It is not uncommon for people with hEDS to be afraid of exercise or movement. Often, there is a history of trauma or pain from trying exercise that keeps people from exploring their body and movements. A skilled physical therapist will assess the laxity of each joint, as well as the muscle strength and recruitment around that joint. Those with hEDS often have impairments in the way their muscles contract around an unstable joint, as the muscles are trying to do the work of the ligaments that aren’t stable enough. Once each joint is assessed for it’s mobility and muscle activation, a specific plan of safe, targeted exercises can be prescribed to facilitate joint control and stability.
Balance and proprioception is another critical piece of the physical therapy plan for those with hEDS. Because many joints lack the appropriate strength and stability, especially in the ankles, knees and hips, it can be difficult to maintain balance or activate the appropriate stabilizers for some activities. Proprioception, which is the awareness or perception of movement or position of joints in the body, is typically quite difficult for those with hEDS due to nerve endings in the joints being injured or traumatized from chronic subluxations or dislocations.
It can be difficult to gain information on where some joints are positioned and how the muscles around them are working, which can lead to further injury and trauma to the joints. Working with a physical therapist on balance training, resistance exercises, and neuromuscular re-education drills can improve the central nervous system’s communication with each joint and improve overall balance and joint position sense.