Common Clues Suggesting Joint Hypermobility Syndrome
In children and adolescents*
- Coincidental congenital dislocation of the hip
- Late walking with bottom shuffling instead of crawling
- Recurrent ankle sprains
- Poor ball catching and handwriting skills
- Tiring easily compared with peers
- So called growing pains or chronic widespread pain
- Joint dislocations
- Non-inflammatory joint or spinal pain
- Joint dislocations
- Multiple soft tissue (including sporting) injuries
- Increase in pain or progressive intensification of pain that is largely unresponsive to analgesics
- Progressive loss of mobility owing to pain or kinesiophobia (pain avoidance through movement avoidance)
- Premature osteoarthritis
- Autonomic dysfunction, such as orthostatic intolerance (dizziness or faintness) or postural tachycardia syndrome (in this form of dysautonomia, in 60˚ upright tilt the blood pressure remains constant while the pulse rate rises by a minimum of 30 beats/min)
- Functional gastrointestinal disorders (sluggish bowel, bloating, rectal evacuatory dysfunction)
- Laxity in other supporting tissues – for example, hernias, varicose veins, or uterine or rectal prolapsed
Based on observations, expert opinion, and case series.
*Ross J, et al. Joint hypermobility syndrome. BMJ. 2011;342:c7167
Examples of Joint Hypermobility & Dislocation due to Ehlers-Danlos Syndrome (EDS)
Kristle Lowell, World Champion in double mini-trampoline, demonstrates joint dislocation at will. She uses Prolotherapy when joint instability interferes with her athletic training and competition.
Systematic Manifestations of Ehler-Danlos Syndrome, Hypermobility Type
Joint Instability can affect all organ systems of the body.
1. Primarily joint instability, as well as fibromyalgia, myofscial pain and complex regional pain syndromes. 2. Comprising xerophthalmia, xerostomia, vaginal dryness, and abnormal sweating. 3. Asthma, atopy, gluten sensitivity, inflammatory bowel disease, and recurrent cystitis are all possible manifestations of an underlying immune system dysregulation. Modified from: Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN Dermatol. 2012;2012:751768. Figure 6.
Prolotherapy Treatment for EDS & Hypermobility
For patients suffering from full body pain, loose joints, and chronic subluxations, Prolotherapy is the ideal treatment. It strengthens and tightens the ligament junctions by triggering the body’s own healing cascade specifically at the site of the injected tissue. This can be applied to many joints during a treatment session in our office, making it an effective way to address extensive body pain. Strong ligaments allow the joints to properly glide through their normal range of motion without constantly subluxing and causing body pain and triggering autonomic nervous system symptoms. The exciting aspect of Prolotherapy for chronic conditions like EDS and hypermobility is that each treatment builds upon itself. The tissue remodeling phase continues into the months after the last Prolotherapy session, lending itself to successful long-term pain relief and joint stability after the treatment series. Read more in detail about our approach to treating EDS
Our Research on the use of Prolotherapy for EDS & Hypermobility
Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome are both heritable disorders of connective tissue (HDCT) characterized by joint laxity and hypermobility. The conditions are both genetic disorders of collagen synthesis, where the adverse effects of tissue laxity and fragility can give rise to clinical consequences that resonate far beyond the confines of the musculoskeletal system. Both conditions have as their hallmark generalized hypermobility which can affect almost every bodily system. The hypermobility can be documented by the Brighton criteria which involves the objective measurement of the hyperextensibility of various joints. While the major presenting complaint of JHS and EDS is arthralgia in multiple joints, if the hypermobility is left unchecked, joint dislocations and degeneration may prevail. While traditional medical treatments, including education and lifestyle advice, behavior modification, physiotherapy, taping and bracing, exercise prescription, functional rehabilitation and pain medications offer some symptomatic control, they do little in regard to curbing the progressive debilitating nature of the diseases. The excessive joint mobility, with its subsequent joint degeneration and multiple joint dislocations, can then lead the individual to seek out surgical intervention, which has suboptimal results in the hypermobile patient population versus the normal population. As such, some patients with JHS and EHS are seeking alternative treatments for their pain including Prolotherapy.
