Health

,

Cyclist’s Hands, Overcoming Overuse Injuries

,

After a ride on your bike, have you experienced numbness, tingling, or pain in your arm, hand, wrist, or little finger? If you have, you could be suffering from an overuse injury. Approximately one-third of all bicycling overuse injuries involves the hands.  The 2 most common are what we call “handlebar palsy” and carpal tunnel syndrome. By making some adjustments to your bike, posture, and by wearing some protective equipment, you can prevent these injuries from occurring.

 

Handlebar palsy

Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in your ring and little finger and controls most of the muscular function of your hand. Compression of the ulnar nerve is a common problem for competitive and recreational cycle enthusiasts, alike. Compression is the result of direct pressure on the ulnar nerve from the grip on the handlebars. Often, the nerve may be over stretched or hyperextended (extension beyond its normal limit) when a drop-down handlebar is held in the lower position. The pressure placed on the ulnar nerve results in numbness and tingling in the ring and little fingers or hand weakness, or a combination of both. Symptoms can take from several days to months to resolve, but surgical treatment is rarely necessary. Rest, stretching exercises, and anti-inflammatory medications, such as aspirin, usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding hyperextension can help to prevent a recurrence.

Carpal tunnel syndrome

Although it is less common than handlebar palsy, carpal tunnel syndrome (compression of the median nerve at the wrist) is another overuse injury that cyclists often experience. Injury often occurs when a cyclist holds the handlebars on top and applies pressure directly on the median nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Symptoms usually resolve quickly once you stop cycling for a short period of time. Although handlebar pressure contributes to these symptoms, there can be other causes for hand pain and numbness; therefore, an evaluation for other possible causes of carpal tunnel syndrome should be performed by your health-care professional.

Prevention with Equipment

Adjust your handlebars, seat and pedals to best suit your body and allow you to sit in a more upright position. Sitting upright will take the weight and pressure off of your hands and wrists. Wearing padded gloves may also reduce shocks and jolts to your body, which travel into your wrist joints from the road and can lead to pain.

The Correct Position for the Wrist

The carpel tunnel is a small gap between the many small wrist bones and a flat ligament at the base of the wrist. Ten tendons go through this small tunnel and are responsible for flexing the hand and fingers. A nerve also passes through this tunnel. Degeneration or mechanical stress can easily injure these small tissues resulting in a loss of function of the hand.

Riding with the wrist flexed like this stresses these small tissues:

I see this position quite often when I conduct rider assessments.

This hand position can lead to injury for two reasons:

  1. The tendons are stretched to near full length.

  2. Vibration or impact from the front wheel, such as a bump in the road, can then cause a trauma as the wrist is forced to extend too far.

The correct position is with the wrist straight like this:

This position allows shock to travel up the arm while supported by the bones and cartilage, which are much stronger tissues than the fine tendons and ligaments supporting the fingers.

 

 

 

Assess and Control Weak Wrist Flexors

One reason we ride incorrectly is simply due to lack of knowledge or bad habits. But another reason can be weak wrist flexors. If you are a regular gym-goer, there are some tests you can do with pressing exercises to assess and control these flexors.

To conduct the test of your hand position you will need a set of grips, a suspension trainer, or a set of rings. You are going to check for correct wrist alignment while you perform a push up on this gear.

Correct wrist position:

Incorrect wrist position:

Elbow Position Is Important, Too

Avoiding injury doesn’t end at hand position, though. Should you hit a large bump in the road, and you manage to avoid wrist injury, the shock will continue to travel up the arm to the elbow. This is the second potential area of injury due to incorrect position.

Elbows should be slightly flexed like the cyclist shown here:

This allows any movement of the handlebars to be taken up by the elbow flexing. If you ride with your elbows stiff or locked, then vibration and shocks may extend the elbow too far and lead to trauma.

So please remember to keep your wrists straight and elbows flexed when out on the bike. 

- Dr. Alex (The Doc)

Sources: http://www.hughston.com/wp-content/uploads/Health-Alerts/vol15no3.pdf

https://breakingmuscle.com/fitness/pain-free-cycling-avoiding-wrist-and-elbow-injury

Statins for Women? Follow up article.

