Low back pain (LBP) is the most common musculoskeletal complaint and the leading cause of disability worldwide. The good news is that back pain is highly manageable, often without invasive measures. However, for individuals with hypermobility, the treatment approach may require a little more nuance.
“Hypermobility” indicates that an individual’s joints are more mobile, or have more motion, than normal. They may simply have more range of motion, or they may have an underlying soft tissue disorder as seen with Ehlers-Danlos or Hypermobility Joint Syndrome. When looking at low back pain through the lens of hypermobility, we have to consider the anatomy of the spine, how it functions, and what variables can change.
ANATOMY OF THE SPINE
The spine is made up of individual bones called vertebrae; we have 24 vertebrae total (7 cervical, 12 thoracic, and 5 lumbar) plus the sacrum and coccyx. When we refer to the low back, we are discussing the lumbar spine specifically, or the bones that live between your ribcage and your pelvis.
The whole spine is a very robust and sturdy structure due to the large bony body of each vertebrae, the various “wings” (called processes) to stabilize it both posteriorly and laterally, and the ligaments and muscles that wrap around it. Our spine is designed to bend and twist and handle loads in all directions.
MOBILITY vs STABILITY
Two critical components of spine health, and minimizing pain, are MOBILITY and STABILITY. With HDS/EDS, the mobility is often excessive, but the stability can be limited. Spinal stability is our ability to control movement and loads in a way that protects the structural elements, preventing injury or damage. We can break down stability into three elements – the passive structural support (bone, ligament), the active structural support (muscle), and the neuromotor control (nerve/sensory system).
HDS/EDS can impact all aspects of the spine – both the passive and active structures. Hypermobility can change the integrity of ligament support within the joints, and decrease the sensorimotor awareness and control, which can significantly impact spine mobility and stability. Individuals with hypermobility will then demonstrate an increased reliance on ACTIVE control.
IMPROVING SPINE STABILITY
In hypermobile individuals, we emphasize active control via muscle strengthening and body awareness. Core strengthening is key in helping with spine stability and decreased prevalence of low back pain. But what exactly is the core?
While we often think of the core as our abdominal muscles, it actually includes so much more! The core is made up of all the muscles supporting our trunk, and can best be described as a canister with a roof, floor, and walls. The roof or upper portion is made of our diaphragm, the lower floor is made of the pelvic floor muscles, and the walls include our abdominal muscles and spinal extensors. These muscles all work together to maintain pressure and stability within our trunk, allowing or preventing movement as needed.
When thinking about core strengthening, we want to make sure we take a 360 degree approach. We try to target the front, back, and sides of the body including abdominals, spine extensors, glutes, lats, etc. Often, isometric exercises (muscle engagement WITHOUT change in length or without movement) are an easy way to start core strengthening with less symptoms. Plank variations are a great example of an isometric core exercise, and a great way to teach our core muscles how to brace or maintain a position against outside loads.
We then want to teach our core how to maintain stability THROUGH movement. The goal is to incorporate movement into all directions, and progressively work toward end ranges. With hypermobility, there is often a greater range of motion available throughout the spine. By strengthening into those ranges, we help minimize the risk of pain and injury. Physical therapy is a great way to help guide strength and stabilization exercises to help minimize pain in individuals with hypermobility.
OTHER TIPS TO MINIMIZE LBP
- Maintain hip mobility and strength
- Change positions throughout the day – try to take more frequent breaks from sustained sitting, especially from a desk job. Take movement breaks on long travel days.
- Use external props w/ sitting and or sleeping – various chairs, pillow supports, etc.
- Be mindful of lifting/movement mechanics
- Prioritize daily movement/activity – daily walks, strength training, pilates, yoga, etc.
OTHER CONCERNS FOR LBP + HYPERMOBILITY
- In individuals w/ EDS/HDS, presenting with low back pain may be indicative of a more sinister pathology or injury, including fracture of spondylolisthesis.
- They may not respond as well as to surgical interventions.
- They are more likely to have more global involvement including pelvis/SI joints, hips, and/or pelvic floor.
Thank you for reading Managing Low Back Pain with Hypermobility.
We hope it has helped you understand more about low back pain related to hypermobility and how you may prevent injury.
Please visit our Low Back Pain page to learn more about other conditions and how we treat different low back pain injuries.
For a thorough evaluation and individualized treatment, contact our Sherwood or Bethany clinic today and be seen in less than 48 hours.
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