Ehlers-Danlos syndrome (AKA Hypermobility Syndrome) is a group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen. (Collagen in connective tissue helps tissues to resist deformation.) Clinically, this syndrome results in ligamentous laxity which, in turn, leads to mal-alignment of the weight bearing joints.
The severity of Ehlers-Danlos syndrome can vary from mild to life-threatening. There is no cure of this syndrome. However, some success has been reported using Prolotherapy and surgical stabilizing procedures (e.g., subtalar joint implant prosthesis):
Prolotherapy involves injecting a sclerosing solution at the site where the ligament attaches to the bone. In theory, this strengthens the collagenous fibers within the ligament where it attaches to the bone. A Cochrane review of the medical literature (2004), using prolotherapy for chronic low back pain, reported inconclusive and conflicting evidence on the effectiveness of therapy.
Corrective surgery has been used to help stabilize weight bearing joints within the lower extremity (subtalar, ankle and knee joints). However, surgery is not indicated in patients having either the Rothbarts Foot structure or the PreClinical Clubfoot Deformity.
Grading Ligamentous Laxity
Figure 1 - Determining the Beighton Score. Beighton's modification of the
Carter and Wilkinson scoring system.
The Beighton Score is a useful screening (guide) technique to help determine if the patient exhibits ligamentous laxity:
- Score 1 point for each of the five simple tests pictured in Figure 1, performing the tests 2-5, bilaterally
Interpretation of Results
Patients who have inherited connective tissue pathology (e.g., Hypermobility Syndrome) will almost always develop muscular hypertonicity. This occurs because the ligaments, due to their laxity, are unable to maintain a stable bone to bone alignment within the weight bearing joints . The body compensates by recruiting the postural muscles to maintain postural stability.
- A Score of two or less suggests the body's ligaments are normal
- A Score of three or four suggests that ligamentous laxity may be present. Proceed cautiously if comtemplating using Rothbart Proprioceptive Therapy.
- A Score of five or more in adults (with a history of chronic joint pain) indicates significant ligamentous laxity.
Clinically, this overuse of the postural muscles produces a constant tightness or overcharging within these muscles.
Patient’s who have inherited Hypermobility Syndrome and the PreClinical Clubfoot Deformity will require a combination of interventions to reduce their chronic muscle pain and/or fatigue:
- Rothbart Proprioceptive Therapy to eliminate the symptoms resulting from the PreClinical Clubfoot Deformity
- Ongoing Physical Therapy to increase the strength and range of motion within their core muscles to attenuate their chronic fatigue.
- Prolotherapy to tighten the lax ligments connecting the major postural articulations (specifically the ankle, knee, and sacraliliac joints)
Dagenais, S.; Yelland, M.; Del Mar, C.; Schoene, M.; Dagenais, S. (2007). "Prolotherapy injections for chronic low-back pain.". Cochrane database of systematic reviews (Online)
Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg (Br) 1964;46(1):65.
Knight I. (2011). A Guide to Living with Hypermobility Syndrome: Bending Without Breaking. Jessica Kingsley Publishers, London
Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain