Key terms

Joint hyper-mobility syndrome (JHS)

Benign joint hyper-mobility syndrome (BJHS)

Ehlers-Danlos syndrome (EDS)

Concepts, Definitions, Questions & Responses

Q3: IF I have developed pain under MY knee cap, could you clarify whether that could be a symptom of an underlying issue?

IAN

What we talked about is the condition of BJHS. It is HEREDITARY and it manifests as a musculoskeletal problem. It involves LAXITY in the CONNECTIVE TISSUE. We discovered that Celeste had her unstable knee [cap/s]. When I hear of [unstable knees or ankles occurring repetitively, along with pain in ribs and shoulders] I begin suspecting BJHS. So I ask the person whether she/he has any digestive issues, fainting, low blood pressure […].  For some people, there are very random symptoms. So that is the link I was making. I am sure osteopathically we could connect [immobility or hyper-mobility] to other conditions, but the issue of mobility is not going to directly drive [the related complaints.]  [emphasis added]

Benign joint hyper-mobility syndrome (BJHS)

“is the occurrence of musculoskeletal symptoms in hypermobile individuals in the absence of systemic rheumatologic ..” 

… “Benign joint hyper-mobility syndrome is thought to be a mild variation of EDS and most closely resembles EDS type III (hypermoblity type), which consists of joint pain, marked hyper-mobility, mild extra-articular involvement, and mild skin changes without scarring.”  https://jaoa.org/article.aspx?articleid=2093276

EDS “Ehlers-Danlos syndrome
“(EDS) is a disease that weakens the connective tissues of your body. These are things like tendons and ligaments that hold parts of your body together. EDS can make your joints loose and your skin thin and easily bruised. It also can weaken blood vessels and organs” https://www.webmd.com/a-to-z-guides/ehlers-danlos-syndrome-facts#1

RESOURCE (we might offer Feldenkrais® and Focusing… )
Hypermobility Syndrome Patient Association,
UK (HMSA, www.hypermobility.org), “a well-organized charity which has an active interactive website
and is supported by medical and allied health practitioners with specialist interests and knowledge.”
From J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309 JHS.
Three primary systems which influence normal movement:
1/ the cardiorespiratory
2/ musculoskeletal
3/ neurological

Progressive closed chain kinetic exercises.

https://www.physio-pedia.com/Closed_Chain_Exercise
” Closed Kinetic Chain (CKC) exercises or closed chain exercises are exercises or movements where the distal aspect of the extremity is fixed to an object that is stationary.

With the distal part fixed, movement at any one joint in the kinetic chain requires motion as well at the other joints in the kinetic chain, therefore, both proximal and distal parts receive resistance training at the same time.[1]

CKC exercises have gained popularity over Open Kinetic Chain (OKC) exercises because many therapists believe that CKC exercises are more reliable and functional.[2]  Uçar et al. affirmed that for rehabilitation post ACL reconstruction, CKC exercises were more effective than OKC exercises at regaining mobility and enabling a quicker return to daily and sporting activities.[3]

Characteristics of CKC exercises and the difference with OKC exercises:[4]

Closed Kinetic Chain (CKC) exercises or closed chain exercises are exercises or movements where the distal aspect of the extremity is fixed to an object that is stationary.

With the distal part fixed, movement at any one joint in the kinetic chain requires motion as well at the other joints in the kinetic chain, therefore, both proximal and distal parts receive resistance training at the same time.[1]

CKC exercises have gained popularity over Open Kinetic Chain (OKC) exercises because many therapists believe that CKC exercises are more reliable and functional.[2]  Uçar et al. affirmed that for rehabilitation post ACL reconstruction, CKC exercises were more effective than OKC exercises at regaining mobility and enabling a quicker return to daily and sporting activities.[3]

Characteristics of CKC exercises and the difference with OKC exercises:[4]

Hypermobility ~ online support group

Where we might even offer Feldenkrais® lessons
~ shall we plan a series …

Feldenkrais® & Osteopathy ~ A Developing Collaboration

with Ian McCarthy (notes compiled by Katarina Halm)

Auxiliary References

“A good learning diary” …
“A learning diary introduces the reader to the main arguments and other important points of a course through student’s own observations and interpretations. A good learning diary reflects student’s own thought and learning processes, and thus, at its best, it is the result of a “dialogue” between a student and the new information introduced in the course. ”

“A good learning diary” …. ” is not only based on the course materials and student’s lecture notes. These are the raw material for a learning diary.” … “the main points and questions” … thus a “student can fairly freely choose what to focus on”, … ” academic writing there always is a need to justify and contextualize the choices made.”
— https://people.uta.fi/~atmaso/teaching/learning-diary.html

“What Is the Tarsal Tunnel?

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.”

“What Is the Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a compression or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.”

Some links to online information

The descriptions above are from this page
https://www.foothealthfacts.org/conditions/tarsal-tunnel-syndrome

A longer article
https://www.ncbi.nlm.nih.gov/books/NBK513273/

And some diagrams from the article
Tarsal Tunnel Anatomy. Image courtesy O.Chaigasame

 

The U.S. National Institutes of Health have published an online Fact Sheet on this syndrome. Click here to open it.

Collaborations with Ian McCarthy ~ meeting notes!

Next meetings
*45 min meeting /+ *30min discussion
6/ Tues, 11. Aug 2020 8:10 am Pacific
7/ Thurs, 13. Aug 2020 7:55 am Pacific
8/ Creating an Account for CoronaPlaza.Life and notes about the program and about Katarina’s class Summer 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Next meetings
*45 min meeting /+ *30min discussion
6/ Tues, 11. Aug 2020 8:10 am Pacific
7/ Thurs, 13. Aug 2020 7:55 am Pacific

# 1-5
Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Next meetings
*45 min meeting /+ *30min discussion
6/ Tues, 11. Aug 2020 8:10 am Pacific
7/ Thurs, 13. Aug 2020 7:55 am Pacific

# 1-5
Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

Next meetings
*45 min meeting /+ *30min discussion
6/ Tues, 11. Aug 2020 8:10 am Pacific
7/ Thurs, 13. Aug 2020 7:55 am Pacific

# 1-5
Collaborations with Ian McCarthy
1/ Mon, 29. Jun 2020
2/ Tues, 7. July 2020
3/ Tues, 14. July 2020
4/ Tues, 21. July 2020
5/ Mon, 27. July 2020

~ 5 annotated drawings

Feldenkrais® & Osteopathy, Developing Collaboration with Ian McCarthy
~ we continue developing the accompanying text

(A) A NEUTRAL pelvis & spine

(B) An ANTERIORLY TITLED pelvis ~ caused by LENGTHENED hamstrings and in turn causing INCREASED LORDOSIS in the spine

(C) – Flared rib cage

Longer weaker ABDOMINALS) are usually present in the presence of longer weaker HAMSTRINGS. In this position, the DIAPHRAGM is put into a shortened or contracted position. This COMPROMISED position limits thoracic mobility. The ribs can no longer go down properly for the exhalation. The ideal relaxation of the ribs/ diagram is impeded.

(D) Stretched/weakened abdominals & tightened lower back

(E) Normal-tension for a stable knee

C – Calf muscle
G – Gleuteal muscle
H – Hamstring muscle
Q – Quadriceps muscle
All the muscles are stressed equally

(F) Tension skewed by weak quad, which must work harder (and tires, thus destabilizing the knee)

Blood Flow Restriction Therapy

BLOOD FLOW RESTRICTION (bands or tourniquets)
“Blood flow restriction training to rebuild muscles after surgery
involves a medical tourniquet to cause ANAEROBIC state in an arm or leg
while exercising AEROBICALLY. This results in the body releasing
growth hormone.” (emphasis added)
— Ian McCarthy June 29, 2020

“Another thing is BLOOD FLOW RESTRICTION (bands or tourniquets). I bought some online recently. Owen’s Recovery Science is the name of the company. The cheaper ones on Amazon are not as good but they do restrict the flow. There will be a good quad and hamstrings activation. It will not interfere with [but enhance] the healing of the bones. You will be cutting off blood for only a minute. You could use this on a bike. The aim is to reduce muscle loss. Also, do not be concerned about rotation in the beginning of the healing process.” (emphasis added)
— Ian McCarthy July 27, 2020

