Problem list
- Poor proprioceptive awareness
- Unable to improve pre-operative function and strength, due to pain
- Safety concerns with dizziness, light headedness and fainting
episodes, combined with reduced mobility
- Low mood due to decreased function
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.