Statins for Women? Not for My Patients

Blog By: Kelly Brogan, M.D. Holistic Women’s Health Psychiatry, NYC

Sometimes, pharmaceutical companies and their doctorly friends collectively make a bold move that shows their hand. Usually, this is in the form of indiscriminately and categorically broadening the eligible candidates for the suddenly lifesaving benefits of a pre-existing product. Recent changes in guidelines put forth by the American Heart Association and the American College of Cardiology aim to expand the recommendations of lipid-modifying statins to include those for whom there is a stated “10-year risk of 7.5 percent or more” of cardiac events, based on a calculator that now eliminates LDL targets. Many thoughtful clinicians have come forth to express their concerns about the impact of this expansion of prescription treatment to 70 million patients, including Dr. Redberg and John Abramson, for the New York Times, stating:

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them.

I’d like to talk about what this means, as a women’s health psychiatrist,  for my people — women, in America, suffering from depression, anxiety, and symptoms of mental illness. Several times a week, I “discuss” (euphemism) with colleagues, including integrative doctors, the fact that I do not want a single one of my patients on statins, for any reason, ever.

Here’s why:

Wrong-Headed Indication

As discussed by Dr. Tom O’Bryan, there is a 17-year lag between availability of paradigm-shifting data and implementation. Misconceptions about dietary — cholesterol and saturated fat — drivers of heart disease still linger despite widespread abandonment of this perspective. This was discussed in an important, recent BMJ commentary by British cardiologist, Dr. Malhotra, who states:

Virtually all the truths about preventing heart attacks that physicians and patients have held dear for more than a generation are wrong and need to be abandoned.

Based on unabated rates of cardiovascular disease despite a generation of statin users, and studies that demonstrate that patients presenting to the hospital with heart attacks don’t have elevated total cholesterol, but they do have (66 percent of the time) metabolic syndrome, or a constellation of findings such as obesity, high triglycerides, low HDL, and insulin resistance. This phenomenon is driven by sugar and trans fat, not dietary, naturally-occurring saturated fat, and not by a lack of statins, but, perhaps, is exacerbated by the statins themselves, and particularly, in women.

This is why, even in the only demographic that has been shown to benefit from statin use (men who have had a previous heart attack) 82 will experience no benefit before one will.  This is at the expense of interference with energy production in every cell because of coQ10 depletion, an unintended but tragic side effect.  In that 83rd patient, anti-inflammatory effects of statins (and not cholesterol-lowering) are thought to drive benefit. These effects are highly achievable in more benign and widely beneficial ways.

Inexcusable Risk

Contrary to what is demonstrated in industry studies, intolerable side effects occurred in 20 percent of those treated with statins in an eight-year retrospective cohort study. Given the total lack of demonstrated benefit in women, as a demographic, we are now, in the realm of iatrogenesis, or doctor-induced harm, which may include decreased cognitive function, cataracts, sexual dysfunction, depression, muscle pain, and now, diabetes. Understanding the pathogenisis of cardiovascular disease, induction of diabetes in women, who will then be put at risk for cardiovascular events, is inexcusable. We have known, at least since this study in the Archives of Internal Medicine, that the risk of new onset diabetes in postmenopausal women was increased by 48 percent. Plain and simple: “Statin medication use in postmenopausal women is associated with an increased risk for DM.”

Brain and Hormone Sabotage

As a women’s health psychiatrist, I am principally concerned with the effects of a low fat diet, poor cholesterol production, and medication-disrupting lipid effects because cholesterol is a primary component of cell membranes, acting as both a filter and a structural reinforcer. Cell membranes are where all of the action is at including receptor function and trafficking of nutrients and toxic elements. Cholesterol is also the precursor to vitamin D, and to pregnenolone and the sex hormones that derive from it, making it critical for appropriate production, feedback, and balance. I discuss these relationships, and its relevance to risk of depression, here:

Perhaps related to these vital functions, perhaps to others yet undiscovered, low cholesterol has also been linked to suicide and depression. (Kunugi et al, Biol Psych, 1997) (Modai at al, J Clin Psych, 1994) ( Lindberg et al, BMJ, 1992) In patients hospitalized for affective episodes, significantly more patients than controls were noted to have low plasma cholesterol. Another looking at the Melbourne Women’s Midlife Health Project suggested that improved performance on memory testing was achieved with increased total cholesterol in women longitudinally monitored.

