As a person with a hypermobility disorder, a physical therapist, and a gymnast, I'll admit that I approach this question with a degree of bias. I have a unique perspective because of my personal history. I was once working as a float therapist covering for other PTs and was intrigued to see a precaution listed in the patient's chart: "Ehler's Danlos - NO STRETCHING". While every case is different and each patient has unique needs, I found it a bit ironic that I would be treating someone with Ehler's Danlos Syndrome (EDS) who was being forbidden to stretch. In fact, I felt that if I followed the evaluating therapist's treatment plan, I would be a bit of a hypocrite.
When a person has a connective tissue disorder like EDS or Hypermobility Spectrum Disorder (HSD), some of their tissues are too flexible. This could mean the tissues in their ligaments, their blood vessels, or any other connective tissue structure. Our bodies are reliant on these connective tissues for many functions. In the PT world however, we are primarily concerned with the way the hypermobility affects the ligaments, fascia, and muscle tendons. Many patients with hypermobility complain that they feel like they need to stretch to relieve tension. The question becomes, is it still safe to stretch when your connective tissues already have extra mobility?
There is a delicate balance in the human body between mobility and stability. The more mobility a person has, the more challenging it is to maintain good control and stability of their movements. Conversely, a person who has a high degree of stability, may find their mobility limited to the point they don't have the range of motion in their joints to perform daily activities like bending over to tie their shoes. Gymnasts are a perfect example of athletes who have to master the ability to achieve a high degree of flexibility, while also maintaining the stability to control their joints to perform various acrobatic skills. The point of the argument being, that the goal of being both mobile and stable can be achieved with the right balance of exercise training.
People with Ehlers Danlos often struggle with feelings of tightness, tension and soreness in their muscles. This is common because their muscles are often working extra hard to help hold their joints stable to make up for the fact that their ligaments are not doing it naturally. Ligaments are supposed to work similar to rubber bands. If you place tension on them, they will naturally resist to try and pull you back into a neutral position. In people with hypermobility disorders, their ligaments don't kick in to stabilize their joints as soon, so their muscles have to do extra work. This can leave them feeling sore, tired and tense because their muscles are overworked. This is especially true if you have not worked with a skilled physical therapist who can teach you how to distribute the work load amongst different muscles to help minimize the strain on any one muscle individually.
When a healthy person is sore after a workout, they tend to stretch to help themselves feel better. This can help promote improved blood flow to their tissues that aids the body in getting oxygen and nutrients to the tissues to help them repair, while moving waste products like lactic acid out. For that reason, stretching is a good thing and can help EDS patients feel better when done right. People with EDS need good blood flow to keep their tissues healthy just like everyone else.
The purpose of stretching for a person with EDS is usually not to improve mobility. Overly aggressive stretching to increase mobility can be counter productive. When seeking to increase mobility, we should always work to ensure that the patient has the muscular stability and control to use that new range of motion safely. This is true of all people regardless of it they have EDS.
If you have EDS and feel like you need to stretch, but it never seems to be enough, physical therapy may be able to help. While most physical therapists will evaluate a patient's strength and flexibility, there are other variables to consider when treating patients with EDS. Your therapist should take a look at you holistically to ensure that your circulation is allowing for your body to process waste products and provide adequate nutrients to your tissues. Sometimes your vascular tissues have been affected by your connective tissue disorder. They may also want to evaluate your nervous system to see if your nerves are sending messages to your muscles to hold them at too high of tension levels.
Every person's body is a little different. Individualized medicine that is tailored to you and your body is important. While this article is intended to help educate providers and patients on stretching and EDS, it is not a replacement for personalized medical advice. If you'd liked to schedule an evaluation for personal recommendations, click the booking tab above.
Great info!!