The Journal of the Canadian Chiropractic Association has carried a noteworthy case series covering three instances of benign joint hypermobility syndrome [BJHS] in female patients in their twenties [1]. It proves an interesting read, as BJHS is a relatively common heritable connective tissue disorder that appears to affect more women than men. Being that many sufferers of BJHS present with joint pain, and being that proprioception (sensory feedback from the affected joints that tells you where you are in space) is also involved, the question of how these patients fare under chiropractic care is an important one.
The authors of this study began the case series by noting that BJHS is an issue for awareness. While joint pain and musculoskeletal complaints are often the presenting issues, the patient themselves might be unaware they have the condition, and lack of awareness may delay the diagnosis and effective management of the condition.
While some people with hypermobile joints remain asymptomatic, and others see it as a perk (if they are dancers or gymnasts for example), there is a third group that does suffer from extra symptoms. When joint hypermobility occurs with any of these symptoms, it becomes BJHS. Symptoms can include [3]:
– Clicking joints
– Easily dislocated joints
– Joint and muscle stiffness or pain
– Extreme tiredness
– Thin or extremely elastic skin
– Recurrent sprains or other injuries
– Fainting or dizziness
– Digestive problems.
This condition is thought to affect “from 5% to 18% in Caucasian populations and up to 43% in non-Caucasian populations [1]”. The authors of the study put forward a very valid point: the restoration of joint mobility and function are typical goals of chiropractors. Thus, we need to raise awareness around the diagnostic challenge and consider the ways in which we manage otherwise straightforward cases of “mechanical pain.”
For the sake of the case series, three Caucasian females in their twenties were detailed.
– A 26-year old female presenting with chronic low back pain, left lower extremity pains, history of injuries, and musculoskeletal complaints. She had no neurological complaints.
– A 23-year old female presenting with left-sided spinal pain extending from the base of the skull to the lower thoracic region of her back. She suffered from clicking hips, eye pain, jaw pain, skin irritation, a history included a fall while skiing, but no neurological issues or significant distress.
– Another 23-year old female presenting with upper and lower back pain, cracking joints, stiff neck, and sharp pain with movements. Her medical history included “panic attacks, anxiety attacks, and depression. She typically slept a few hours without sleep aid and medication, and approximately five hours when taking a sleep aid. She rated her current stress level, which disrupted her sleep, as “severe.”
Interestingly, the second and third of the women had not undergone chiropractic care for their complaints. The first, however, was a chiropractic student whose complaints were exacerbated by “prolonged sitting, cycling, crossing legs, fatigue and positioning for side-posture lumbar manipulations in chiropractic technique class.”
Her attending chiropractor introduced a plan of management that “included ergonomic modification when sitting in class, restrictions from involvement as a training partner in technique class, soft tissue therapy to relieve the myofascial component of her complaint, an exercise program directed at improving strength, flexibility and endurance” and some limited spinal manipulation. This modified course of care was met with improvement, and it would be another seven years before she would report a return of low back pain.
For the second patient, her treatment included “manipulation directed at the upper thoracic and cervical” areas. She was given a strengthening routine using weight machines. After four treatments in nine days, she reported “good resolution of her complaint.”
The third of the patients, who was also diagnosed with a cervicothoracic strain, was treated with soft tissue therapy, spinal manipulative therapy to hypermobile segments’, and strengthening exercises. Unfortunately, this patient did not complete her proposed course of care. She only attended 12 of the 16 proposed visits, however, she reported that her presenting complaint had improved.
The full case report (reference below) includes full details including subluxation listings and comprehensive commentary and is well worth a read. However, it should be noted that, in all three cases, some small modifications in the spinal manipulative therapy to allow for hypermobility in combination with some extra care recommendations such as soft tissue work and exercise, resulted in relatively successful care outcomes for all three.
Case series’ never answer all questions when it comes to the conditions they cover, nor can we generalize based on the outcomes. There is certainly more work to be done, both in terms of chiropractic research and basic science research when it comes to Benign Joint Hypermobility Syndrome. But either way, with a keen eye for the symptoms and complications, and a little modification to technique, it is quite possible to aid the quality of life of the BJHS sufferers under our care.
We look forward to seeing what else research has to offer in the coming years.
REFERENCES:
1. Boudreau PA, Steiman IS, Mior S, (2020), “Clinical Management of Benign Joint Hypermobility Syndrome: A Case Series,” Journal of the Canadian Chiropractic Association, 64(1), https://www.chiropractic.ca/wp-content/uploads/2020/05/117831-1_Chiro_64_1f_Boudreau.pdf retrieved 28 May 2020
2. Simpson M (2006), “Benign Joint Hypermobility Syndrome: Evaluation, Diagnosis and Management,” The Journal of the American Osteopathic Association, September 2006, Vol. 106, pp. 532-536, https://jaoa.org/article.aspx?articleid=2093276 retrieved 28 May 2020
3. Staff Writer (2020), “Joint Hypermobility” NHS Inform, https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/joint-hypermobility retrieved 28 May 2020
