Signs & symptoms of subluxations or joint instability may manifest in various ways, including:

• Locking, buckling, or inability to weight bear or put pressure on the affected joint.
• Sensation of heaviness or difficulty in using the affected area.
• Surrounding musculature may feel bruised or tender to the touch.
• Physical deformities, such as the presence of a sulcus sign, may be noticeable.
• Increased fatigue in the area, even with minimal use.
• Audible sensations like popping, clunking, or clicking, which may occur more frequently and be painful.
• Emotional reactions, such as apprehension about using the joint, fear of movement, feelings of guilt and frustration, and confusion regarding the symptoms and their management.

Why Do Subluxations Happen?

 

Several factors contribute to our anatomy, including genetic predispositions (such as having a connective tissue disorder) or experiencing trauma. These factors may make it harder for our joints to stay stable. When our joints struggle to maintain stability on their own, we may  become more prone to subluxations/dislocations.

 

Stability depends on three things:

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What is the Beighton score?

The Beighton score is a tool used to assess joint hypermobility, which is currently the only score used in the hEDS diagnostic checklist. It consists of a series of movements that assess the range of motion in the joints, and a score out of 9 possible points is given based on the number of movements that can be performed. The score cutoffs vary depending on age and gender, with different cutoffs for children, adolescents, and adults. 

Beighton score:

≥6 pre-pubertal children and adolescents

≥5 pubertal men and woman to age 50 

≥4 men and women over the age of 50

The benefits and strengths of the Beighton score:
One of the strengths of the Beighton score is its ease of use – it is performed quickly and easily without needing any equipment. It also has great inter- and intra-reliability, meaning that if one doctor says a patient “passes,” it is very likely that other doctors will agree.

What doesn’t the Beighton score account for?

However, it has some limitations as well. The Beighton score does not account for pain, function, or other symptoms, and its ability to truly reflect generalized joint hypermobility has been questioned. Additionally, the Beighton score has extremely wide ranges of specificity and sensitivity, and no studies have been done to test its validity from a diagnostic standpoint. This means that relying solely on the Beighton score for diagnosis can result in a significant number of missed diagnoses.

The limitations of the Beighton score:

One of the main limitations of the Beighton score is that it primarily focuses on the upper extremities, which may not accurately reflect generalized joint hypermobility. Additionally, the Beighton score does not account for pain, function, or other symptoms that may be present in patients with hypermobility disorders. This can result in patients being misdiagnosed or undiagnosed despite presenting with symptoms of hEDS/HSD.

Other helpful scoring systems and diagnostic tools:

It is important for both patients and clinicians to understand the limitations of the Beighton score and to seek out additional assessments if hEDS/HSD is suspected. Other scoring systems and diagnostic tools are available and should be used if you suspect a patient is struggling with hEDS/HSD and they do not “pass” the Beighton score. The other scales that can be used include 

• The 9-point Beighton modification
• The Hospital del Mar criteria
• The Rotes-Querol scale
• 5pq
• The Carter-Wilkinson criteria
• The Windsor scale

If you suspect that you may have hEDS/HSD or if you have been misdiagnosed or undiagnosed due to the limitations of the Beighton score, I encourage you to seek out a specialist in your area. The Ehlers Danlos Society Providers List is a great resource for finding specialists who can accurately diagnose and treat hypermobility disorders.

Seeking hypermobility support?

If you have any questions or concerns about hypermobility disorders, I would love to connect with you on a discovery call where we will discuss your individual situation and decide together how I can support you during your hypermobility journey.

If you’re struggling with hypermobility disorders, I understand how overwhelming it can be, read about my story here. I’m here to support you every step of the way!

Reference:

Hurst, B., Krahn, J., Harmsen, S., et al. (2022). Beighton score alone fails to diagnose the majority of patients with hypermobile Ehlers-Danlos syndrome: A retrospective analysis of a multicenter EDS cohort. medRxiv. doi: 10.1101/2022.04.25.22274226.

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If you have ever been to a chiropractor, you have probably had your neck adjusted and thought nothing of it. Maybe it even made you feel better!

Chiropractic adjustments have been shown to give short-term relief to some people sometimes. Any tool that can give relief is a powerful tool to use, especially on people with chronic pain.

When it comes to hypermobility, our connective tissue is built differently. This makes our ligaments lax (like a stretched out rubber band) instead of spring-like. In our upper cervical spine, we have some important structures. This includes our brainstem, spinal cord, nerve roots, and many other important structures. When the ligaments in our neck are lax, we become at risk for something called Craniocervical Instability.

Unfortunately, many chiropractors who perform spinal manipulation are not aware of the consequences that cervical instability may have on a patients quality of life. We are also not well-informed of the impact an HVLA thrust may have on these lax ligaments.

Risk VS Reward

First, what is an HVLA adjustment?