Controlling for multiple confounding variables, 300 women in Sweden were found  to be significantly more depressed when they had the lowest percentage of total cholesterol in the cohort. This is a concerning correlation in light of recommendations that aim to throw women under the cholesterol-sabotaging bus.

Better Medicine for Healthier Brains and Hearts

Cardiovascular disease is a multi-factorial inflammatory problem with disparate drivers in different people. Lifestyle medicine is the best and most sophisticated intervention, and the only one indicated here, with no exceptions for women.  This begins with good old exercise and diet. I advocate for no grains and sugar, consistent with what our genome is expecting to see. This is a naturally high fat approach with a focus on pastured meats, wild fish, eggs, nuts, and seeds. Know that any increase in cholesterol that may occur is consistent with beneficial profiles, and improvement in inflammatory markers.  Most of the time, however, I am aiming to increase cholesterol to support my patient’s mental and hormonal health, working at improving liver synthesis and healthy dietary fats.

Most of my patients know that I’m a huge eggophile. Studies such as this one that noted three eggs (yolks) daily with carbohydrate restriction resulted in improvement in all lipid parameters and HDL help to support my assertion that whole, natural foods do not promote diseases that have only come into existence since the gifts of the industrial revolution and Snackwells over bacon type recommendations.

We all know, intuitively, that exercise is a critical answer to the burning question of how do we heal ourselves, and particularly, in a population concerned about cardiovascular disease and the Interheart study demonstrated that 90 percent of first cardiac events could be prevented by lifestyle modification. The known and validated benefits of exercise, however, may be eclipsed by use of a statin, which is just the cherry on top!

What are the parameters that relate, in a predictive manner, to metabolic syndrome and associated inflammation? Unfortunately, none of these figure into the handy calculator the AHA is planning to use for the new statin indications.  These include:

  • fasting insulin
  • hemoglobin A1C
  • homocysteine
  • NMR or VAP lipid profiles which screen for particle density
  • hsCRP
  • fasting glucose

Balancing thyroid function is an important and vastly overlooked variable, particularly in women, because of its role in the enzymatic processing of LDL cholesterol in the liver — i.e., you don’t have a “cholesterol problem” if you also have a “thyroid problem,” which is grossly overlooked by most conventional physicians, as I discuss here.

Strategic implementation of activated B vitamins such as B12 and folate and vitamin D can also mitigate inflammatory compounds such as homocysteine and hsCRP.

All told, we have here an unsafe, unnecessary product that will now be recommended to healthy people to make them sicker, all when simple, health-fortifying lifestyle changes have been proven to be effective and globally transformative in ways no pill could ever hope to be. Women, listen up, and listen good to those trying to save you from a pharmaceutical fate. It’s a depressing, confusing, libido-less, fat, and potentially lethal destiny, and there’s a path to vitality paved with common sense. Walk it.

Statins, is the Help Worth the Harm?

Cracking the Cholesterol Myth: How Statins Harm The Body and Mind

by Kelly Brogan, MD and Sayer Ji

A new study finds the chemical war against cholesterol using statin drugs was justified through statistical deception and the cover up of over 300 adverse health effects documented in the biomedical literature.

Better safe than sorry, right? This is the logic that defines the grasp that the pharmaceutical company has on our psyche. Perhaps your mother, father, brother, and boyfriend have been recommended cholesterol-lowering medication, just to help hedge their bets around a possible chest-clutching demise. In fact, recent guidelines have expanded the pool of potential statin medication recipients, so that there are very few of us who seem to be walking around with acceptable levels of artery clogging sludge.

