Exploring Lumbar Hypermobility – Physio Advice on How to Manage.

I wrote a previous post for our Blog on hypermobility in the Fall of 2023. Since then, our clinic has seen a significant influx of new clients seeking therapists that better understand hypermobility as well as Ehlers-Danlose Syndrome(EDS).

This is for good reason. With there being no concrete objective tests or imaging (xrays, etc) that confirm or diagnose clients living with hypermobility syndrome affecting some (or many) of their joints, they have often cycled through multiple practitioners. Many end up confused with conflicting information and recommendations regarding care. Understandably, this can lead to feelings of frustration and hopelessness as one’s quality of life depends on being able to participate in life without being limited by pain and also being able to do the sports and hobbies that one loves.

I’m going focus this particular post on the lumber spine (lower back) as this is one to the most common areas we see affected by hypermobility syndromes and one that many of our clients come to us seeking Physiotherapy treatment for.

What exactly is happening in lumbar hypermobility or acutely painful episodes related to instability of the lumbar spine?

For most, this syndrome will affect a few specific joints and they may deal with repetitive episodes of these joints being a problem followed by periods where they have no pain.

There may be a sensation of something “slipping out of place”, usually with an activity that seems fairly mundane, like washing the dishes, bending down to pet the dog or putting on socks. This is often followed by a strong muscle spasm and pain, sometimes debilitating in nature in which one can’t walk or move and must lie on the floor.

Understandably, these episodes can be very alarming and difficult to work through. Despite there often not being anything pathologically wrong, many wonder if they should seek emergency medical care at the emergency department of the hospital due to the intensity of the pain. This commonly results in being told to take pain medication and rest and that “there is nothing wrong”. Hard to believe when you can barely breath or move due to the intensity of the pain you are experiencing!

The joints within the spine are affected by many systems including the nervous system, the muscles attaching to the bones of the joint, the visceral system (internal organs and their related tissues) and more. Therefore, the answer to exactly what is happening during these episodes is not always simple.

In joints that have more range than average, the ligaments supporting them are looser and allow for more movement than in other spines. Therefore, usually they will be more easily affected by things such as suboptimal positions during sleep, sitting or travel.

They will also respond worse to a change in schedule such as less exercise and more time spent working/sitting at a computer. Add stress and lack of sleep into the equation, and you have a system that is not optimally able to support itself and is vulnerable to the infamous “slipping out” that so many report during episodes of acute low back pain.

What is the best treatment for lumbar hypermobility?

Everyone’s situation, nervous system and history are going to be different, so the answer here must be based on a thorough assessment and discussed with the client.

One of the biggest pieces of advice I would give is to be cautious with practitioners who give you definite answers about what you need the first time meeting you. Hypermobilty syndromes are complicated and individual and require a sensitive approach that encourages you to start building intimacy with your body and a greater understanding of works for you and the particular demands of your life including your sports, hobbies, work and specific activities of daily living.

One of the discussions I start on day one with clients is always that we are here to support them in learning about their body and that I will be able to give them some things that *likely* will be beneficial but ultimately, they are going to need to learn what works best for their body.

In general, in the acute phase, focusing treatment on settling down pain and restoring function and movement through gentle manual therapy incorporating joint mobilizations (not aggressive manipulation/cracking), muscle-energy techniques (contract/relax), taping/bracing to provide support; gentle inner-range exercise and education regarding learning to move safely so the joint is supported as the muscles begin to let go of their protective spasm state.

Caution should be used with deep tissue release or massage as the muscles are most often tightening to protect the joint. This is often why massage alone can make these episodes worse unless there has been a more comprehensive treatment provided.

Once the acute episode has settled and less-painful movement and function have been restored, beginning to work on creating stability through learning safer ranges of movement; improved habitual habits for sitting, sleeping, etc; some form of cardiovascular exercise that helps to warm the soft tissues and provide flexibility of the muscles instead of aggressive stretching of the muscles; and strengthening including both deeper core and stability work (modified or rehab-based Pilates with a Physiotherapist is often a great way to start this) as well as weight-bearing resistance training preferably using free weights and incorporating dynamic elements as time goes on.

Most of the clients we have working through issues related to hypermobility syndromes or Ehlers-Danlos have been treated very poorly by our medical community.

It’s time for us to do better. You aren’t weird and strange, these problems are common and multifaceted and you deserve to work with healthcare professionals that validate and support you in your journey.

Our team of Therapists are committed to providing you a safe place to explore what works best for you and to support you on your journey to getting back to your life pain-free and at your best.

Book an appointment with one of our Physiotherapists here.

Katrina Sovio, Clinic Director and Registered Physiotherapist.

References:

Ehlers-Danlose Society

2. Hershkovich O, Gordon B, Derazne E, Tzur D, Afek A, Lotan R. Symptomatic Joint Hypermobility Is Associated with Low Back Pain: A National Adolescents Cohort Study. J Clin Med. 2022 Aug 30;11(17):5105. doi: 10.3390/jcm11175105. PMID: 36079031; PMCID: PMC9456634.

3. Goode A.P., Cleveland R.J., Schwartz T.A., Nelson A.E., Kraus V.B., Hillstrom H.J., Hannan M.T., Flowers P., Renner J.B., Jordan J.M., et al. Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis. BMC Musculoskelet. Disord. 2019;20:158. doi: 10.1186/s12891-019-2523-2.