REFERENCE
Owens Recovery Science – Blood Flow Restriction Rehab
https://www.owensrecoveryscience.com/?gclid=CjwKCAjwmf_4BRABEiwAGhDfSTuiXsuV2RCE3STsbuCQqSilXBeWKI4-ZknXbYS9kZ6qduzIi4JlMxoCMisQAvD_BwE

Left AIC – LEFT ANTERIOR INFERIOR CHAIN PATTERN

“Most certainly. PARTICULARLY in the THORAX, because of the larger RIGHT diaphragm, the LIVER being on the RIGHT. We are innately, primitively if you will, predisposed to working very hard in this region. I find as an osteopath that does a lot of visceral manipulation and release that you typically get a lot more tightness on the RIGHT side than you do the LEFT. That is why I say the rib flare on the LEFT side is more prominent in the population. So I agree, I think we work far too much from the RIGHT side, particularly in the thorax.” [emphasis added]
— Ian Mccarthy July 21, 2020

“There is a very common PELVIC PATTERN that I find prevalent in the population. LEFT INTERIOR CHAIN PATTERN. We are not perfectly symmetrical as humans. Anatomically we have a heavy LIVER on the RIGHT side, heavy HEART on the LEFT side, so lots of VISCERAL ASYMMETRIES. Larger RIGHT DIAPHRAGM. Neurologically we are predisposed to sit and walk on the RIGHT LEG more than on the LEFT. We are fighting to be symmetrical.” [emphasis added]
— Ian Mccarthy July 21, 2020

Two PDF References from Ian McCarthy

With appreciation for annotations by Ian McCarthy from the PDF Manual Therapy 12 (2007) 298–309 Masterclass
Hypermobility and the hypermobility syndrome
Jane V. Simmonds/a,!,1, Rosemary J. Keer/b,2
/a University of Hertfordshire, School of Health and Emergency Professions, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
/b Central London Physiotherapy Clinic, Harley Street, London, UK
Received 5 March 2007; received in revised form 6 March 2007; accepted 12 May 2007
available online at http://www.sciencedirect.com

Reading Hypermobility J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309
FOLDER https://www.dropbox.com/sh/1q9steogaxo1xm6/AACv5db1aWijblPmJzO7ShLEa

16 replies
  1. happybones
    happybones says:

    REFERENCES DIRECTLY APPLICABLE TO OUR STUDY FOR MON JULY 27, 3030
    “frequent causes of musculo-skeletal symptoms
    in children and adolescents, particularly girls, aged
    between 13 and 19 years of age.
    The predominant presenting complaint is pain, which
    is often widespread and longstanding, with patients
    reporting pain ranging from 15 days to 45 years
    (El-Shahaly and El-Sherif, 1991). In addition there are
    many other symptoms reported by patients associated
    with the joints, such as, stiffness, ‘feeling like a 90 year
    old’, clicking, clunking, popping, subluxations, dislocations,
    instability, feeling that joints are ‘vulnerable’ as
    well as symptoms affecting other tissues such as
    paraesthesiae, tiredness, faintness, feeling unwell and
    suffering flu-like symptoms (Keer, 2003). Fig. 3 illustrates
    a typical patient pain chart. Complaints are
    sometimes difficult to match with the way the patient
    looks or moves (Russek, 2000) as individuals frequently
    look well and move well. This infrequently leads
    to the patient being misunderstood and at worst
    the patient is made to feel like a hypochondriac and
    may be labeled as having psychological problems
    (Child, 1986).
    Extra articular manifestations of the syndrome may
    include skin fragility and laxity (Grahame, 1999, 2003a),
    AUTONOMIC disturbances (Gazit et al., 2003; Hakim and
    Grahame, 2004), ocular ptosis, varicose veins (Mishra et
    al., 1996), bruising (Bridges, 1992; Kaplinsky et al.,
    1998), urogenital prolapses (Al-Rawi and Al-Rawi,
    1982; El-Shahaly and El-Sherif, 1991), Raynaud’s
    phenomenon (El-Garf et al., 1998), development motor
    co-ordination delay (DCD) (Kirby and Sugden, 2007),
    alterations in neuromuscular reflex action (Johansson
    et al., 2000; Stillman et al., 2002), NEUROPATHIES, tarsal
    ARTICLE IN PRESS
    300 J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309
    and carpal tunnel syndrome (Francis et al., 1987; March
    et al., 1988), fibromyalgia (Acasuso-Diaz and Collantes-
    Estevez, 1998), low bone density (Mishra et al., 1996,
    Gulbahar et al., 2006), anxiety and panic states (Bulbena
    et al., 1993) and depression (Grahame, 2000).” [emphasis added]