But how is it that drug companies got a foothold? How have they convinced doctors that their patients need these medications, and need them now? They are banking (literally) on the fact that you haven’t brushed up on statistics in a while.

It turns out that a common sleight of hand in the medical literature is the popularization of claims around “relative risk reduction” which can make an effect appear meaningful, when the “absolute risk reduction” reveals its insignificance.  In this way, 100 people are treated with statin medications to offer 1 person benefit, and the change from a 2% to a 1% heart attack rate is billed a 50% reduction rather than a 1% improvement, which is what it actually is.

Perhaps this would still qualify as better safe than sorry if these medications weren’t some of the most toxic chemicals willfully ingested, with at least 300 adverse health effects evident in the published literature so far, with at least 28 distinct modes of toxicity, including:

Beyond the known fact that statin drugs deplete the body of two essential nutrients: coenzyme Q10 and selenium, they are also highly myotoxic and neurotoxic. Because the heart is one of the most nerve-saturated muscles in the human body, these two modes of toxicity combined represent a ‘perfect storm’ of cardiotoxicity – a highly ironic fact considering statin drugs are promoted as having ‘life-saving’ cardioprotective properties.

A powerful expert review by Diamond and Ravnskov decimates any plausible indication for these cholesterol-lowering agents, giving full consideration to the above mentioned side effects.

They plainly state:

“Overall, our goal in this review is to explain how the war on cholesterol has been fought by advocates that have used statistical deception to create the appearance that statins are wonder drugs, when the reality is that their trivial benefit is more than offset by their adverse effects.”

The Cholesterol Meme

It’s tempting to look the number one killer of Americans in the eye, and say, “WHO did this? Who is responsible?” It is also consistent with American perceptions of health and wellness to demonize a natural and vital part of our physiology rather than look at lifestyle factors including government subsidies of inflammatory food products.

Not only is low cholesterol a problem, but it puts an individual at risk for viral infection, cancer, and mental illness because of the vital role that lipids play in cell membrane integrity, hormone production, and immunity.

A broadly toxic xenobiotic chemical, statin medications have only been demonstrated to be of slight benefit by statistical manipulation. For example, Diamond and Raynskov elucidate that:

  • The JUPITER trial of Crestor vs placebo resulted in increased fatal heart attacks in the treatment group which were obscured by combing fatal and nonfatal infarctions.
  • In the ASCOT trial was used to generate PR copy boasting Lipitor’s 36% reduction of heart attack risk, a figure arrived at through use of relative risk reduction from 3 to 2%.
  • The HPS study has 26% drop out rate prior to the beginning of the trial (which also demonstrated a 1% improvement with treatment), so that those with significant side effects were functionally excluded from the study.

While no study has ever shown any association between the degree of cholesterol lowering and beneficial outcomes described in terms of absolute risk reduction (likely because they would be perceived as insignificant), the adverse effects are not only always presented in these terms, but are also minimized through the technique of splitting common side effects up into multiple different categories to minimize the apparent incidence.

These side effects are real and common and include “increased rates of cancer, cataracts, diabetes, cognitive impairment and musculoskeletal disorders”.  Their paper focuses on three primary adverse effects, all of whichare likely to land you in the “sorry to have thought I would be better safe than sorry” category.

Cancer

In at least four trials, statistically significant increases in cancer incidence was found, and handily dismissed by all authors as insignificant because they claimed “no known potential biological basis” is known.  This may be because the authors are still thinking of cancer as a genetic time bomb that has nothing to do with mitochondrial dysfunction, loss of lipid integrity, or environmental exposures.

With statistically significant increases in cancer incidence and deaths, in some trials, the minimal cardiovascular benefit is far eclipsed by the cancer mortality. In one of the only long-term trials, there was a doubling of the incidence of ductal and lobular breast cancer in women taking statins for more than ten years. One of many reasons that women should never be treated with these medications.

