A common question I hear from my patients and clients who have been diagnosed with Ehlers Danlos Syndrome (EDS) or Hypermobility Spectrum Disorder (HSD) is, “If my joints are so loose, why do I feel so tight?” A feeling of tightness of the muscles, often resulting in pain and discomfort is very common among those with these diagnoses. EDS and HSD cause increased laxity of the ligaments, which causes “looseness” of the joints. The brain will do whatever it can to attempt to stabilize the joints. One of the things the brain can do is instruct the muscles surrounding the loose joints to increase their tone. This increased muscle tone can help improve joint stability. However, this can also result in the muscles staying in a hypertonic state. Hypertonic muscles do not fully relax but instead stay “on” all the time.
This hypertonicity can become a problem first because muscles that never relax are not able to use the muscle pumping mechanism to move waste products out of and nutrition into the muscle cells resulting in muscle pain, aching and soreness from accumulation of waste products or this lack of nutrition to the muscle cells. Additionally, this can result in relative weakness in that once a muscle is fully contracted, it cannot contract more. So a muscle that is already being held in a constant contraction just to stabilize a joint will not be available to contract much further to generate strength when it is called upon to do so. Third, this increased muscle tone is often not balanced around the joint. Ideally the muscle forces around the joint would be balanced so that they would result in what is known in Dynamic Neuromuscular Stabilization (DNS) as functional joint centration. Functional joint centration allows for utilization of maximum surface area contact within the joint with balanced co-activation of all the muscles around the joint.1 When muscle tone around the joint is not balanced it can result in increased risk of subluxation or in injury as a result of focused compression and poor joint loading. And finally, the constant work being done by the muscles to maintain this hypertonicity results in fatigue, which can explain why many patients with EDS and HSD report physical exhaustion with typical daily tasks.
“437.1 – shoulder NorMal1” by iem-student.org is licensed under CC BY-NC-SA 2.0
Often when people suffer from pain and fatigue resulting from a feeling of tightness in their muscles they seek out release techniques such as massage and myofascial release work either from a practitioner or through self-massage practices using balls, rollers, sticks, etc. This can be problematic when this hypertonicity is a functional adaptation of the body to deal with the laxity of the ligaments. If the release work is successful then the joints will no longer have whatever stability was being provided by the hypertonicity. Release work without retraining the correct muscle activation for functional joint centration can be disastrous for those with hypermobility. In most cases the brain will re-engage the hypertonicity as soon as possible to stabilize the joints. So at best the release work will be almost immediately undone. At worst the release work will result in instability and risk of subluxation of the joints. In my physical therapy treatment I use rehabilitation techniques from DNS to help my patients attain functional joint centration. This enables them to use their muscles to stabilize their joints in the most efficient way possible while still allowing for full freedom of movement of the joints and without resulting in fatigue, tightness and pain.
For more information on EDS-HT, HSD, as well as other EDS subtypes I highly recommend checking out The Ehlers-Danlos Society.2