    — from Manual Therapy 12 (2007) 298–309
    Masterclass
    Hypermobility and the hypermobility syndrome
    Jane V. Simmondsa,!,1, Rosemary J. Keerb,2
    aUniversity of Hertfordshire, School of Health and Emergency Professions, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
    bCentral London Physiotherapy Clinic, Harley Street, London, UK
    Received 5 March 2007; received in revised form 6 March 2007; accepted 12 May 2007
    available online at http://www.sciencedirect.com

    Reply
  2. happybones
    happybones says:

    ““““““““““`
    NEW SPECIAL HEADING NOTES FROM THE MEETINGS
    AT THIS LINK ARE THE LINKS TO THE THREE PDFS LISTED BELOW
    in the section on CROSSINGS
    #toggle-id-20 at https://thinkinginmovement.ca/feldenkrais-lab/
    Feldenkrais® & Osteopathy, Developing Collaboration with Ian McCarthy (notes compiled by Katarina Halm) 200707
    Feldenkrais® & Osteopathy, Developing Collaboration with Ian McCarthy, Matilda, Celeste (notes compiled by Katarina Halm) 200714
    Feldenkrais® & Osteopathy, Developing Collaboration with Ian McCarthy, Barbara, Celeste (notes compiled by Katarina Halm) 200721

    ““““““““““`
    NEW SPECIAL HEADING A GOOD LEARNING DIARY
    “A good learning diary”
    “A learning diary introduces the reader to the main arguments and other important points of a course through student’s own observations and interpretations. A good learning diary reflects student’s own thought and learning processes, and thus, at its best, it is the result of a “dialogue” between a student and the new information introduced in the course. ”

    “A good learning diary”

    ” is not only based on the course materials and student’s lecture notes. These are the raw material for a learning diary.” … “the main points and questions” … “student can fairly freely choose what to focus on”, … ” academic writing there always is a need to justify and contextualize the choices made.”
    https://people.uta.fi/~atmaso/teaching/learning-diary.html

    Reply
  3. happybones
    happybones says:

    Looking for these references
    ~ to post link to a pdf if found …
    For YOLANDE
    relating to “NEUROPATHIES, tarsal
    ARTICLE IN PRESS
    300 J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309

    Reply
    • happybones
      happybones says:

      In relation to JHS
      “These systemic signs and symptoms
      may include urogenital problems (prolapse,
      incontinence), vascular problems (bruising, varicose
      veins, low blood pressure), neural problems (clumsiness,
      unsteadiness, paraesthesiae, NEUROPATHIES). Furthermore,
      poor response to local anaesthetics has also been
      associated with JHS (Arendt-Nielsen et al., 1990) and
      may result in significant distress for individuals when
      not recognised or believed, for example, by a dentist
      when carrying out dental work or an obstetrician during
      childbirth.”
      — Section underlined by Ian McCarthy from Manual Therapy 12 (2007) 298–309
      Masterclass
      Hypermobility and the hypermobility syndrome
      Jane V. Simmondsa,!,1, Rosemary J. Keerb,2
      aUniversity of Hertfordshire, School of Health and Emergency Professions, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
      bCentral London Physiotherapy Clinic, Harley Street, London, UK
      Received 5 March 2007; received in revised form 6 March 2007; accepted 12 May 2007
      available online at http://www.sciencedirect.com

      Reply
  4. happybones
    happybones says:

    /1 Reading Hypermobility from page 298 to ‘recognize’ J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309 JHS.1 (11.3 MB) 200721-1
    https://www.dropbox.com/s/34tdrmt073zxq76/
    /2 Reading Hypermobility to top of page 301 ‘childbirth’J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309 JHS.1 (7.3 MB) 200724
    https://www.dropbox.com/s/b62gpd9y7mdff9j/
    /3 Reading Hypermobility short recap selection from page 301-302 J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309 (3.8MB).m4a 200725
    https://www.dropbox.com/s/93zcd8endbdlxyp/