Myopathy

As one of the more well-known side effects of statins, muscle breakdown and associated pain, or myopathy has also been obscured in the literature.  Despite an incidence up to 40% in the first months of treatment, researchers only catalogue patients who had muscular symptoms in addition to elevations in a blood measure called creatine kinase (CK) at ten times normal for two measures (not 9.9, not 8, and not one measure).

In fact, a 2006 study in the Journal of Pathology found that statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia,” indicating that statin-associated muscle damage may be a universal, albeit mostly subclinical problem for the millions put on them.

Central Nervous System Dysfunction

Linked to suicide in men, depression including postpartum, and cognitive dysfunction, low cholesterol is not a desirable goal for the average psychiatric patient, aka half of the American population.

It turns out that 25% of the total amount of cholesterol found in the human body is localized in the brain, most of it in the myelin sheath that coats and insulates the nerves:

 “It has been estimated that up to 70% of the brain cholesterol is associated with myelin. Because up to half of the white matter may be composed of myelin, it is unsurprising that the brain is the most cholesterol-rich organ in the body. The concentration of cholesterol in the brain, and particularly in myelin, is consistent with an essential function related to its membrane properties. “[i]

The cell membrane, specifically, is highly vulnerable to damage by statins:

“The cell membrane is an 8 nanometer thick magical pearly gate where information, nutrients, and cellular messengers are trafficked through protein gates supported of phospholipids and their polyunsaturated fatty acids. Cholesterol and saturated fat provide essential rigidity in balance with other membrane components. Without them, the membrane becomes a porous, dysfunctional swinging gate. In a self-preservational effort, cholesterol supports production of bile acids, integral to the breakdown and absorption of consumed essential dietary fats.” Source

By extension, behavioral and cognitive adverse effects may be the manifestation of this fat-based interference.  Diamond and Ravnskov state:

A low serum cholesterol level has also been found to serve as a biological marker of major depression and suicidal behavior, whereas high cholesterol is protective [54–57]. In a study by Davison and Kaplan [58], the incidence of suicidal ideation among adults with mood disorders was more than 2.5-times greater in those taking statins. Moreover, several studies have shown that low cholesterol is associated with lower cognition and Alzheimer’s disease and that high cholesterol is protective.

A review article called Neuropsychiatric Adverse Events Associated with Statins: Epidemiology, Pathophysiology, Prevention and Management discusses the state of the literature around the intersection between mental health and cholesterol control. Despite generally dismissing a strong signal for concerning psychiatric adverse events, the article seems to conclude the following:

  • Severe irritability, homicidal impulses, threats, road rage, depression and violence, paranoia, alienation, and antisocial behavior; cognitive and memory impairments; sleep disturbance; and sexual dysfunction have all been reported in case series and national registries of those taking statin medications.  Sound like the laundry list of rapidly spoken side effects at the end of a drug commercial? To anyone with a history of or current psychiatric symptoms, the role of these now ubiquitous medications should be appreciated.
  • The signal for lipophilic statins – simvastatin and atorvastatin – was stronger which makes mechanistic sense since these medications penetrate the brain and brain cholesterol deficiency has been implicated in bipolar, major depression, and schizophrenia.

Of course, none of these findings nor their suppression should be surprising because there is no pharmaceutical free lunch, and because Americans are so accustomed to interfacing with human health through the lens of a one pill-one ill model. We are yanking on that spider web and expecting only one thread to pull out.  This perspective would be less disturbing if it didn’t serve as the foundation for medical practice, determined by boards such as the American College of Cardiology and The American Heart Association , the majority of whom have extensive ties to the pharmaceutical industry. An industry that has paid out 19.2 billion dollars for civil and criminal charges in the last 5 years alone.

So, the next time you hear of a doctor recommending a cholesterol-lowering intervention, tell him you’ll take that 1% risk and spare yourself cancer, cognitive dysfunction, myopathy, and diabetes. And then go have a 3 egg omelette WITH the yolks.

,

Grand Opening

,

Last Friday and Saturday was the Grand Opening at Tulsa Chiropractic Associates. It was a great success! We had a lot of people drop by, get tours of the office and check out all our modalities, all the kids had fun with the balloon guy and the bounce house, the food was good, and I got to be live on the radio! I just wanted to thank everyone who came out and supported us. I can't wait to see you again soon!

