173. Ehlers-Danlos Syndrome (EDS) Basics for PTs: hEDS, Pain, and Smarter Exercise Dosing

Kasey welcomes listeners to the PT Snacks podcast for physical therapists and students and introduces a brief episode on Ehlers-Danlos syndrome (EDS). Kasey highlights common patient issues such as joint pain, dislocations, tendinitis, and muscle cramps, and discusses how physical therapy can improve quality of life through resistance training, proprioception, balance, aerobic and functional conditioning, pain neuroscience, and graded exposure to reduce kinesiophobia. 

00:00 Welcome and Disclaimer
00:18 Episode Focus on EDS
01:21 EDS Types Overview
02:20 Hypermobility EDS Basics
02:33 Why Collagen Matters
03:16 PT Goals Pain and Fear
04:02 Training Approaches for hEDS
04:31 Load Management and Recovery
05:48 Lifestyle Factors Sleep Stress
06:52 Wrap Up and Contact

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Transcript

Hey, welcome to PT Snacks podcast. This is Kasey, your host, and if you're tuning in for the very first time. I just need you to know that this is meant for physical therapists and physical therapist students who are looking to grow your fundamentals in bite-size segments of time. If you're not one of those, you're still welcome to be a part of it, but this is not medical advice. Today's episode is gonna be brief. We are going to talk about Ehler's Danlos syndrome and know this is not just another name for someone who is super flexible, contrary to, what I've heard a lot of people say, this is actually a connective tissue disorder. So the purpose of today's episode is really just to cover all the different types and highlight one in particular, , that we might see quite often in physical therapy, which is the hypermobility subset. So with that, we'll talk about what briefly in the research has been done to help these patients. And maybe how you could take that into account with your patients who do have this condition. So before we go into that, if you've been listening to this show and you're like, wow, this is great I'd love to leave a review, that would be fantastic if you would. Um, just wherever you listen to that. 'cause that really does make a big difference. So with that being said, let's just dive right in. As I mentioned before, this is a connective tissue disorder, so there's 14 different subtypes that can share characteristics of Ehler's Danlos, um, which would be joint hypermobility, skin and vascular weakness, and general fragility of connective tissues. Let's just dive into all the different types that there are. So 13 of these are rare monogenic disorders. We have our classical EDS, vascular EDS, kyphotic EDS, arthrokilasia EDS, brittle cornea syndrome, classical- like EDS type one, classical- like EDS type two, musculo contractual EDS, myopathic EDS, periodontal. EDS, spondylosplastic EDS. I'm almost done. Dermatoses. peraxis EDS, cardiac valvular, EDS, hypermobile, EDS, and hypermobility spectrum disorders. So the hypermobility subtype. Or hEDS is the most common, where one in 10,000 people or to one in 15,000 people can have this condition. So most come from out of all of these A from harmful gene mutations that produce proteins such as collagen, type one, type three. Five or enzymes that play a pretty big role in the synthesis of these collagens or in the production of proteoglycans. And if you remember anything about studying the histological aspects of wound healing and new tissue formation or connective tissue, these are pretty important. Like really important. So with this, this is a patient where we need to keep the actual aspect of what this disease means in mind when we are giving appropriate load for these patients. PT physical therapy has been found to actually be very helpful for improving these patients' quality of life. And so we have to know how to manage several things. Both in a reduction of pain and also a reduction of kinesiophobia. It's just imagine if you have this condition not knowing whether what you're doing is going to be exasperating your symptoms, exasperating your pain or you are really not responding well. Patients who have EDS have significantly as a whole, just more joint pain, uh, they're more likely to experience joint dislocations, tendinitis, and muscle cramps. So what do we do as physical therapists? Resistance training can be very beneficial as well as proprioception, balance aerobic and functional training for conditioning and decreasing kinesiophobia, which kinesiophobia's, just to define it, is basically a fear of movement. Pain, neuroscience, and graded exposure can be very helpful for these patients. Again, this is a connective tissue disorder. This impacts a lot of their day-to-day life. So all these things we need to make sure that we keep in mind. Again, these patients have abnormal collagen and connective tissue repair, so that can be linked to defective or delayed healing when we work out. We are basically creating a stimulus that our body, while it's controlled, has to heal from to grow stronger, right? We're adding something that is catabolic breaking down tissues so that our tissues respond in an increase in their tolerance to future stress, right? If I'm doing bicep curls. And I'm working those muscles a lot. Um, this helps to create a stimulus for my body to hopefully, if it's the right amount of load, respond by getting stronger or be able to do more reps, whatever it is I'm training with these patients, they may need a slower ramp up period of time and a little bit less load than someone that does not have this condition walking into your clinic. So it's probably best to see what is their baseline activity and dose them slowly in their progressive overload so that we make sure that they actually have a lot of healing time and making sure that their recovery process is on point. Ask them, what is your sleep like? Are you getting good sleep, your nutrition how are stress levels? All the things that are pretty much all the low hanging fruit that probably a lot of Americans could improve on, but things where it's really important for this patient population because they already have. Delayed healing. So making sure that we are making that just as important as our exercise program and really we probably do that for everybody. That is something you need to keep in mind if you're doing strain training. Things like balance and all that. Again, depending on their baseline mobility, that can feel like a workout too. It may not feel hard to you, um, if you don't have this condition. But again, you don't have this condition. So, just like any person, you're trying to figure out what they wanna be able to do, what they've been doing, and you're trying to build a bridge. It's just the rate at which you build that bridge might have a slower incline than someone who is perfectly healthy. So it's important to have graded programming and good recovery. Now, what you should have gotten from this episode is what Ehler's Danlos actually is that there's a lot of subtypes with hEDS being the most, common one. And then how this information impacts the type of exercise programming that you're gonna do for this patient while also emphasizing good recovery. If you have any questions, feel free to reach out at PTex podcast@gmail.com or you can find me on Instagram. I also just started a TikTok. I'm a millennial, y'all, I don't know what I'm doing, but if you want to help a sister out, you just find me on there. You can shoot me a message. Other than that, I hope you guys have a great rest of your day, and until next time.