Hypermobility Syndrome

Many people experience hypermobility in one or more of their joints. This means that the joint can move beyond the expected normal ranges for that joint. This is often referred to as being “double-jointed”. Usually, this condition has no symptoms and one is able to lead a normal life, unless there is an injury to the joint, causing pain and/or inflammation. If numerous joints are involved and symptoms are present, then one is believed to have hypermobility syndrome. This syndrome has a strong genetic link and thus often runs in families.

Signs and Symptoms

As mentioned earlier, a hypermobile joint often has no symptoms, unless injury to that joint occurs. However, the symptoms of the syndrome include:

·         Pain in the knees, hips, elbows and fingers

·         Clicking in the joints

·         Recurring joint sprains and dislocations due to instability of the joints

·         Fatigue

·         Dizziness and fainting

·         Scoliosis is more common in individuals with hypermobility syndrome and this can result in back pain

·         Joint hypermobility decreases as we get older, as we become less flexible with age

The following signs can be seen in individuals with hypermobility syndrome:

·         The ability to hyperextend the knees and/or elbows past 10 degrees

·         The ability to stand with the palms flat on the floor while keeping the knees straight

·         The ability to touch the thumb to the forearm

Hypermobility syndrome is diagnosed by means of physical examination according to the above-mentioned signs, as well as various additional tests. There is no blood test or x-ray to diagnose this syndrome.

Treatment and Management

Because there are often no symptoms, treatment is often not required. The condition generally improves as individuals get older because flexibility of the joints decreases with age. If a joint has been sprained or dislocated, then that joint will be treated for that specific injury. The pain associated with hypermobility syndrome can be treated with appropriate pain management drugs according to your doctor. Exercise therapy is particularly important in managing this condition, as the muscles surrounding the joints can be strengthened to improve stability of the joints, thereby reducing the risk of injury. A biokineticist can assist in prescribing and monitoring an appropriate exercise programme that strengthens the muscles while minimizing the risk of risk of injury.

Prognosis

Generally, there are few or no long-term side effects of joint hypermobility. However, in severe cases, individuals may develop arthritis at a later stage. It is, therefore, important to manage the condition with appropriate strengthening exercises from an early age to prevent any injuries and long-term side-effects.

References

http://www.medicinenet.com/hypermobility_syndrome/page2.htm

http://www.nhs.uk/Conditions/Joint-hypermobility/Pages/Introduction.aspx

Cerebral Palsy

Cerebral Palsy (CP) is a non-progressive condition that results from a lesion in the brain that occurs either before, during, or shortly after birth, resulting in the abnormal development of the brain. Failure of the brain to develop properly can occur during the first or second trimesters of pregnancy and can be caused by genetic disorders or limited blood supply. A lesion may also develop as a result of injury to the brain before, during, or after birth, such as a traumatic blow to the head or bleeding in the brain.

Depending on the severity of the lesion and the part of the brain affected, individuals with CP will present with varying degrees of disability. However, the general characteristic features of CP are limited mobility, poor coordination, and a limited ability to maintain posture and balance. These individuals may be wheelchair bound, unable to walk at all, or may be able to walk, but with an abnormal gait, or walking pattern. They will also often present with spasticity in the hands and arms, and a misshapen mouth, resulting in drooling and slurred speech. Their cognitive function is usually not affected, therefore, it is important not to treat them as cognitively impaired simply because they drool and have a slurred speech.

Because of the varying degrees of disability in CP patients, every person must be assessed and treated as an individual according to his/her goals and degree of disability. Adaptations to the assessment and management of these individuals will need to be made to accommodate each individual’s needs and goals. Any medications that the individual is taking must be considered, as these may alter his/her response to exercise. It is important to realize that the lesion in the brain cannot be reversed or changed by exercise; however, exercise therapy can help to improve the symptoms of spasticity, poor balance and muscle weakness associated with CP. It is also important to note that a person with CP may experience increased spasticity and decreased coordination shortly after exercise, but this is not uncommon and will return to normal.

Individuals with CP are often sedentary, due to their lack of mobility. This increases their risk of developing sedentary diseases, such as cardiovascular disease and stroke. It is, thus, important that they embark on an appropriate, regular exercise programme in order to reap the physiological and psychological benefits of regular exercise. Improvements in mood and self-esteem are also associated with exercise, which the CP patient will benefit from. The exercise programme should incorporate all the major muscle groups (if still functional) and should be aimed at improving cardiovascular fitness, muscles strength and flexibility, thereby increasing one’s independence to carry out his/her daily activities and, in turn, improving one’s sense of self-worth. A biokineticist can assist in the design, implementation and adaptation of such an exercise programme.

References

ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities

Anterior Cruciate Ligament (ACL) Rehabilitation

A common knee injury amongst the active population is the damage to or rupture of the anterior cruciate ligament (ACL). The role of this ligament is to stabilize the knee joint by stopping the bottom of the leg from collapsing forward under the knee joint, particularly during deceleration, landing, or turning and cutting actions. It is unusual for the ACL to be injured in isolation; often other ligaments and/or the meniscus are also injured. Those at greater risk of tearing the ACL are, therefore, those involved in jumping and pivoting sports, as well as contact sports, such as soccer and rugby. A muscle strength imbalance between the hamstrings and the quadriceps muscles (back and front of the thigh respectively) can also increase the risk of this injury occurring.

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Signs and Symptoms

As the injury occurs, a popping, tearing, or snapping sensation may be heard or felt, followed by swelling around the knee joint. Pain may be felt immediately or occur later and may range from mild to severe. The pain may be felt deep in the knee joint or, more commonly, on the front side of the knee. Generally, one is able to walk on the affected leg; however, this is often associated with a feeling of the knee wanting to collapse or a general feeling of discomfort. Because of the high likelihood of other surrounding tissues being damaged as well, it is important to consult a specialist for further investigation.

