Abstract:
In the complex landscape of neuromyofascial science, one particular challenge that has captured my attention is the underdiagnosed condition of hypermobility, especially prevalent among females. My clinical observations have revealed that hypermobile women, often presenting with histories of exceptional flexibility, are at a significant risk of sustaining invisible injuries from whiplash. This abstract delves into the nuanced injury patterns that hypermobility entails, emphasizing the need for specialized diagnostic approaches like spinal biopsy to uncover injuries that standard imaging fails to detect. By shedding light on this issue, I aim to advance our understanding and treatment of neuromyofascial pain, advocating for personalized care that addresses the unique vulnerabilities of hypermobile individuals.
Navigating the nuanced intersection between hypermobility and neuromyofascial pain has been a cornerstone of my practice. Hypermobile females, forming a substantial portion of the complex chronic pain cases I encounter, present a unique diagnostic challenge, particularly in the context of whiplash injuries. Their distinct physiological traits—such as remarkable flexibility and unusual softness of the skin—often mask the severity of their spinal injuries, making conventional diagnostic methods insufficient. This introduction is an invitation to explore the intricate relationship between hypermobility and spinal trauma, highlighting the imperative for specialized diagnostic and therapeutic strategies that cater specifically to the needs of hypermobile patients.
A frequent patient type that I see in clinic is that of the hypermobile female. I do see hypermobile males, but that is very uncommon.
This is an important whiplash sub-category, as this type of patient is typically underdiagnosed of their injuries. The hypermobile females represent about 30% of the complex chronic pain group in my practice.
The story is typically a female with a history of more than great flexibility.
Usually, they have performed dance or ballet as a child because performing the splits was easy without any effort and so many of the dance moves are easy to perform.
They are what is called a natural dancer, or gymnast.
But what happens when the spine is injured in these females?
I have assessed and examined many hypermobile females after injury, and have acquired an injury pattern.
Their skin is soft and appears of younger than average age.
The range of motion of spine and joints will be higher than normal.
The ROM may not be equally distributed in their bodies, so some have loose upper bodies, some have lose lower bodies, and someare loose all over.
These females have a tendency to dislocate or sub lux joints, so a story of ankle injuries and shoulder injuries are common
As a group, I find that, on exam, they have minimal trigger point changes in their muscles of their arms or legs, so specifically, their muscles are absent of natural trigger points, even when I felt they should be strongly present on exam from an injury.
The spine may also appear to lack obvious injury after an accident with cursory exam.
Even Xray and MRI will under report spinal injury as they are literally loosely put together.
However, using specialized tissue and spinal biopsy techniques, I can report that these people do develop serious spinal injuries which are invisible to MRI but are detectable with spinal biopsy assessment, and are treatable.
Untreated these whiplash changes may cause even more aberrant movement in the spine than in non hypermobile people.
Specifically, after a whiplash event, I find significant injuries affecting the neck and upper back or medically, the cervical and thoracic spine, causing a condition I have labelled spinal myelopathic syndrome, or SMS.
Now SMS can occur in anyone, but it is even more likely in hypermobile females after a whiplash event, and it is not seen in their imaging easily.
The common symptoms are that of post concussion syndrome with other body aches affecting the arms and legs without triggers or range of motion loss.
I have a more complete explanation of spinal myelopathic syndrome, which I have also labelled as the laymen form of spinal concussion syndrome.
The points to remember is that hypermobile people are more at risk for long term spinal complications after whiplash as their spinal soft tissue allows for more vertebral movement and soft tissue tearing from a similar acceleration or deceleration injury.
It will be difficult to diagnose as their examination appears normal as they are naturally hypermobile, and the imaging does not show the spinal injuries.
Special bimanual or hand examination of the spine may show retrolisthesis of the vertebrae and other changes, and special biopsing does confirm injury helping to guide special treatment for recovery in these females.
The journey through understanding the intricate dynamics between hypermobility and neuromyofascial pain underscores a critical realization: the path to effective treatment is fraught with challenges yet ripe with potential for meaningful recovery. The insights gained from exploring the unique predicaments of hypermobile females illuminate the broader implications of neuromyofascial injuries and the necessity for a tailored approach to care. As we continue to explore and innovate within this field, my commitment to providing empathetic, patient-centered care offers a beacon of hope for those seeking relief from the often invisible torment of neuromyofascial pain.
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