Problem list
Differential diagnosis, investigations and treatment After discussion, and with the patient’s explicit consent, a letter was written to their Primary Healthcare Physician, General Practitioner (GP), to request a referral to a specialist Rheumatologist who dealt regularly with EDS and other connective tissue disorders. The specialist Rheumatologist diagnosed the patient with hEDS using the 2017 International Classification [1, 3] and they also suspected PoTS. Therefore, they made an onward referral to a Cardiologist and for a tilt table test [4, 22, 23]. The patient reported that she felt listened to, felt the value of understanding her own body better and felt having a ‘label’ helped her explain her problems to family, friends and work colleagues [9]. She shared with us that she had previously ‘lost her faith’ in physiotherapy, as exercises prescribed by past practitioners had caused pain exacerbation, so it was important for us to build trust and a relationship to help find a way of improving her strength, proprioception and function.
To address the issues listed on the problem list we suggested a trial of DMO® leggings which not only provide compression to aid blood pressure in the legs [23], but also provide proprioceptive feedback to aid her postural control. With this patient we wanted to reduce her sway back posture and knee hyperextension as we found that this decreased her pain. Sway back posture has been reported to increase the joint pressure around the anterior acetabulum, the area which is often inadequately covered by the hip socket in DDH [37]. The patient’s decreased awareness of her body posture meant she was unable to maintain the position which decreased her pain, therefore we wanted to assess to see if a DMO®, in the form of leggings which also encompassed the hip and pelvic region, could assist in reducing her sway back posture. Core control, hip, lower limb, breathing and proprioceptive exercises [41] were tailored to her needs so that they were manageable; paced to accommodate her pain, chronic fatigue and dizziness; and were relevant to helping her function post-operatively. In a systematic review of exercise programmes for hEDS patients, a period of 4-8 weeks was commonly reported in studies [41]. Our exercise programme had a longer time span (16 weeks) as it was dictated by the planned surgery date.