Hypermobility is a condition when some or all of your joints can move beyond what is considered a normal range because your ligaments are loose or weak. The most common joints to be hypermobile are elbows, wrists, fingers and knees. Most people will have no associated pain or medical issues with hypermobility, but you may experience pain and stiffness in your joints or muscles, repetitive sprains and strains, dislocation of your joints and poor balance and coordination.
Other conditions associated with hypermobility are tiredness, thin and stretchy skin and bladder or bowel problems. To manage these you may need to be referred to a specialist, such as a rheumatologist.
Hypermobility often runs in families and the exact cause is not known.
Hypermobility can’t be cured, but physiotherapy can help to improve how hypermobile joints are supported by the muscles and ligaments around them so that you don’t need to limit your activities. As physios, we will assess your joints for hypermobility as well as assessing your motor control, the muscle strength around these joints, your gait, your proprioception and your balance. Based on this we will provide you with a comprehensive exercise programme to strengthen areas of weakness and improve your proprioception, balance and motor control. We will also give you feedback on how to alter your gait to reduce the load on ligaments and soft tissue to reduce the likelihood of injury.
If you are having bowel and bladder problems, it might be worth also speaking to a dietician/nutritionist, and a gastroenterologist or urologist.
With hyper mobility there is no recovery as it is a condition that needs to be managed to avoid musculoskeletal injuries.
Read our article in Sebra News W2 on hypermobility.
Most people fall from time to time, but recurrent falls are more common in older people, and can result in fractures, soft tissue injuries or an increased fear of moving and going out.
Recurrent falls could have multiple causes, among them tiredness, changes in eyesight, changes in gait pattern, changes in the ability to balance, and muscle weaknesses.
When assessing someone who has fallen repeatedly or is afraid of falling, we will discuss with them when and where they’ve fallen – or are afraid of falling – to help us understand the reasons behind their falls. Once we understand the causes and assess their gait, we can provide them with exercises to improve their balance and strength. Gait re-education could include a walking aid assessment: assessing any aids they’re currently using or providing advice of walking and mobility aids that might be helpful both in and out of the home.
We will also practise a “reverse fall” technique to ensure that they can get on and off the floor and give them advice on how to get themselves up if they do have a fall, or, if they have assistance, what position they need to get into to be helped up. We will also assess the home and make recommendations of changes that could reduce their risk of falling, whether that’s moving or removing furniture or using aids for tasks they might be finding difficult.
Osteoporosis is when the quality of your bones deteriorates resulting in increased risk of bone fractures. There are two stages to osteoporosis – osteopenia and then osteoporosis. The stage is determined by how much your bone density has been has reduced, which is diagnosed with a bone density scan. Symptoms of osteoporosis can be mild impact fractures, particularly in the wrist, back and hip, height loss, receding gums, a stooping posture and lower back pain.
To either slow down or potentially reverse the osteoporotic changes in your bone it’s vital to have a review by your GP or rheumatologist who specialises in osteoporosis. They will look at your bone density scan to see where there are changes and do blood tests to look at your calcium and vitamin D levels. You should make sure your diet is rich in calcium and vitamin D, but your doctor may also advise you to take supplementary vitamin D initially at high doses. Some lifestyle changes, such as giving up smoking and reducing alcohol consumption can also help as these can affect how well your bone absorbs the calcium and vitamin D.
Osteoporosis can be due to a reduction in either calcium and/or vitamin D which are required for maintaining bone health and rejuvenation. It’s also more common in menopausal women due to oestrogen being the hormone that regulates bone health. It is also commonly seen in people with eating disorders due to their restricted food intake and being underweight. Having an inactive lifestyle can also result in osteoporosis as you will not be providing impact to your bones which stimulates bone rejuvenation.
Physiotherapy will be targeted at helping to promote bone health through a tailored strengthening and resistance training programme, which will include impact activities through both the arms and the legs to stimulate bone rejuvenation. We will ensure that this is appropriate for your stage of osteoporosis, but also ensure that you recover from any fractures that you might be suffering from at the time.
Read our article in Sebra News W2 on osteoporosis.
There are two main types of arthritis, rheumatoid arthritis and osteoarthritis, both of which cause pain and inflammation around the joints and both of which can be improved with physiotherapy.
Osteoarthritis is characterised by changes in your joints at the joint surfaces. It is diagnosed using X-rays and MRI scans, which will show thinning of the cartilage that coats the end of the bones and thickening of the bone to increase the weight-bearing surface. This may result in the joint being in an abnormal position over time. The pain that you experience is not due to the joint surface changes, but the soft tissue surrounding the joint because the biomechanics of your joint change, resulting in overloading of some soft tissue structures and stretching of others.
You would typically suffer with osteoarthritis in your back, neck, knees and hips. Without maintaining strength and control around the affected joint, this can cause the joint to worsen during acute flare-ups of osteoarthritis, you can experience swelling and localised pain to the area.
Osteoarthritis is a normal part of the ageing process, and everyone will have some changes in the joint surface as they get older.
Rheumatoid arthritis is an autoimmune disease where inflammatory periods result in deformed, painful, stiff and swollen joints. Typically, this is in your hands and feet, but you can get it in your other joints. You’re normally diagnosed by X-rays and blood tests to see your metabolic or inflammatory markers and a rheumatologist will help you manage your symptoms with a combination of steroids, anti-rheumatic drugs and anti-inflammatories.
Physiotherapy for rheumatoid arthritis can help to reduce the speed of joint changes and maintain joint mobility and strength. Your physio can help with mobility and strengthening exercises when you’re not experiencing acute flare-ups, and can also recommend activities for the affected joints to reduce the likelihood of flare ups, such as playing the piano, knitting or cross stitch for the hands and fingers.
Osteoarthritis can be managed really well with physiotherapy too. Soft tissue release is useful to release muscles that have become tight and are restricting movement of the joint or making it more difficult to adequately contract your muscle to move easily. We will provide an exercise programme to regain full joint mobility and increase muscular strength around the affected joints to ensure that you can move your body in a controlled manner without overloading certain parts.
If the arthritis is in the joints of your lower limb, we might also look at your gait pattern and provide you with advice to improve your gait, and if the joint surface has changed significantly, we could refer you to a podiatrist or orthotist to recommend support device for your shoes or around the affected joint to help reduce the load on the soft tissues around it.
Read our article in Sebra News W2 on osteoarthritis myths.
With gout you’ll have severe pain in or around the toe joint that is affected – typically the big toe joint. The joint will also be swollen and red and this may include your feet and sometimes your calf. The onset of the pain is usually over a few hours.
Gout is caused mainly by too much uric acid in the body, resulting in crystals forming in the joints which causes them to become swollen, red and painful. You’re more likely to get it if you eat a lot of red meat, some types of fish, fruit juice and sugary drinks. It can also be seen in people whose kidneys don't filter out the uric acid.
With gout you should see either your GP or a rheumatologist to verify you have gout and check the level of uric acid you have in your blood. Uric acid levels can usually be managed with a change in your diet to reduce the food that causes high levels of uric acid to be released, or there is medication that can manage gout on a daily basis. You may need stronger medication during acute attacks of gout. Also, it's good to reduce alcohol.
From a physiotherapy point of view, to help prevent gout we’ll provide you with an exercise programme to strengthen and mobilise the joints that are stiff and weak, but also provide you with general strength exercises. This is good to manage this condition, as it will reduce the amount of stress on your joints. If your gout is due to liver function, it’s really important to drink plenty of water to avoid dehydration.
Gout is a condition that needs to be managed long-term.
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