Through our case studies, we have found that Prolotherapy offers great hope for those with symptoms from generalized hypermobility because it is designed to successfully treat the ligament and tissue laxity that accompanies JHS and EDS. Some of the rationale for using Prolotherapy for patients with EDS and JHS are that it has a high safety record, is comprehensive (all or most joints can be treated at each visit), is an outpatient procedure, is cost effective (compared to surgery), pain relief is often quick, and it provides joint stabilization. Perhaps its greatest asset is the fact that this one treatment modality can handle most of the painful musculoskeletal conditions that occur in individuals with EDS and JHS. Prolotherapy could also contribute to the treatment of hypermobility disorders also by preventing the development of precocious osteoarthritis. It has long been known that individuals with JHS and EDS suffer with premature osteoarthritis in various joints and the amount of degeneration correlates with the extent of the individuals hypermobility. The combination of extreme hypermobility and repeated injury is presumed to be what leads to the early osteoarthritis. This is most likely the reason that the hypermobility type of Ehlers-Danlos Syndrome is the most debilitating form with respect to musculoskeletal function.
While the primary author has twenty years experience treating JHS and EDS musculoskeletal symptoms with Prolotherapy, future studies will need to be conducted to best document the exact role Prolotherapy has in the treatment of the musculoskeletal symptoms and hypermobility of JHS and EDS and if it can prevent future joint degeneration in these individuals. The complete results can be read here: Hauser R, Phillips H. Treatment of Joint Hypermobility Syndrome, Including Ehlers-Danlos Syndrome, with Hackett-Hemwall Prolotherapy. Journal of Prolotherapy. 2011;3(2):612-629.
Our other studies on regenerative treatment outcomes for EDS & hypermobility
- A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain
- Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review
- Joint Instability Treatment with Prolotherapy
Patient Success Stories using Prolotherapy for EDS & Hypermobility
AL, with a history of Ehlers-Danlos Syndrome, had multiple shoulder dislocations despite 4 reconstruction surgeries, including a labral repair. AL’s shoulder was dislocating daily before coming for Prolotherapy. Because of her severe multidirectional instability, she required 12 Prolotherapy visits over the course of 12 months to stabilize her shoulder.
Stabilization surgeries are often ineffective for patients with Ehlers-Danlos Syndrome.
Multi-joint Instability, POTS, Ehlers-Danlos Syndrome Type III
For 5 years, eighth grader Louise S managed her EDS pain with weekly chiropractic care, until chronic multi-joint dislocations became incapacitating, keeping her from her love of gymnastics, as even bumping into things would cause her joints to dislocate. Louise came to CMRS from Europe along with her mother, looking for an answer to this life altering disease. After 5 treatments of Prolotherapy, Louise was able to become proficient at aerial circus, with improved overall body, core and shoulder strength, without dislocations.
Joint instability causes bones to move excessively, because the ligaments are too loose. Traditional medicine is limited as far as helping the suffering EDS patient, but Prolotherapy treats the loose ligaments at the core of the disease, safely and effectively giving patients like Louise their lives back.
21 Year-Old Female with Ehlers-Danlos Syndrome, Hypermobility Type
EK first began experiencing the symptoms of Ehlers-Danlos Syndrome, Hypermobility type in the fifth grade, when one of her knees subluxed. Over the next 12 years, the pain and joint subluxations spread to other joints including the other knee, elbows, shoulders, and spine. EK tried many different forms of therapy including physical therapy, massage, ultrasound, taping, and compression braces which managed her pain well enough to perform daily activities as well as gymnastics, track, and cross country. At the age of 19, she tore the meniscus in her right knee and underwent surgical meniscus repair. Following the operation, she experienced intense pain, and subsequently underwent a second operation. While the symptoms in her knee appeared to be resolved, pain in her other joints persisted. During this time, EK also began experiencing other health issues including hypothyroidism, eczema, chest pains, food allergies, irregular menstrual periods, and degenerative disc pain in her neck and back.
In the search for a treatment for her joint pain, EK found Prolotherapy, which she felt was needed for the pain in her neck, thoracic, low back, knees, and shoulders. During this time, she continued physical therapy, and managed her pain with multiple medications. After a year and a half of minimal improvement, her pain doctor referred her to Caring Medical in Oak Park, Illinois for Prolotherapy. As a 21 year-old college student, EK was living with constant joint pain, which disturbed her ability to exercise, study, and sleep. She contemplated dropping out of school. By this time, she also suffered from joint dislocations in her shoulders and elbows causing its own amount of excessive pain and stiffness. Her spine, including the neck, thoracic, and lumbar regions, would also “freeze,” sending shooting pain up and down her back.
