Article - Pain Management for Benign Joint Hypermobility Syndrome

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Pain Management for Benign Joint Hypermobility Syndrome

Relief of Severe Pain

Drugs

Take strong enough analgesia to relieve pain and muscle spasm. Non steroidal

anti-inflammatory drugs can be very effective, as long as you do not suffer

from stomach ulcers as well. Panadol is effective in relieving post

treatment pain

Antidepressants

Antidepressants can be effective for their muscle relaxant property and can

promote good sleep.

Homeopathic Treatments

Some homeopathic and herbal remedies can provide some relief. Echinacea root

has been found to be particularly effective.

Hydrocortisone Injections and Physiotherapy

For very severe, painful episodes, hydrocortisone injections and intensive

physiotherapy, in the first 24 hours may be necessary.

Local Heat

The application of local heat (hot water bottles, baths, heat rub creams,

heat lamps, ice gels) maybe soothing.

Stretch

Performing specific local stretch techniques.

Self Mobilisation

Performing self mobilisation techniques. These must be smooth and rhythmic.

Magnet Plasters / Bracelets

Magnet Plasters and bracelets help relieve pain for some people.

Splints / Clasps and Supports

Splints, clasps and supports can help to provide relief for elbows, knees

etc.

TENS

TENS units are useful for pain relief in many areas.

Relief of Chronic Pain, Muscle Stiffness and Fatigue

Even if the person with hypermobile joints is pain free and leads a normal

life, it is essential that full movementthrough their joint range is

maintained.

Daily stretches are of paramount importance. The thoracic spine is the first

place to stiffen in adolescents and 90° trunk rotation should be encouraged.

To ensure 90° rotation, try sitting in a dining chair and twisting around to

hold the back of the chair, so that your shoulders are at right angles to

your pelvis. Repeat to the opposite direction. Do this once a day.

It is important that daily sessions of muscle relaxation should also occur.

If you feel that you might need help with relaxing, ask your physiotherapist

to teach you some of the techniques.

Ensure that you breathe with your diaphragm. It is important that you

oxygenate your bodt maximally to keep the tissues healthy and energetic. The

diaphragm is the most energy efficient muscle of respiration.

Isometric / static strengthening exercises should be done to stabilise the

joints.

Balance education and proprioceptive improvement exercises should be

encourage too.

There may be a need to support the flat foot with insoles and a referral to

a podiatrist or physiotherapist may be indicated.

Abdominal muscle strengthening exercises are important too. Prior to any

movement of the upper or lower limbs, the trunk is stabilied by the

automatic contraction of the abdominal muscles. When the abdominals are

weak, the trunk, which includes the back, is less stable, limb movements are

less co-ordinated and back injury more likely.

Lying for 5 minutes daily, on your side or back, with your legs curled up,

helps the discs imbibe water, thereby improving their hydration and shock

absorbing properties.

Good hydration of body tissues is an essential factor in protection, repair

and maintenance. Drinking plenty, (preferably water) before and after sport,

is vital for healthy tissues.

Participating in racket sport has been found to significantly increase upper

trunk strength and reduce the incidence of neck and shoulder pain.

Make sure you rest your joints each day. This does not mean that you must

lie down and sleep but ensure you avoid fixed positions. FIDGET!! Only stay

at one task or in any one position for a maximum of half an hour.

Have a daily programme of management; pace your activities, avoid repetitive

tasks and fixed positions, keep your joints moving without overstretching,

try taking up Yoga or Pilates exercise.

Change your way of life - the way you move; when to exercise; continually

correct your posture; take rest times

Become a problem solver by managing daily tasks to suit your body. Look at

ways of changing your environment so that, for example, work surfaces are at

the correct height, avoid continually bending. Provide cushioning between

your body and the world with softening aids, adaptations of your

environment. These could include self help tchniques such as wedge cushions,

strapping to prevent over movement of vulnerable joints, muscle and nerve

stretch exercises, massage and treatment of tender trigger points.

Treatment of Associated Problems

Fidgety legs syndrome is when you have butterfly feelings of twitching in

the muscles or cramps. These can often be relieved by stretching the legs,

pressing your feet against the tailboard of the bed, using a hot water

bottle on the muscles or joints and taking a couple of Paracetamol before

going to bed.

'Flu like symptoms often occur when the thoracic spine becomes stiff.

Passive or active mobilising techniques of the spinal and rib joints can

alleviate the symptoms.

In Difficult Situations

Remember to fidget. If you are having extensive dental work performed, tell

the dentist about your hypermobility and ask him / her to allow you regular

breaks so that you may close your mouth and move your neck to prevent post

treatment pain.

On long car journeys its is very important to stop, get out of the vehicle,

stretch and walk a short distance to relieve stiffness and muscle aching,

before resuming the journey.

Specific Aids

Head and Neck

Pillows: These come in a variety of shapes, degrees of softness and price.

Car pillows help to support your neck, especially if you fall asleep. Desk

slope (or ring binder files) help when you are writing.

Thoracic Spine and Shoulders

Gentle vibrating massagers can provide relief for stiff achey muscles.

Lumbar Spine

Sitfit cushions, seat wedges, lumbar rolls, car support back rests, car seat

wedges, mattress overlays, pillows laid lengthways in the bed to support

your back and hips, big exercise balls or swiss balls (to help re-educate

balance), kneeler chairs.

There are all sorts of aids to encourage good posture with computer use:

shaped keyboards, paper holders, arm supports etc.

Knees, Hips, Feet and Heels

Shooting stick type seats to take on long walks, taking a second pair of

shoes to work (with a different heel height), shock absorbing insoles and

heel pads, pillows between the knees to sleep, metatarsal domes, support

insoles (AOL / Formthotics).

Hands and Arms

Wide grip and light weight pens (Dr Grip), small bags that can be carried

across the shoulders, back packs with wide cushioned straps and slings with

velcro, front fastenings