- Alex (The Doc)

,

Have you heard of Joint Hypermobility Syndrome?

,

This is a great article at Yoga International by Bernadette Birney about something that isn't spoken of enough in yoga. Yoga is not always about increasing your flexibility. Sometimes your yoga journey can be more about learning to listen to, and care for your body and building strength, and stability. Everyone's yoga is as unique as themselves!

https://yogainternational.com/article/view/joint-hypermobility-syndrome-yogas-enigmatic-epidemic

Joint Hypermobility Syndrome: Yoga’s Enigmatic Epidemic?

January 11, 2016    BY Bernadette Birney

“It’s called Joint Hypermobility Syndrome,” the neurologist said.

After meeting an insanely high health insurance deductible this year, I considered asking my husband to run over my foot with his car for the grim satisfaction of sticking my health insurance company with the bill.

 

Instead, I opted to address as many health concerns as possible. The migraines that have plagued me since childhood were high up the list so I booked an appointment with a neurologist who specializes in headaches.

After reviewing my history and examining me he asked, “Would you mind bending forward to touch your toes?”

I folded in half, uttanasana-style, easily putting my palms on the floor and touching my forehead to my shins. He did a double take, made a note, then gestured me back up onto the table.

“Straighten your elbow, please,” he said.

“All the way?” I asked.

“Yes, all the way.”

He bent and straightened my elbows and knees, but I could have told him they hyperextend. He’d already seen x-rays of my spine’s scoliotic curves in my chart. He pulled at my skin to test its elasticity.

“Do you have muscle pain?”

“Tons,” I said. “My neck, shoulders, and low back hurt all the time. My sacroiliac joints are unstable, and I have a couple of ribs that move out of place. I’ve had wrist tendonitis since childhood, and an elbow tendonitis that acts up if I’m not careful.”

“Does the yoga help?” he asked.

“Yes—IF,” I replied, “if I’m conservative, which I am. If I push into my flexibility I pay for it.”

“Can you bend your thumb backward to touch your wrist?” he asked.

“Not anymore. I used to do all that kind of stuff as a kid—touch my feet to my head, stick my foot behind my head,” I said. “I was really bendy. I’m still a lot bendier than the average human, but not nearly as bendy as some of my colleagues.”

I am what I call a “tight, bendy person.”

My joints are quite mobile—hypermobile—but my muscles are tight, with chronic knots. I’m careful when I practice yoga—with myself and with my yoga students—but am perpetually nursing one ache or another.

Socially and politically I’m left of liberal. But on the mat, in part because of my excessive flexibility, I’m a die-hard conservative. You could say I’m kind of a fuddy-duddy. 

“How long did it take you to do that?” wistful students have asked over the years when I sit cross-legged with ease. For many of them, their hips are so tight that they can’t even imagine being comfortable in that position.

“I’ve always been able to do this,” I tell them, not wanting to misrepresent yoga’s capabilities.

I’m not boasting. My mobility is pathological.

The neurologist explained that my symptoms pointed to Joint Hypermobility Syndrome (JHS), a condition characterized by joints that move beyond normal ranges of motion.

In yoga class, those who have difficulty touching their toes may feel their lack of flexibility as a liability, and of course it can be. However, while inadequate range of motion isn’t optimal, it’s not nearly as perilous as excessive range of motion.

People with JHS often suffer from musculoskeletal and joint pain and soft tissue injuries like strains, sprains, tendonitis, and dislocations. Because our ligaments are unstable, we have an increased tendency to have scoliosis, TMJ, spinal disc problems, flat feet, and headaches.

Dr. Alan Pocinki, an MD who practices in Washington D.C.’s metro area, and who has written what is in my opinion a groundbreaking article about JHS, explains: “Because…the ligaments [are]…too loose and therefore cannot do their job well, the muscles…are forced to do more of the work…than they are meant to do, so they become strained.” 1

“We don’t really understand this condition yet,” my neurologist told me. “It may be caused by a mutation in collagen genes.”