EK’s first Prolotherapy treatment at Caring Medical consisted of Prolotherapy injections to her neck, spine, both scapulas, low back, and knee. Within a week of her first visit, EK reported a decrease in her thoracic and scapular pain and improved physical stamina and energy. A month later, she began running again and no longer required treatment to her knee. By her second visit, EK had discontinued all use of pain patches, and only required occasional Tylenol for pain and muscle relaxers to help her sleep. For the next six months, EK continued to receive monthly treatments to her neck, thoracic, and shoulders, showing gradual improvement of pain and well-being. After eight months of treatments, EK no longer required any pain medications, was no longer experiencing any joint dislocations, and was back to running and gymnastics. After her initial eight months of therapy, she was seen an average of once per year throughout her college and Masters program. She has not been seen for treatment for over seven years now, during which time she has received a PhD in her chosen profession. She continues to lead a full life, without daily pain or disability. She has no limitations while exercising most days.
Sometimes Prolotherapy is so successful that when the joints are stabilized, even clients with Ehlers-Danlos Syndrome, do not need further treatments. To be fair, EK did need more than the customary three to six visits, most likely because of the Ehlers-Danlos Syndrome. I have not seen this client for over seven years, but have communicated with her, and I can emphatically say that she now has a completely normal productive life. She went from living in fear of multiple subluxations in multiple joints, to complete stability in those joints, even with exercising most days. Prolotherapy, in this patient with Ehlers-Danlos Syndrome, appears to have permanently stabilized the unstable joints. Read the entire case report here.
Female with Ehlers-Danlos Syndrome, Hypermobility Type
PF is now a 55 year-old retired school teacher and mother of two adult children who lives in Canada. She came to Caring Medical because her Prolotherapy doctor, Fred Cenaiko, MD, retired. She had always known she was “hyperflexible” but had controlled her various joint aches, pains, and subluxations with physiotherapy and chiropractic care. Her pain became unbearable 15 years prior to the first visit at Caring Medical, when she began experiencing pain and instability in her left sacroiliac (SI) joint. After seeing many specialists over the course of several months for her SI pain, including her general practitioner, orthopedists, physiotherapists, and chiropractors, PF was left upset and disappointed by her continued pain and lack of improvement. She was having difficulty working, in addition to raising her two children. If something wasn’t found to help the unrelenting pain, she was destined to soon be completely disabled. Chiropractic adjustments helped for a few hours only to have her lower back go out again. She was told by one orthopedist to get a sacroiliac fusion.
As her low back pain increased, so did the rest of her joint pain. Her popping, clicking, and a feeling of looseness throughout her body increased. No longer were physiotherapy and chiropractic manipulation able to control her pain. Within a year, she had whole body pain and instability that almost completely disabled her for two and a half years. She was unable to take care of her children and she had to rely on strong pain medications in order to function. One day, her European-trained physiotherapist gave her some research articles from medical journals that talked about the tightening of joints with Prolotherapy. PF noted that the main doctor doing Prolotherapy was in Oak Park, Illinois, Dr. Gustav Hemwall. When she called Dr. Hemwall’s office, she was referred to Dr. Fred Cenaiko who worked in Saskatchewan, Canada. It was Dr. Cenaiko who diagnosed PF with Ehlers-Danlos Syndrome, Hypermobility type, and began treating her back and other areas of her body every six weeks with Hackett-Hemwall dextrose Prolotherapy. It took PF, 1.5 years of receiving dextrose Prolotherapy to her lower back to experience complete resolution of her SI pain. She reports that her other joints, including her knees, shoulders and hips healed much more quickly and she only required a couple treatments to each joint to resolve her pain complaints.
