Treatment of Joint Hypermobility Syndrome,
Including Ehlers-Danlos Syndrome, with Hackett-Hemwall
Prolotherapy
Ross
A. Hauser, MD & Hilary J. Phillips
Joint hypermobility syndrome (JHS) and Ehlers-Danlos
Syndrome (EDS) 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.
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. Prolotherapy works by initiating a
brief inflammatory response, which causes a
reparative cascade to generate new collagen and
extra cellular matrix giving connective their
strength and ability to handle strain and force.
Prolotherapy has a long history of success
treating ligament injuries, including patients
with joint hypermobility. Studies on
Prolotherapy have shown that it eliminates
chronic pain even in those patients who have
been told by their medical doctor(s) that
surgery was the only treatment option for their
pain.
Some of the rationale for using Prolotherapy for
patients with EDS and JHS include 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 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.
