Why is Rehabilitation of the hip and pelvic area so important to Hypermobile Individuals?

 In Ehlers-Danlos Syndrome, Hypermobility Spectrum Disorders, Joint Hypermobility Syndrome, Management Skills, Therapy Options

I am a physiotherapist in Brisbane with a special interest in hypermobility related connective tissue disorders so most of the clients I see have hypermobile-Ehlers Danlos Syndrome, Hypermobility spectrum disorder or Asymptomatic Generalised Hypermobility

I have observed in my clinical practice that around 90% of symptomatic hypermobility clients have hip or pelvic issues.  Common complaints are locking, giving way, clunking, popping, incontinence and pain. There are many different structures that contribute to these issues including the joints (Hip, Sacro-Iliac Joint (SIJ) and Pubic Symphysis), the soft tissues (muscles and their tendons), the nerves and also referred pain from the low back and other structures.

It is not overly surprising that hip/pelvic complaints are common, as many hypermobile people have lots of painful areas throughout their body but in my opinion, rehabilitation of the muscular control around the hip, pelvis and low back is pivotal to improved quality of life and maintenance/improvement of function in simple and complex hypermobile clients.

So why are the hips and pelvis so important in rehabilitation of a hypermobile individual?

  • The Pelvis provides support and protection for the uterus, bladder, bowel and intestines.
  • The muscles of the pelvic floor control bladder and bowel function.  Weakness of these muscles can contribute to stress incontinence, or on the other end of the spectrum, overactivity of the pelvic floor muscles can contribute to an overactive bladder, constipation and painful intercourse.
  • The muscles of the hip provide a large amount of sensory information (joint proprioception) to the brain about the position of the body and the balance of your foot, knee, hip and trunk
  • The gluteus maximus (outer layer of butt muscle) is the largest muscle in the body and provides the power for many common movements including getting in/out of a chair, walking upstairs/hills and squatting.
  • The correct timing and function of the deeper stabilising muscles (deep hip flexors, gluteus minimus and the deep external rotators) of the hip and pelvis can improve the feeling of stability of the hip joint and decrease the frequency of unwanted cracks and pops.
  • To walk in an energy-efficient manner, transfer of weight from one leg to another through a balanced hip and pelvis position is required1.
  • The hip and pelvic position can provide a stable postural base to support arm and neck activity during upright activity when standing and walking.  For example, exercising when standing in this position (see picture) can lead to a pain flare-up in any or all of the following areas – neck, shoulders, knees, back, SIJ.
  • Walking or standing with a significant “hip drop” (or Trendelenburg) is often observed in painful hip issues including gluteal tendinopathy2, SIJ issues as well as knee, foot and back problems.
  • If you have a history of ankle sprains, research suggests you may also have outer (lateral) hip muscle wastage3. Most of my clients with EDS have chronic ankle sprains and ankle rolling, so improving the strength of the entire leg is important.
  • Improved hip control can often relieve muscle overactivity, gripping, pain and compressive loading in the middle (thoracic) and lower (lumbar) area.

The ability to move and transfer your weight effectively from one leg to another during walking requires co-ordination of many muscles – it isn’t just necessary for you to build strength and bulk but it also requires development of muscle timing and retraining of the brain’s ability to recruit the appropriate muscle at the appropriate time and at the appropriate intensity. 

Too much work on any one muscle can place stress or strain on other areas. Strategies can be also be implemented to reduce feelings of muscle tightness or overactivity.   But be careful as this tension in the muscle system can be the holding you together and you must give the system strength and stability before releasing your compensations.  

If you haven’t had success with rehab before then I would suggest you talk to your therapist about hip rehabilitation. It is often hard to find a physiotherapist such as myself with extensive hypermobility knowledge but if you can find a therapist up-to-date with hip and pelvic knowledge then that may be another option for you, and while they teach you about the hip/pelvis you can educate them about hypermobility. 

For further information of all things “Hip”, I would suggest you look at a website I am involved in https://hippainhelp.com.  We have many interesting blog posts that help all those with hip problems learn about up-to-date evidence-lead research.  We also have a growing directory of professionals with a special interest in hip and pelvic conditions, who can assist in your rehabilitation.

Some recent blog posts from Hip Pain Help that you may find helpful include:

Sharon Hennessey is a physiotherapist with 23 years of experience and is the hypermobility team lead at Not Just Bendy within the PhysioTec practice in Brisbane.  Face-to-face and telehealth consultations are available at Not Just Bendy with Sharon, Chen and other members of the hypermobility team.

Sharon is also a co-founder of the website https://hippainhelp.com which is focused on delivering accurate information about hip and pelvic conditions and connecting people with professionals with the specific knowledge to assist them.

References:

1Lewis, C. and Sahrmann, S. (2015). Effect of posture on hip angles and moments during gait. Manual Therapy, 20(1), pp.176-182.

2Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med. 2015;45(8):1107‐1119. doi:10.1007/s40279-015-0336-5

3 Friel K, McLean N, Myers C, Caceres M. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006;41(1):74‐78.

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