After one and a half years of doing Prolotherapy, PF was completely pain free. Because various joints of her body would begin to sublux and become painful over time again, she and Dr. Cenaiko realized that receiving Prolotherapy two to three times a year was what was needed to keep her stable and pain-free. PF has continued to receive Prolotherapy two to three times per year for the past 13 years. She was able to complete the necessary years as a teacher to be eligible for full retirement benefits from teaching. Prolotherapy also helped her get back to being the type of mother, wife, and friend that she wanted to be. PF currently swims laps, jogs, or hikes on a daily basis with no pain. She states that she also enjoys biking but she has to be careful because if she cycles at a high resistance for long distances, her knees start to become unstable. PF also avoids massages because she has noticed that massages tend to loosen her joints. Dr. Cenaiko retired in 2010 and referred PF to Caring Medical to continue her maintenance Prolotherapy treatments.
It has not been the “norm” at Caring Medical for a client with Ehlers-Danlos Syndrome to need periodic Prolotherapy treatments. Dr. Cenaiko used dextrose as the proliferant for PF. When I evaluated her and noticed that indeed there were some joints that were unstable, I suggested at her first visit to Caring Medical that we use a strong proliferant. To start, she received dextrose Prolotherapy with sodium morrhuate added to the solution. While she still believes she will need Prolotherapy twice per year, it is my hope that we will get her joints stable enough with the stronger Prolotherapy treatments, that eventually she will no longer need Prolotherapy. This case is presented here so patients with Ehlers-Danlos Syndrome know that generally Prolotherapy can permanently stabilize joints. But some patients, like PF, are happy that Prolotherapy is available if periodic treatments are necessary. Read the entire case report here.
31 Year-Old Female with JHS, with Constant Shoulder, Thoracic and Rib Subluxations
NP is a 31 year-old registered dietitian who came to Caring Medical in February 2009 from a referral by her osteopathic doctor, because of the diminishing benefits manipulation was having on her pain. She was very interested in the potential benefits Prolotherapy might have on her significant shoulder and thoracic/rib pain. She stated that she “has always had loose joints” and for most of her adult life has needed either chiropractic or osteopathic care to function. Her significant pain started 10 years earlier while on the rowing team at college. Her primary pain was located in the left T1-T4 area and left shoulder. A previous MRI of the thoracic area was read as normal. She had tried acupuncture, electrical stimulation, physical therapy, and various medications and manual therapies without lasting relief.
On physical examination, she had noticeable ligament laxity in multiple thoracic/rib junctions (costovertebral) and her left shoulder easily subluxed anteriorly. Her Beighton Hypermobility Score was 5. At the initial visit, dextrose Prolotherapy was given to her left thoracic facets and costovertebral junctions. When seen one month later, she felt 40% better and another Prolotherapy treatment was given to the same area. She was not seen again until June and felt her thoracic pain didn’t need treatment anymore but she wanted to start treatment for her left shoulder instability. Because of the degree of instability, sodium morrhuate (1cc/10cc syringe) was added to the dextrose Prolotherapy solution and treatment was given primarily to the anterior shoulder.
NP did not return for one year because of resolution of her thoracic and shoulder pain with the previous Prolotherapy treatments. When seen in June 2010, her primarily complaints were clicking, pain and an “unstable feeling” in the left hip. On physical exam, a definite palpable click was felt and a moderate degree of instability was seen. Her anterior and posterior left hip was treated on that date and again one month later. She had complete resolution of these symptoms. She was seen in October 2010 because of low back pain which wasn’t resolving with physical therapy and exercises. Physical examination revealed hypermobility of her left sacroiliac joint. Dextrose Prolotherapy with sodium morrhuate was administered to the left lower back region emphasizing treatment of the left sacroiliac joint.
When NP was seen again in February 2011, the only complaint she had was recurring subluxation of her left shoulder joint during activity. She again had evidence of shoulder joint instability anteriorly. Treatment of dextrose Prolotherapy with sodium morrhuate to this area resolved this issue.
It is common with genetic hypermobility cases for symptoms to “pop” up in other joints once the primary painful and hypermobile areas are stabilized with Prolotherapy. For instance, NP had hip instability that was stabilized with Prolotherapy, subsequently causing her hypermobile left sacroiliac joint to cause symptoms. The nice effect of Prolotherapy is that even with genetic hypermobility syndromes, the joint pain is often relieved permanently. But sometimes periodic treatments are needed because of the recurrence of joint hypermobility in a previously treated area. Read the entire case report here.