    Reply
  5. happybones
    happybones says:

    Noting small edits for Feldenkrais® & Osteopathy, Developing Collaboration with Ian McCarthy, Barbara, Celeste (notes compiled by Katarina Halm) 200721.pages

    Reply
  6. happybones
    happybones says:

    Chart from top of page 302 J.V. Simmonds, R.J. Keer / Manual Therapy 12 (2007) 298–309
    Box 1
    5 point hypermobility questionnaire (Hakim and Grahame 2003).
    o Can you now [or could you ever] place your hands flat on the floor without bending your knees?
    o Can you now [or could you ever] bend your thumb to touch your forearm?
    o As a child, did you amuse your friends by contorting your body into strange shapes or could you do
    the splits?
    o As a child or teenager, did your kneecap or shoulder dislocate on more than one occasion?
    o Do you consider yourself ‘‘double-jointed’’?
    Answering yes to 2 or more of these questions suggests hypermobility with sensitivity of 85% and
    specificity 90%.

    Reply
  7. happybones
    happybones says:

    ** To add reference Blood Flow Restriction Therapy After Closed Treatment of Distal Radius Fractures Cancio JM, Sgromolo NM, Rhee PC.

    ** To add reference NEUROPATHIES as quoted in the pdf

    Reply
  8. happybones
    happybones says:

    BLOOD FLOW RESTRICTION [bands or tourniquets]

    “Blood flow restriction training to rebuild muscles after surgery
    involves a medical tourniquet to cause ANAEROBIC state in an arm or leg
    while exercising AEROBICALLY. This results in the body releasing
    growth hormone.” (emphasis added)
    — Ian Mccarthy June 29, 2020

    “Another thing is BLOOD FLOW RESTRICTION [bands or tourniquets]. I bought some online recently. Owen’s Recovery Science is the name of the company. The cheaper ones on Amazon are not as good but they do restrict the flow. There will be a good quad and hamstrings activation. It will not interfere with [but enhance] the healing of the bones. You will be cutting off blood for only a minute. You could use this on a bike. The aim is to reduce muscle loss. Also, do not be concerned about rotation in the beginning of the healing process.” (emphasis added)
    — Ian Mccarthy July 27, 2020

    REFERENCE
    Owens Recovery Science – Blood Flow Restriction Rehab
    https://www.owensrecoveryscience.com/?gclid=CjwKCAjwmf_4BRABEiwAGhDfSTuiXsuV2RCE3STsbuCQqSilXBeWKI4-ZknXbYS9kZ6qduzIi4JlMxoCMisQAvD_BwE

    Reply
  9. happybones
    happybones says:

    From https://www.hypermobility.org/other-sources-of-help
    Here are some other organizations which you may find useful:

    PoTS UK (https://www.potsuk.org/) Providing information and support about postural orthostatic tachycardia syndrome (PoTS) for sufferers, medical professionals, family, and friends

    Pain Concern (http://painconcern.org.uk/) Work to improve the lives of people living with pain and those who care for them.

    Ehlers-Danlos Support UK (https://www.ehlers-danlos.org/)

    Brittle Bone Society (https://brittlebone.org/) supports people with Osteogenesis imperfecta

    Stickler syndrome UK (https://stickler.org.uk/) is a non-profit organisation that provides information for families, healthcare and medical professionals affected by or caring for people with Stickler Syndrome.

    The Arthritis and Musculoskeletal Alliance (ARMA) (http://arma.uk.net/) is the umbrella body for the arthritis and musculoskeletal community in the UK.

    Pain UK (https://painuk.org/) an alliance of charities providing support and help for those living with pain. Pain management, healthcare advice. tips and resources available.

    The Ehlers-Danlos Society (https://www.ehlers-danlos.com/) Formerly the EDNF, support collaborative research and education initiatives, awareness campaigns, advocacy, community-building, and care for the EDS and HSD population. They’re developing a Global Registry of patients with EDS or HSD

    Reply

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