People with JHS are prone to fibromyalgia, osteoarthritis (which occurs more rapidly in loose joints), and neuropathic pain or numbness.1 We often bruise easily, and have unusually elastic and velvety skin. We may be markedly uncomfortable standing for prolonged periods of time.

Our nervous systems tend to be overly responsive. Dr. Pocinki writes that “In recent years, [JHS] has been associated with a variety of autonomic nervous system problems. (The autonomic nervous system regulates all body processes, such as heart rate, blood pressure, breathing, digestion, and immunity.)” 1 So we may have circulatory problems (for example, low blood pressure, light-headedness upon standing, cold hands and feet, heart palpitations, varicose veins, and in extreme cases blood vessels can even rupture. And we’re prone to digestive issues like acid reflux and irritable bowel disease. 1

According to Pocinki, “To compensate for stretchy blood vessels…most people with hypermobility appear to make extra adrenaline...”1 Over time, excessive adrenaline production can exhaust our adrenal glands, leading to fatigue, difficulty sleeping, anxiety, and depression. 2 Speaking from personal experience, being chronically achy and exhausted takes a major toll. 

My neurologist continued on to tell me that autoimmunity is also associated with the condition. That likely explains my Hashimoto’s disease, which is an autoimmune disease of the thyroid. Hashimoto’s made me more likely to develop the thyroid cancer that resulted in surgical removal of my thyroid last February, hence meeting my insurance deductible, which is how I wound up in the neurologist’s office to begin with.

JHS and its similar but more severe sister condition, Ehlers-Danlos Syndrome, are thought to be genetic. Women are around three times more likely than men to have JHS. As children our extreme flexibility may have been considered cute and encouraged—especially if we were involved in activities like gymnastics and ballet.1

Obviously a conversation about JHS is relevant to yoga, yet I’ve never heard the condition referred to in any yoga class or publication. I have a hypothesis that, because flexibility is generally positively reinforced in yoga classes, there’s a good chance if we looked we’d find higher incidences of JHS among yogis than in the population at large.

People tend to enjoy things we’re good at. Speaking from my own early yoga experience, I equated being limber with being “good at yoga.” I enjoyed my practice more because I felt successful. That early “success” encouraged me to stick with it.

Imagine a scenario in which an instructor with JHS teaches yoga. Flexible people might emulate a pathological range of motion, while tight yoga students—or even those with a perfectly healthy and more normal range of motion—may feel unsuccessful or “not good at yoga.”

Actually, we probably don’t have to imagine this scenario. I think it happens all the time.

I’m a yoga teacher, not a physician, and diagnosis is far outside my professional scope of practice. That said, I see hypermobile students frequently and…wonder.

Yoga can still be great for people with JHS. Stabilizing the muscles around our joints by strengthening through light resistance is helpful.

It’s imperative, though, that we use good alignment when we practice asana and that we refrain from hyperextending our joints. Heavy lifting isn’t good for our joints either, so we may have to modify poses to decrease weight-bearing. For example, bringing our knees to the floor in chaturanga dandasana, or skipping chaturanga entirely. We might need to move more slowly if we become light-headed.

Obviously, restorative yoga, pranayama, and meditation are great support for our nervous systems.

At this time there is no cure for JHS. Right now we can treat the symptoms but not the underlying cause. That said, the confirmation a diagnosis brings could be a huge relief. It was for me.

When you’re tired, achy, and stressed for long enough, it’s easy to dismiss yourself as a complainer or hypochondriac. Understanding there are real physical reasons at play affirms I’m not nuts, emotionally frail, or crazy—at least, no more so than anyone else.

References:

1. Alan G. Pocinki, MD, PLLC, Joint Hypermobility and
Joint Hypermobility Syndrome, (2010).
2. William C. Sheil Jr., MD, FACP, FACR, Hypermobility Syndrome
(Joint Hypermobility Syndrome), (4/29/2015).

 

All photography provided by Dr. Alex Kvach & Leta Willcox unless otherwise noted.