General Rehab Strategies for HSD/EDS

Presented by Heather Purdin and Patricia Stott

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Video Runtime: 99 Minutes, Learning Assessments: 48 Minutes

This course discusses ways to progress and modify manual therapy interventions to address changing symptoms of the HSD/EDS patient. It highlights typical postural faults for those affected by hypermobility and tissue laxity and their effects at distant joints in the body. It outlines exercise progression continuums to consider when choosing an exercise. It educates the learner in lifestyle modifications that will assist with regulation of the autonomic nervous system, and how to modify exercises for those struggling with POTS/fatigue. It clarifies current expert opinion about stretching for this population. Lastly, it discusses the biopsychosocial approach and coaching tips for managing physiologic issues, psychological symptoms, and social implications. This course is appropriate for those in physical therapy, occupational therapy, and athletic training.

Meet your instructors

Heather Purdin

Heather Purdin has been a practicing PT in an outpatient setting for 26 years and has a special interest in chronic pain, fibromyalgia, and connective tissue disorders. She is president of the Oregon Area Ehlers-Danlos Society. She is also president of Good Health Physical Therapy & Wellness, a private practice specializing…

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Patricia Stott

Patricia Stott treats primarily those with HSD/EDS and those considered highly sensitive patients at her own practice, Elevation Wellness, outside the Denver metro area in Colorado. Also trained in functional and herbal medicine, she works on health and wellness through holistic strategies with these patients, both in person…

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Chapters & learning objectives

1. The Order of Interventions: Before Exercise

The biopsychosocial approach works best for the complex medical issues involved with treating HSD/EDS. Starting with outcome measures appropriate for this population and considering the whole patient, including the multiple layers of pain generators and the body mechanics of activities of daily living, are components of an adequate assessment of a HSD/EDS patient. Manual therapy assessment and treatment should be modified depending on the type of pain or issue the patient is presenting with. A case example will aid the learner in thinking through progression of stability exercises to perform before any general strengthening exercises are prescribed.

2. The Order of Interventions: Exercise Based

This chapter reviews precautions for exercise in this population and gives guidance in progressing from simple stabilization exercises to more complex movements prior to strengthening exercises. The chapter highlights the importance of proprioception exercises to reduce pain and improve function and reviews research findings on exercise and HSD/EDS. Exercise progression continuums are highlighted to guide the learner in choosing appropriate exercises. Cardiovascular exercise benefits, tips for safe stretching, and bracing and taping to support continued participation in exercise will be discussed. The case study continues in this chapter to assist processing of the material.

3. Modifying Exercises for Autonomic Dysfunction, POTS, and Fatigue

This chapter will discuss the effects of autonomic dysfunction on exercise tolerance and provide guidelines for exercise modification and progression. The chapter will discuss common problems associated with exercise and provide examples of modifications that make exercise possible/tolerable. The chapter highlights the lifestyle modifications that patients will need to implement to manage their condition successfully. The case study continues for integration of learning principles.

4. Interventions to Regulate the ANS

This chapter presents the spinal conditions that are more common in the HSD/EDS population along with the presentation, differential diagnosis, and in-clinic suggestions. While these conditions are considered more rare in the general population, they tend to be more prevalent and/or more symptomatic within the HSD/EDS population.

5. What About Stretching?

This chapter educates the learner on when to employ stretching exercises with the hypermobile patient and modifications that should be considered for safety. The chapter covers some of the benefits of stretching and whether yoga is considered safe for this population.

6. General Activity Recommendations and the Biopsychosocial Approach

This chapter educates the learner on screening to perform to determine whether it is appropriate and safe for the patient to attend a medical visit. The chapter highlights the influence of psychological history on outcomes and helps differentiate between symptoms driven from psychological causes and physiologic drivers. Guidance in coaching patients in lifestyle choices, sport participation, and stress management techniques is reviewed. This chapter finishes with a case study to synthesize use of the information presented.