I spent almost 10 years working in adult rehab before I transitioned to pediatrics. I still teach joint protection, but I teach it differently. Kids rarely have JRA or joint damage in general. What they have in spades are serious degrees of hypermobility. And the methods to use joint protection strategies so that tissue damage is minimized are different:
Joint protection strategies for hypermobility need to be adapted from those for other disorders, in order to obtain the best results and put clients at low risk of accidental injury.
What’s So Different?
- Hypermobility can create a different type of joint strain than OA or other joint damage, and different types of soft tissue damage. Understanding the way placing force on hypermobile joints can damage them is essential to understanding how to guide clients correctly.
- Excess mobility reduces sensory feedback even when pain isn’t a factor, and can create different types of pain that aren’t as common as in RA, OA, or other joint deformities. I laugh a little bit , and then groan, when I see articles on proprioceptive loss in hypermobility that focus on only lower extremities. There are a whole bunch of joints above the waist, guys, and hypermobility affects each and every one of them as well. Just because you aren’t using them to walk doesn’t mean you don’t need proprioception to use them…..! I wonder who thinks this is just a lower extremity issue?
- Hypermobility appears to cause dyspraxia that can “disappear” after a few repetitions, only to reappear after a while or with a new activity. How can that be? It can’t. Praxis doesn’t work like that. What you are seeing is a lack of sensory feedback that improves with repetition, only to be replaced with a lack of skilled movement from fatigue, or from overuse of force, or pain. This is really poorly understood by patients, and even by some therapists, but makes perfect sense when fully explored.
- Hypermobility is seen in a wide range of clients, including younger, more active people who are trying to accomplish skills that are less common in the over-60’s set that we see for OA. Different goals lead to different needs for joint protection strategies and solutions.
- Joint damage isn’t evident until long after ligament damage has been done. People with hypermobility at every age need to protect ligaments, not just joint surfaces. This isn’t always explained.
- Their “normal” was never all that normal. Folks with RA and OA often have years, even decades, of pain-free life to draw on for motor control. Hypermobility that has been with a person for their entire life deprives them of any memory of what safe, pain-free movement, should feel like. They are moving “blind” to a degree. Incorporate this fact into your treatment.
- So many people are hypermobile in multiple joints that the simple old saws like “lift with your legs, not your back” won’t cut it. Whatever you learned in your CEU course on arthritis won’t be exactly right. Think out of the box.
- The reasons for hypermobility have to be accounted for. Genetic disorders like PWS, Down syndrome, and Heritable Disorders of connective Tissue (HDCTs) bring with them other issues like poor skin integrity and autonomic nervous system dysfunction. Always learn about these before you provide guidance, or you risk harm. We therapists are in the “do no harm” business, remember?
This fall I may start writing a workbook on addressing the use of joint protection, energy conservation, pacing and task adaptation for hypermobility. There is certainly nothing out there currently that is useful for either therapists or patients.
in the meantime, please read Need a Desk Chair for Your Hypermobile School-Age Child? Check out the Giantex Chair , Hypermobility and Music Lessons: How to Reduce the Pain of Playing and Why Injuries to Hypermobile Joints Hurt Twice