HVLA stands for high-velocity low-amplitude (lots of speed not a lot of force) which is the type of thrust being applied during most chiropractic adjustments. The noise you hear is a bubble forming in fluid surrounding your joints. There are many theories about what is happening neurologically during an adjustment. The general consensus is that there is a short-term neurological effect that may decrease pain and increase range of motion.

For anyone who has experienced pain, you know how powerful this relief can be. It can get you back to work, exercising, and hanging out with loved ones without constantly thinking about the pain. Adjustments can be a great tool, but short term relief is not worth the risk of life-altering changes that can happen by adjusting a hypermobile neck.

There are currently no studies (for obvious reasons) comparing adjustments on hypermobile necks to controls because it would be extremely unethical. As a chiropractic student with CCI and hEDS, I can confirm that cervical adjustments made my symptoms extremely worse. I am very fortunate that nothing affected me long term, but many are not as lucky.

Common Comorbidities Seen In The Hypermobile Community

Ligament laxity is a reason in itself to not get a cervical adjustment, but common comorbidities seen in this population make this even more imperative.

Many of these patients suffer from MCAS, POTS, CCI, Chiari, and other comorbidities that put them at higher risks for things like CSF leaks, intracranial hemorrhage, and other life threatening complications.

Short-term relief is not worth the risk of these complications. Especially when there are other ways to get relief, and many hypermobile patients do not feel relief from spinal manipulation anyway.

What Should Your Provider Look For?

HSD and hEDS are extremely under-diagnosed. It is estimated that 1 in 500 people have hEDS yet only 1 in 5000 are diagnosed. You may seek out a Chiropractor for symptoms of hypermobility like dysautonomia, severe neck pain, headaches, nausea, vision changes, brain fog, and more. In the general population, these are all reasons a Chiropractor may want to adjust someone.

It is important for Chiropractors to remember that their patient may have no idea they are hypermobile, or what hypermobility is. Your Chiropractor should perform the “Beighton Scale” in order to rule out hypermobility. This scale has issues, but it is a good place to start.

A Note To Anyone Practicing Spinal Manipulation

If you suspect your patient is hypermobile and you are unsure how to proceed, please find someone in your area that does. The Ehlers Danlos Society has a list of practitioners who specialize in hypermobility.

Remember, it is okay to say, “I don’t know enough about this, but I will find someone who does”

I get asked constantly “Why would someone with hypermobility ever go to a chiropractor?” Believe it or not, Chiropractors can and SHOULD be doing more than just adjustments. The beautiful thing about chiropractic is our large scope of practice.

Chiropractors should focus on education, symptom relief, self-management, flare-up management, and lifestyle changes with every patient. We are here to guide you in the right direction…we are not here to “fix” you, put your bones back in “alignment” or “unblock” your nervous system. Like any profession, you will find good and bad Chiropractors. The right one will focus on the above, rather than making you feel like you need them to survive.

Safer Options For Hypermobile Bodies

Like we mentioned before, adjusting is a great tool for some people when it comes to symptom relief. There are many other passive modalities that can be just as effective. These include but are not limited to:

• Soft tissue work
• Gentle mobilizations if tolerable
• IASTM/cupping etc
• Ocular Movement
• Estim/heat/ice etc

Obviously, each patient will fall somewhere different on the hypermobile spectrum. What is safe for someone may not be safe for someone else. A proper informed consent should ALWAYS be done before any treatment.

There is nothing magical about any of these passive modalities, including an adjustment, but they are safer and may provide relief to your patients. Finding passive modalities that work for you can be very powerful. Short-term relief when living with chronic pain can be life-changing.

Your provider should help you find the right modality for you and your bendy body!

The post Hypermobility & Adjustments first appeared on The Hypermobile Chiro.

Some basic truths about the chiropractic adjustment

Spinal adjustments, spinal manipulations, cracky backy -whatever you want to call it – are all doing the same thing: talking to your nervous system.  Adjustments feel great but the education and intention behind them is far more important than what is actually going on in your tissue. 

What you see: HVLA thrust at a joint in its end range of motion.

What you hear is called cavitation.

The popping noise is simply a gas bubble forming in the fluid surrounding your joints. The force and resulting sound may have you thinking that we’re moving bones around, (and fixing you) but we are actually just providing stimulation to your nervous system. 

If the positive effects are very short-term, what is the point of an adjustment?

The most important thing is that the adjustment will allow you to move easier, which gives you time to create strength and stability in the area. By having this short term relief, you will be able to see your body’s capabilities. This sends a different message to your brain; telling it you can move through this range of motion and access this range all on your own. Can you get that short term relief without an adjustment? 10000000% yes. You just need to find the ways that work best for your body and mind! 

But can’t chiro’s find the exact location that NEEDS to be adjusted?!?