22 Year-Old College Student, Self-Manipulator with Severe Bilateral Shoulder and Knee Pain and Instability
JR, a 22 year-old male college student, came to Caring Medical in April of 2010 for complaints of bilateral knee swelling and shoulder instability. His lateral knee swelling began after he took up running in 2009 in preparation for entering the military upon graduation from college. He stopped running and was evaluated by an orthopedic surgeon who did an MRI and found an oblique tear of his lateral meniscus in both knees. The surgeon recommended arthroscopic surgery but JR looked for an alternative. He received one platelet rich plasma (PRP) injection on three separate visits with only minimal help. He sought a consultation at Caring Medical for Prolotherapy because of the minimal improvement with the PRP injections alone.
His shoulder issues started in 2005 (at age 17) after he tore the labrum in his right shoulder and had surgery to repair the tear. Despite having surgery, he continued to feel instability and pain in his shoulder. Because of his bilateral knee and shoulder pain and instability, even his ability to do non-impact sports like swimming had been affected.
Physical examination revealed joint hypermobility throughout his body, with a Beighton Hypermobility Score of 5. JR admitted that he frequently self adjusts or pops many of the joints in his body. Physical examination of his knees revealed significant bilateral grinding/crepitation with moderate to severe patellar hypermobility. He was instructed not to self manipulate his joints upon starting Prolotherapy, as this could potentially disrupt the connective tissues that are repairing after treatment. Dextrose Prolotherapy with sodium morrhuate was administered around the patella, as well as the various ligaments of both knees. Bilateral intraarticular Human Growth Hormone (2iu/joint) was also given. Because of the improvement in his knee pain with the first treatment, when seen one month later, his shoulders were also treated. He did not return until five months later, because of some continued symptoms, though he was feeling more stability and strength in his knees and shoulders. The knees were no longer swelling and he was back to an active exercise program.
JR returned for three more treatments from October to December 2010. This totaled five treatments to his knees and three treatments to his shoulders. At his last visit, JR reported that he was back to swimming and weight training without limitation, and only had an occasional crepitation in his shoulders but did not have pain. As for his knees, the crepitation was greatly decreased as well as the swelling. He has not yet tested his knees by running.
This case shows that some folks, even with Joint Hypermobility Syndrome, may be doing something to themselves to worsen his or her condition. In this case, JR was what we term a “self-manipulator.” He was manipulating himself an estimated hundred times per day. It becomes a habit. He cracks his neck, low back, thoracic, shoulders and other joints. It is imperative for hypermobile patients not to self-manipulate as this just further stretches the ligaments and makes them even more hypermobile. Eventually they are so loose that the only way they can keep in place to is to self manipulate. Obviously, Prolotherapy to the joint and spine instabilities is a better option. In JR’s case, I (R.H.) believe he should get treated until he is back to running. Read the entire case report here.
18 Year-Old Female goes from Anti-Depressants and Anti-Anxiety Medications to Pain Free at 28
When SB came to Caring Medical in March 2009, you would not have believed that this was the same woman who had walked into the office in 2001 as an 18 year-old. She was now a graduate of the prestigious Chicago Art Institute, happily married, and able to exercise. She was taking no medications. This was a far cry to the person seen in 2001 who was in constant pain and on Zoloft, Tylenol #3, Prozac, Clonazepam, Effexor and Soma. From the age of six to 12, SB was active in gymnastics. She had to stop gymnastics when her right hip became painful and, despite lots of therapies and doctors, developed into a constant throbbing pain. Her list of previous therapies to resolve this pain included: physical therapy, prescription medications, deep tissue massage, nerve blocks, acupuncture and Feldenkrais. At the time of her initial consult, she was almost suicidal because the pain was so bad. On physical examination, she had joint hypermobility throughout her body, with a Beighton Hypermobility Score of 6. After a thorough discussion that her prognosis was good but would require a lot of Prolotherapy, she and her mother agreed that SB should start Prolotherapy on her right hip, which was diagnosed as hip joint instability with labral tear.
