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Forum Name: Rheumatology Topics

Question: Joint laxity- Whom should I see for associated pain


 philking - Wed Jul 28, 2010 5:03 pm

I suffer from joint hyper mobility and have my whole life. I’ve just only recently, however, been diagnosed with it. I’m a male student (early 20s) that lives a predominately sedentary lifestyle (though am in relatively good shape because I do plenty of non-taxing exercising). Though the hyper mobility was more fun (look what I can do!) than it presented a problem when I was younger, within the last few years, I’ve recently started to experience joint popping and pain in various places. Most notably, my right femur pops every time I take a single step ascending stairs, and often when I’m just walking across flat surfaces (even carpeted ones). Although I haven’t experienced pain concurrently with the popping, I’ve been experiencing pains in bed at night right where my femur pops. I’ve just recently had an X-ray, moreover, which came back “unremarkable“. I’m quite certain, therefore, that it has everything to do with my joint hyper mobility.

My question: I’m wondering what I can possibly do about the various pains I experience as a result of my hypermobility. I’ve tried the gamut of OTC analgesics (to no avail), and have asked both my former primary physician and a rheumatologist to treat my symptoms, but was refused help by both. On top of other disappointments with the medical profession (and they are many) I’m losing hope that I’ll find a doctor who will give me more than a “Well what do you want ME to do about it?”. At this point, I’m starting to think I'm better off going back to suffering in silence, as depressing as it sounds.

So, in short, who should I see/ what should I tell them/ what should I do at this point? Thanks.
 Dr.M.Aroon kamath - Wed Jul 28, 2010 10:49 pm

User avatar Hi,
Analgesics are at best only symptomatic.
The cornerstone in the management of individuals with joint hypermobility is physical therapy to strengthen the muscles which surround and stabilize the joints.You stand to gain significantly by being under the care of an expert physical therapist who can tailor the exercises to a given individual.

A physical therapists generally would decide on what sorts of disabilities exist in a given individual and the priorities.

Joints and the muscles that move them act as a single unit.The proprioceptors within the joints and the ligaments appear to have a feed-back control (a feed-back loop)over the muscles that move the joints as well as muscles that stabilize the joint(stabilizing muscles-which may be more proximal in location).They complement each other.

Thus, physical therapy to enhance the stability and function of the joints may involve,
- strengthening of the muscles that actually move a joint and
- strengthening of the more proximal stabilizing muscles.


"Dynamic" stabilization exercises are recommended by some.These involve gentle.short range, sustained tonic exercises that are believed to enhance the function of the feed-back loop that we mentioned earlier by stimulating the 'postural and slow twitch muscle units' within the muscles in question.Exercises such as co-contraction and co-activation of muscle groups(agonists and antagonists) is also one of the techniques recommended.

The extent of benefits one may gain out of physical therapy ultimately will depend upon,
- availability of expertise (with special interest in treating individuals with joint hypermobility disorders),and
- patient compliance.


As far as you are concerned, i feel that analgesics are not the answer and you must find an expert physical therapist and comply with his/her guidance.
Best wishes!
 philking - Thu Jul 29, 2010 1:04 am

Thank you very much for your reply. I most probably will look for a good physical therapist sometime soon for associated problems with my hyper mobility. However, one (of many) of my other problems is chronic pain in my right wrist post corrective surgery for a fractured scaphoid bone. It’s mobility is limited, I’d guess it has about 75% of its former range, and whenever I hit the limit in either direction, it hurts (for example, I couldn’t do a normal pushup (due to the angle of the wrists it requires) if my life depended on it). Luckily I was never an athlete to begin with, because I couldn’t play any sports that put a significant strain on the wrist ever since I had the surgery. I mentioned this chronic pain to the same rheumatologist, and he directed me to the surgeon that performed the operation. This was unfortunate for me because I already had an appointment with the surgeon, but cancelled it because I falsely presumed seeing him and the rheumatologist both would be redundant. Now I have to wait for god knows how long to get an appointment with the surgeon again.

In any case, since the chronic pain in my right wrist is not solely the result (though perhaps partially) of my hyper flexibility, but more the after effect of surgery, and since I still regularly perform the very same exercises for the wrist that I was taught from the physical therapist I saw after the surgery, I don’t think there’s much more for me to do for the wrist physical therapy wise. Though I treat it like I’m supposed to, that doesn’t stop it from hurting/ cramping regularly from doing things as simple as writing or typing for extended periods of time. The 35 minute writing portion of the LSAT, for example, caused it to bother me throughout. It’s no fun, frankly. But again, it could be worse. At least I’m not athletic, or I would probably have been ruined. Though my hip is the latest nuisance, my right wrist is the oldest of the most bothersome of the lot of my health problems, 3 years running, now.

My joint pains, then, aren’t just limited to my hyper mobility, and I probably should have made that explicit in my first post. However, in addition to complaining of pain from my hyper mobility AND my right (and dominant) wrist, neither the rheumatologist, nor the former primary, would prescribe anything. I realize physical therapy IS beneficial for my wrist, and that’s why I’m still doing what they taught me. However, it’s simply not enough to eliminate my wrist from paining me during the most trivial of activities. My request of analgesics, then, took both of these problems together. I figured it was about the only option for my wrist, short of possibly another surgery (to end up leaving it worse off, perhaps?). I could understand (though still probably wouldn’t like) being refused were my only problems from issues such as my femur popping (I also have TMJ pain, by the way, and wear a night guard for it regularly), but with the wrist pain added to it, I simply don’t understand .

But assuming that I don’t want/ can’t afford another surgery right now, and that I’m still doing the physical strengthening exercises I was taught in physical therapy for my wrist, is my asking for a stronger analgesic, after having attempted to self medicate myself with OTC analgesics ever since I had the surgery, really that preposterous of a request as to be twice refused?
 Tom Plamondon PA-C - Mon Aug 09, 2010 8:15 am

User avatar Hello,
Regarding the issue of pain control for chronic right wrist pain secondary to hypermobility syndrome and post fracture repair of the scaphoid: changing from OTC analgesia to prescribed medication will need to be discussed with your family physician. There are increased risks of dependency and addiction with long term narcotic pain medication use and according to some studies (e.g in chronic low back pain conditions) efficacy is very low.
Other consideration are heat and cold modalities, splinting and continued exercise.

Regarding the hypermobility syndrome: dynamic stabilization exercises for whole body are important as other areas of the body will tend to flare up with popping and pain so start now to prevent future problems.

Take care.

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