309, , (Hypermobility and the hypermobility syndrom)     kostar en slant i fulltext om man inte har abonnemang på arbetsplatsen –  men annars väldigt fullständig artikel.

Här nedan ett sammandrag-

Abstract

Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life.

This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes;

  • education and lifestyle advice,
  • behaviour modification,
  • manual therapy,
  • taping and bracing,
  • electrotherapy,
  • exercise prescription,
  • functional rehabilitation
  • collaborative working with a range of medical, health and fitness professionals.

Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.

Från EULAR 2004 Hypermobility Symposium i Berlin finns följande utdrag

Kan hämtas ner på www.medscape.com/viewarticle/537938

i fulltext om man registrerar sig först (kostnadsfritt)

 

 

  • Rosemary Keer, Director, Central London Physiotherapy Clinic, Harley Street, London, UK

JHS frequently presents with a complex array of symptoms, with pain being the predominant feature. Other reported symptoms include feelings of instability, subluxation, dislocation, stiffness, and incoordination. The condition is often not recognized and symptoms can therefore be present for a long time before a diagnosis is made. This can lead to physical deconditioning [ 16 ] and psychological effects such as anxiety, anger, and the loss of confidence in oneself and in healthcare professionals.

The basis for the symptoms is thought to lie in lax connective tissue, which predisposes the patient to trauma from overuse and misuse of joints and soft tissues [ 17 ]. This results in poor movement patterns or movement abnormalities, which can further stress the joints and soft tissue, particularly during repetitive activities and prolonged static postures.

Physical therapy is the mainstay of treatment in JHS and needs to address all of these issues to be successful. A management plan is usually made up of five elements:

  1. 1.        Restoration of a normal range of movement, even if hypermobile: The physical examination is concerned with the concept of relative flexibility [ 18 ] and treatment is then directed at mobilizing hypomobile (stiff) areas and improving or gaining control of hypermobile areas.
  2. 2.        Correction and prevention of movement dysfunction: Hypermobile individuals frequently have difficulty focusing movement in a particular area, probably due to defective proprioception [ 9 ]. Therefore movement re-education involves improving postural control and alignment, joint position sense, balance, and proprioception.
  3. 3.        Improving/gaining joint stability: Hypermobile individuals show a tendency to rest at the end of range of joint movement in an attempt to find more stability. It seems sensible to encourage maintenance of more neutral joint positions in order to prevent ligament strain. This involves developing effective core/trunk stability initially and progressing to improving stability around peripheral joints in an attempt to produce balanced movement and control of hypermobile joints throughout their full range and throughout normal daily activities [ 19 ].
  4. 4.        Advice and problem solving: This should be tailored to each individual patient and should include reassurance, education about the disorder, and general advice on joint care, with a particular focus on avoiding sustained and unhelpful postures. Problem solving and advice regarding specific activities and lifestyle modifications may be necessary for some patients.
  5. 5.        General fitness: It is important to develop an enjoyable, relevant and customized exercise program to improve stamina, strength, and endurance and to encourage a lifelong commitment to exercise. This is essential for maintaining good physical fitness in order to resume normal daily activities and return to sport performances. Exercise in water has anecdotally been found to be particularly beneficial to JHS sufferers.

The main aim of treatment is to increase function, decrease disability, and enable the patient to confidently and effectively self-manage the condition.