SB came in somewhat regularly for a two year period, during which time she received dextrose Prolotherapy with sodium morrhuate. She was slowly weaned off of all of her medications. By the time was she was 20, her hip was stable and pain free. She was back to regular exercise and attending college. From the years 2002-2007 she was seen once to twice per year because of joint instability in other areas including the shoulder, neck and elbow. The reason she came to the office in March 2009 was for what she called “tune up treatments” of her right hip and shoulder, at which time she wrote she was forever grateful for Dr. Hauser and the Prolotherapy treatments. She was seen once in 2010 for the same “tune-up treatments.” She noted that the Prolotherapy had gotten her 95% better, but could feel the right hip and neck symptoms recurring.
It is important to note for patients with JHS and EDS that, in some instances, Prolotherapy can give permanent relief to an unstable joint. Sometimes, perhaps because of the genetic component to the conditions, patients with JHS and EDS may need what SB calls “tune-up” treatments once or twice a year. While this is not ideal, the patients typically don’t complain because the rest of their lives are extremely “normal.” Even if a joint becomes too unstable, they have the knowledge that Prolotherapy can always be used. There is comfort in this fact. SB has not taken pain medications, except an occasional acetaminophen, in years. She has been off anti-depressants and anti-anxiety medications for over eight years, and has not seen a psychiatrist in over 10 years. She is one of the most delightful people I have ever had the opportunity to meet and treat. Read the entire case report here.
Active 61 Year-Old Female with JHS
In January 2009, BB, a 61 year-old skier, came to Caring Medical saying she “didn’t want anything to slow her down.” BB always knew she had a tremendous amount of joint flexibility, and thus, excelled at yoga as well.
She had a significant past medical history with five years of suffering with bilateral hip, knee, and elbow pain. She continued to be active, including skiing with a very restrictive knee brace, despite her right knee MRI showing a medial meniscus tear, and her right hip MRI showing a high-grade partial-thickness tear involving the gluteus minimus insertion onto the right greater trochanter as the dominant finding with paritendonitis and trochanteric bursitis; low-grade tenoosseous strain of the iliopsoas insertion the lesser trochanter without tendon tear; more substantive iliopsoas bursitis. BB was a strong natural medicine advocate and exclaimed that “No orthopedic surgeon is doing surgery on me!” She was told by a skiing friend to look into Prolotherapy.
BB was diagnosed with JHS and like SB, had evidence of hypermobility throughout. Her Beighton Hypermobility Score was only 4, but many joints had excessive mobility. She was told that she was an excellent Prolotherapy candidate, but because so many joints were involved it would require some time for all of the instability to resolve.
BB was seen at Caring Medical on 10 occasions over the course of the next two years for treatment. Her elbow responded after four treatments, allowing her to get back to exercise, which included weights and push-ups. Her right knee needed five treatments, and her hips each needed nine treatments. Now BB is back to cycling up and down the hills of Colorado and skiing at a high level without braces and without pain.
Some patients with JHS and EDS can function at a high level for most of their lives without needing a lot of medical intervention. In BB’s case, her body didn’t start to suffer the effects of her hypermobility until she was in her mid 50’s. She is an extremely motivated and active person who tried everything she knew to stabilize her joints. When the orthopedic surgeons in Colorado started talking about various “potential” surgeries for her, she looked into Prolotherapy. I suspect that with her extreme sports mentality I may be seeing her periodically for a while. But I am happy for her being able to get back to all of her activities without braces, and look forward to her having an extremely “active” retirement! Read the entire case report here.
48 Year-Old National Caliber Athlete with Pelvic Floor Dysfunction and JHS
JD came to Caring Medical in extreme distress because she was no longer able to work as a physiotherapist, athletic trainer and Pilates instructor. She was a 48 year-old wife and mother from Ontario, Canada and her pelvic pain had completely disabled her. She explained that her previous life as an athlete included Canadian National rhythmic gymnastics team, international level dragon boat and outrigger paddling, recreational triathlons, cross country skiing and water skiing.
JD always had what she called “extreme flexibility.” She had a series of injuries including the following:
- 2004 – plantar fascia pain
- 2006 – severe hip pain on the greater trochanter
- 2007 – inguinal pain, requiring inguinal hernia repair x 2
- 2008 – right groin exploratory surgery and inguinal nerve ablation. Her right groin pain did not resolve. MRIs at this time revealed a torn rectus abdominus, right hip dysplasia, and labrum tear.
