Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome: A Case Report

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SOURCE:   J Chiropr Med. 2014 (Mar); 13 (1): 35–42 ~ FULL TEXT

Richard G. Strunk, DC, MS, Mark T. Pfefer, RN, DC, MS, Derrick Dube

Research Clinician Cleveland Chiropractic College,
Overland Park, KS.

OBJECTIVE:   The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain.

CLINICAL FEATURES:   A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS.

INTERVENTIONS AND OUTCOMES:   The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index.

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CONCLUSION:   This patient with BJHS who had decreased disability and spine pain improved after a course of multimodal chiropractic care.

KEYWORDS:   Chiropractic; Joint hypermobility; Low back pain; Manipulation; Neck pain

From the FULL TEXT Article:


Benign joint hypermobility syndrome (BJHS) is a hereditary connective tissue disorder defined by pain and hypermobility in multiple joints. [1-4] Benign joint hypermobility syndrome is also known as joint hypermobility syndrome and hypermobility syndrome.

Furthermore, it is important to be aware that BJHS shares similar clinical features to Ehlers-Danlos syndrome–hypermobility type(EDS-HT). Both BJHS and EDS-HT can present with generalized joint hypermobility, abnormal skin features, recurring joint dislocations, chronic joint/extremity pain, and a positive family history. The close association between BJHS and EDS-HT causes many to view them as the same condition. [5, 6] However, with the lack of readily available clinical testing, the association between BJHS and EDS-HT is not definitive.

Benign joint hypermobility syndrome is considered to be more common in African, Asian and Middle Eastern populations and is also more common in females and younger individuals. [4, 7-11] The true prevalence of BJHS is unknown, but estimates range from 5% in the United States to 43% in African populations. [7, 12] It is diagnosed by patient history and/or physical examination findings such as generalized joint hypermobility, chronic limb and or back pain, and connective tissue lesions. These history and examination findings are grouped into “major” and “minor” criteria called the Brighton criteria (Figure 1). [13]

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