Management

Depending on the severity of the damage to the ACL and the involvement of the surrounding structures, an ACL injury is either treated conservatively or surgically.

Conservative management involves rest, ice, compression, elevation and immobilization of the knee joint to reduce swelling. Crutches can be used if walking is too painful. Pain-free range of motion exercises are performed to maintain mobility in the joint. Gentle and appropriate strengthening exercise are done to maintain muscle strength. Physiotherapy is very important in these initial stages of recovery. Upper body exercises can be continued throughout the recovery period. Strengthening, range of motion and proprioception and balance exercises can be progressed appropriately by a biokineticist until the individual is back to full function. This can take anywhere between 6 weeks to 3 months, depending on the severity of the injury and the compliance of the individual with the rehabilitation programme.

If there is a complete rupture of the ACL or multiple surrounding tissues are also affected, surgery is usually recommended so that an individual can return to contact or pivoting-type sports. Depending on the other structures damaged, the repair and recovery will be slightly different. A graft is taken from the hamstring muscle to repair the ACL, which means that the hamstring muscle also needs to be carefully rehabilitated and strengthened to avoid a later hamstring injury. After surgery, the affected leg is immobilized in a full-leg brace, which can be locked at various degrees of flexion and extension. One will more than likely be non-weight-bearing for between 2 and 6 weeks, again depending on damage to other structures, such as the meniscus. Physiotherapy is crucial to maintain range of movement in the joint and reduce swelling. Again, gentle strengthening exercises are done to maintain muscular strength around the knee. Once the brace is removed, the rehabilitation will follow in a similar fashion to the conservative treatment plan, progressing appropriately with the guidance of a biokineticist, with an additional focus on the rehabilitation of the affected hamstring muscle. If properly rehabilitated, one should be able to return to sport if they have not lost the nerve to do so.

References

Foundations of Athletic Training: Prevention, Assessment and Management

Polio and Post-Polio Syndrome

Poliomyelitis is an acute, viral, epidemic disease that attacks the motor neurons that control the leg muscles, resulting in paralysis and, therefore, atrophy of the affected muscles. The virus eventually clears itself and one recovers fully, leading a normal and active life. However, up to 40 years later, an individual who had contracted the virus previously can start to develop similar symptoms of fatigue, weakness, and muscle and joint pain that were experienced at the time of contraction. This is known as Post-Polio Syndrome (PPS) and it affects at least one quarter of those initially affected. Other possible symptoms include sleep disorders and intolerance to cold.

Depending on the severity of the virus, varying portions of the leg muscles will be affected, directly affecting one’s functional ability, strength and power. A limp is often present due to muscle loss in the leg, and balance is generally poor on the affected leg. The lack of use of the leg due to weakness further contributes to muscle wasting, thereby exacerbating symptoms.

Exercise is essential in the management of PPS; however, an appropriate and individualised programme is essential for success. The affected motor units may not increase in strength; however, the surrounding unaffected muscles can be strengthened to support and compensate for the affected muscles. Core and upper body strengthening exercises should be included to improve posture and gait (walking pattern). Appropriate whole body exercises should be done to include as many muscle groups as possible and increase physical fitness. Those with PPS are also more susceptible to depression and exercise plays an important role in managing depression, by increasing one’s sense of achievement and well-being. Fatigue is a common symptom amongst people with PPS, so an appropriate intensity with many rests must be prescribed. An individual with PPS should be able to continue with an appropriate exercise programme on a regular basis on his/her own, adjusting the programme accordingly. However, initially it is important to see an appropriate exercise specialist, such as a biokineticist, to be assessed and start an suitable exercise regime.

References

ACSM’s Exercise Management for Person’s with Chronic Diseases and Disabilities

Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease is a hip condition that affects young children, mainly seen in boys, between the ages of 3 and 12 years. It occurs when there is a reduced blood supply to the head of the femur, that is, the ball at the top of the thigh bone that fits into the hip joint (a ball and socket joint). The exact cause of the reduced blood supply is not known. The result of this reduced blood supply is that the bone starts to die, becoming brittle. This causes the hip joint to collapse, as the head of the femur loses its ball shape.

 

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Signs and Symptoms

The most common sign is that the child may gradually develop a limp, which may not necessarily be accompanied by pain. However, mild hip and knee pain is common and can last for months; this pain is usually related to activity. Often the pain is referred into the groin area. There is a loss of range of movement in the hip joint. As a result of the limp, loss of muscle mass may occur in the thigh. The affected leg may also become shorter, due to the lack development as a result of not placing full weight on the leg. If a child in this age group starts to limp and develop pain in the hip area, that is unexplained, this condition must be suspected and one must contact a medical practitioner for further investigation.

Management

The primary goal is to ensure that the ball stays in the socket, so that the child does not dislocate the hip joint. Depending on the severity of the disease, this may require immobilization of the hip with the use of a brace. Bed rest may be necessary initially to reduce acute symptoms. Some activities may need to be adjusted in order to avoid placing too much weight on the hip joint. In some cases, crutches may also be used to assist in weight-bearing. Physical rehabilitation is necessary later on to rebuild muscles surrounding the hip joint and to regain range of motion in the hip joint. Surgery may only be required in very severe cases.

Prognosis

It is important that children with this disease see their medical practitioner regularly to monitor the healing process. Generally, children who develop this condition under the age of 6 years and who receive the appropriate treatment, recover fully. Those who develop it after the age of 6 years may develop a deformed hip joint and are more susceptible to developing arthritis later in life.

References

Foundations of Athletic Training: Prevention, Assessment and Management

http://www.nlm.nih.gov/medlineplus/ency/article/001264.htm