First off, and this is an important note to remember, nobody needs an adjustment. It is a nice pain-relieving tool, but it is not changing your bone structure or fixing anything. Chiropractors do not fix you, because you are not broken. Additionally, while some might have you believe that adjustments are very specific, evidence actually shows that we are not specific in our adjustments and the method of adjustment is irrelevant. The evidence also shows that they don’t need to be specific to have an effect!

So, if adjustments aren’t realigning me, then what in the world is happening?

Adjustments provide neurological input and stimulation to the nervous system. They talk to your nervous system and deliver sensory messages. This allows for a possible short term increase in range of motion and pain relief. 

But you swear you’ve seen  “changes in alignment” after an adjustment… 

After an adjustment, your body is moving differently due to the recent nervous system stimulation. This can show up as a shift in a leg length or an untilted head. It is important to realize these ‘alignment changes’ are short term and you can get to that point without the adjustment. 

Another reason for this change is something called Practitioner Implicit Bias. This is the unconscious bias that affects our actions in a way contrary to our intentions.  An example of this is when Chiropractors re-check your leg length and have that AHA moment that they are the “same length” now. In reality, they are not trying to scam you. They genuinely believe and see that change, but it is really just their implicit bias. 

Are all Chiropractors just lying to get money?

Most chiro’s do not intentionally scam you, but subconsciously, they may. To prevent yourself from getting scammed, look for a provider that educates you about your body, provides resources for mindset shifts, and promotes overall movement. Pain is not always mechanical or physical, it is also not always a bad thing. Don’t get manipulated by the scam providers

Now you may be asking: why even go to a chiropractor? 

Believe it or not, chiropractors have a very thorough education on the human body, including the brain-body connection. I repeat, we can not realign your bones (you can’t realign something that never went out of alignment), but we can guide you in a direction to shift your mindset and educate you on your body’s capabilities. We can help people process through their struggles differently than they would on their own. By talking to the nervous system, we help the system achieve a place it may not have gotten to in a very long time, allowing you to gain that strength and stability your body is craving. One amazing thing that chiropractors are extensively trained at is ruling out red flags. We spend more time with you than a PCP will and can get to know you on a more personal level. This gives us the ability to truly get to the cause of your issues and reassure you that nothing is wrong with you, or find a plan if something serious is going on. We are here to listen, redirect, educate and support you through the pains of life. 

So, is adjusting safe? 

For most people, yes, but proper informed consent should ALWAYS be given. You should be aware of any risks that may accompany an adjustment prior to receiving one. Chiropractors spend a lot of time in school learning about red flags and reasons not to adjust someone (contraindications). Unfortunately, there is good and bad in every profession. Many chiropractors are not practicing within their scope, and are doing contraindicated adjustments. Adjusting Hypermobile Necks would fall into the contraindicated category. Please ensure you have been given proper informed consent before any form of spinal manipulation.

All information from this post is based on the current evidence supported in the following studies 

• Placebo Mechanisms of Manual Therapy: A Sheep in Wolf ‘s Clothing?
  • Joel E. Bialosky, PT, PhD1,2, Mark D. Bishop, PT, PhD1, Charles W. Penza, DC, PhD1
• Unraveling the Mechanisms of Manual Therapy: Modeling an Approach
  • Joel E Bialosky, Jason M Beneciuk, Mark D Bishop, Rogelio A Coronado, Charles W Penza, Corey B Simon, Steven Z George
• Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study
  • A Plank 1, A Rushton 1 2, Y Ping 1, R Mei 1, D Falla 1, N R Heneghan 3
• Analysis of zygapophyseal joint cracking during chiropractic manipulation
  • J W Reggars 1, H P Pollard
• ‘Cracking joints’. A bioengineering study of cavitation in the metacarpophalangeal joint.
  • A Unsworth, D Dowson, and  V Wright

The post What Is An Adjustment? first appeared on The Hypermobile Chiro.

Getting diagnosed with Hypermobile Ehlers Danlos syndrome can be extremely confusing and frustrating for not only the patient, but also the practitioner. hEDS is the only type of EDS that does not currently have a genetic marker. This means diagnosis is based off of clinical criteria.

In 2017, the Ehlers Danlos society created the diagnostic checklist currently used for diagnosis of Hypermobile Ehlers Danlos Syndrome.

It is important to note that MSK providers like Physical Therapists, Chiropractors, and Occupational Therapists can tell if you meet the diagnostic criteria, but they can not currently give you a formal diagnosis. 

I highly recommend printing out the checklist and filling it out with a trusted provider. You could also fill it out yourself to the best of your own ability. Once completed, bring the checklist to a geneticist/rheumatologist/EDS specialist for a formal diagnosis.

Here is your go-to guide for filling out the checklist!

Criteria 1: Beighton Score

The Beighton score is out of 9 possible points and based on your age, you must meet a certain score to be diagnosed with generalized joint hypermobility.

The post hEDS Diagnostic Criteria first appeared on The Hypermobile Chiro.