Joint hypermobility - in spinal and also other joints?

Joint hypermobility is for example, when you can bend your wrist enough so that your thumb points straight back along your forearm.
Knee or elbow hyperextension (past straight) can mean the same thing.

Ligamentous laxity has allowed an increased range of movement of these joints, assuming that you haven't had a fracture which wasn't set straight.

You may have a mild form of Ehlers-Danlos syndrome. This is mostly but not always familial.





Spinal joint pain and stiffness, or laxity?

The majority of people who see me with pain from their spine , are helped by mobilizing stiff spinal joints.
Quite often however, the pain was not coming from the stiff joint.

Very commonly, the pain is even on the opposite side of the body, to the stiff joint!

What is going on here, is a stiff posterior joint forcing its neighbours or its opposite partner, into abnormal position and movement.

This other joint can become painful because of ligamentous strain, producing inflammation or muscle spasm there.

The same applies to the sacro-iliac joints. I very commonly find that a stiff sacroiliac joint is causing pain in the opposite side buttock and thigh.

If you have degenerative disc disease, with say, bulging discs on CT scan, the pain may come from this. The stiff joint has placed extra strain on the damaged discs.



How to examine for which spinal joints are sore

The methods of examination for joint fixations, are detailed on the Lumbar spine and the thoracic spine pages.

It is not possible to examine individual posterior joints for tenderness, as the thick spinal muscles over them may be tender.

One can examine an individual spinal level for tenderness. I place one finger across a supraspinous ligament and apply a downward jerky springing force on this with the heel of my other hand.

Finding the gap between the little bones up your back is easy if you're thin and healthy, but can be very difficult otherwise. If you press in and roll your fingertip up and down at the same time, there is a little dip between the bones.

In joint hypermobility, this dip is a deep gap you can push your fingertip right into. This is not uncommon in a joint next to one which has long standing stiffness.

In degenerative disc disease, when the discs are dessicated and have shrunk, this gap between the bones at the back, will be narrower and hard to feel. Pinching in from the sides with thumb and forefinger may help. The skin will move with your fingers as you feel the contours of the underlying bones, to feel the slight notch between them.



A very common scenario is the person who comes in with acute low backache, tender over the last couple of lumbar spine levels, but with a joint stiff further up their lumbar spine.

Mobilizing the stiff joint can often relieve their pain.

Their bulging disc pain from disc degeneration at the bottom joints, was brought on by muscle tightness and twisting from the stiff joint further up.

When spinal joints become stiff they twist and tip to the side a little.



Joint hypermobility treatment

As inferred above, mobilizing stiff joints is the first step.

Tightening the muscles which work across the loose joint is the next step.

You can easily test the strength of your Lower trunk core stability. Sit on the edge of a table facing a mirror, legs dangling over the edge. Fold your arms across your chest and attempt to sit straight and still, as you lift one knee then the other. See if you wobble.

Apart from overall core stabilizing exercises , a specific technique can be applied over a single loose joint.
Have someone poke their finger into your back, and attempt to hold still rather than be pushed forwards.
They do above and below the joint on each side, 4 positions in all, an inch or two from the midline.

This will exercise the tiny muscles which connect the two bones, and over a time will strengthen them.

Prolotherapy is another option. This involves injecting a sugar solution into the ligaments of the loose joint, which produces inflammation and subsequent strengthening of the collagen connective tissues.



References for joint hypermobility page

The list of conditions which can lead to general joint hypermobility includes Ehlers-Danlos syndrome, Marfan syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, downs syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita. (from Wikipedia)

In his book "Spinal Manipulation," J.F.Bourdillon quoted...

"In their study of abnormal lumbar spines Froning and Frohman found that an increase of motion was common in levels adjacent to those showing restriction. A similar observation was recorded by Jirout."

Froning, E. C. and Frohman, B. (1968) Motion of the lumbo-sacral spine after laminectomy and spinal fusion, J. Bone Jt. Surg50A 897-918

Jirout, J. (1955) Studies in the dynamics of the spine, Excerpta Acta Radiol 46 Fasc



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