- 2009 – right rectus abdominus repair and removal of mesh. Re-injury of right inguinal area. Another right inguinal hernia repair with mesh.
JD’s first appointment at Caring Medical was in August 2009. She had multiple complaints but her primary pain areas were the pelvic floor, pubis, groin, left knee and left ankle. She received some Prolotherapy in Canada previously, but because she did not feel the technique used was aggressive enough, she was not happy with the results. JD said her main goal was get to back to teaching Pilates full time. The pain was completely disabling her from working and driving, and she was becoming very depressed. Her pain was increased with most movements and activities including sitting, standing and walking. She was diagnosed with JHS with her main problem being subluxation of the pubic symphysis. She was felt to have pubic instability and this was causing the majority of her pelvic pain. She had instability of the left knee and left ankle. These areas were treated with dextrose Prolotherapy with sodium morrhuate every four to six weeks. When JD came for her third visit in December 2009 she noted that she was feeling much better. Her groin pain had improved to the point that she was water jogging two to three times per week and doing some core workouts. She started working again, two mornings per week, and was able to drive short distances. On this third visit, she started treatment on her right hip because of popping, clicking and pain from hip joint instability. She was feeling much stronger and less pain overall until she re-injured her right oblique abdominal muscle and this started her right pubic/groin pain again.
At her February 2010 visit, the pubic symphysis was treated again, as well as the right hip. At this visit, JD noted a new pain in her lower right back which was also treated with dextrose Prolotherapy with sodium morrhuate at that time. Over the course of the next year, JD was seen in the office three times (including seven months between two of the visits) necessitating treatment to her left knee, right hip, and new-onset metatarsalgia of her left foot. To date, her disabling groin pain is down to a manageable level, but feels that some of the pain is secondary to the two meshes she has in her. JD is back to work, but not full time like we had hoped.
When writing case studies, it is often difficult to illustrate the extreme disabling effects of JHS and EDS. I included the case of JD to show that a national caliber athlete can be broken down by these conditions to the point where she could not even work as a full-time athletic trainer/Pilates instructor. In her case, she was on the verge of a nervous breakdown prior to Prolotherapy, and shed many tears at her first consultation. When she was most recently seen, in February 2011, it was primarily because she had fallen on the ice and re-aggravated her right hip and left knee pain. Her groin was not treated, which was the original disabling injury for which she first came to Caring Medical. JD no longer suffers anxiety about when her next joint is going to sublux, because she knows she can get Prolotherapy to treat future injuries. The peace of mind that comes with Prolotherapy for JHS and EDS patients goes a long way. Read the entire case report here.
Ankle Instability from Ehlers-Danlos Syndrome
Kristle Lowell, Double-Mini Trampoline World Champion, diagnosed with EDS was experiencing severe instability from multiple ligament injuries of her left ankle and received massage, physical therapy, cortisone and NSAIDS, from which she saw no long-term relief. Kristle suffered a career threatening injury to her ankle, which made gymnastics training unbearable. She came to Caring Medical and received 2 PRP Prolotherapy treatments. Her ankle was stabilized, enabling her to compete and place second in national championships and qualify for world championships.
Cortisone, NSAIDS, PT and MT do nothing to strengthen the ligaments of an unstable joint. Prolotherapy strengthens the injured ligaments and stabilizes the joint.
More Information about Prolotherapy for EDS & Hypermobility
How well do you understand the cause of your hypermobility pain?
Take the Joint Instability Quiz! This quiz covers how musculoskeletal pain develops and which important diagnosis is often missing when people are suffering from chronic pain.
Articles about Prolotherapy for EDS & Hypermobility
Videos about Prolotherapy for EDS & Hypermobility
How do I know if I’m a good candidate?
Just like you, we want to make sure you are a good fit for our clinics ahead of your appointment. We value your time and we also schedule a lot of time with our providers and team to accommodate your visit. Most of the EDS patients who require our specialists’ care travel quite a distance from out of the state/US, but even if you are located within a couple hours of our clinics, we want to make sure you are a good fit for us first! Give as much detail as you wish to share to help our team determine if you are potentially a good Prolotherapy candidate. You can upload MRI reports or other imaging reports, if they are relevant to your current case.