I had a patient that came in today with knee pain. She was looking for more prolo therapy, which had helped her last year. (Prolo therapy uses an injection of an irritating solution to stimulate cartilage and ligament growth) Her evaluation today revealed that both knees had slightly relaxed anterior cruciate ligaments. That meant that both of her tibia’s (the lower leg bone) would move a bit further forward than normal on her femur (the upper leg bone). My clinical experience has found that this forward movement of the tibia on the femur equates to knee pain (especially on ascending and descending steps). It is usually an easy (typically one treatment) fix on someone who has healthy knees.
Today’s findings led me to test her arms for joint hyper-mobility (ligament laxity). She had an old fracture of her left elbow, which made it stiff, so we tested her right elbow. Her elbow joint was indeed hyper mobile (it bent further than normal). We discussed how she had been hyper mobile for as long as she could remember and that no one thought much of it.
Joint hyper mobility is typically not an issue when you are younger. Your joints move a bit more than the “normal” persons and you might be into ballet or gymnastics where these are desirable traits. But, as we age, all of our tissue sags (gets looser). This includes your joints. Now, in middle to older age, these patents have joints that are even more loose…and predisposed to injury. Those who are on the lesser side of this laxity tend to push though and still participate in activities, but they are more prone to injury. Those who are on the more lax side have a different outlook. Their nervous system understands that they are much more prone to injury – these folks avoid running, gym class, etc. and may even have panic attacks if they have to do something as simple as going to the grocery or gym class. On a subtle level their bodies equate exercise with the possibility of getting injured… and they will go to great lengths to avoid injury.
Evaluation of the hyper mobility is done by a few methods. The one I use was invited by a colleague (Damon Whitfield, DO) and is called the Lack of Resistance (LOR) test. It evaluates the sequence of events that happens when a joint it straightened. The muscle should reach its end of motion, then you will feel the tendon engage and typically (in a normal person) the tendon will stretch and stop the joint motion before you reach the ligaments. In someone with hyper mobility, the tester will feel the ligaments engage and sometimes even the joint reach its bony limits. This is a rapid test to assess joint hyper mobility/ligament laxity.
Once diagnosed, the treatment if often very specific supplementation. I have seen this transform patients and completely relieve not only their knee pain, but other aches and pains by helping to remove their laxity.