Introduction
The Ehlers-Danlos Syndromes (EDS) are a group of heritable connective
tissue disorders characterised by joint hypermobility, tissue fragility
and skin extensibility [1]. Hypermobile EDS (hEDS) is the most
common subtype, and is associated with pain, activity limitations and
participation restrictions [2]. hEDS is diagnosed through clinical
examination using the 2017 International Classification [1,3].
Additional consideration must also be given to the comorbidities that
exist alongside the main condition due to its multisystemic nature.
These include Postural Tachycardia Syndrome (PoTS) [4], Mast Cell
Activation Syndrome (MCAS) [5], gastrointestinal issues and bladder
and bowel problems [6]. These comorbidities can play an important
role when it comes to rehabilitation planning [7]. Comorbidities are
associated with worse health outcomes, more complex clinical management,
and increased health care costs [8].
This group of patients are poorly recognised and poorly understood, as
highlighted in recent studies of healthcare experiences [9, 10, 11].
Physiotherapists play a central role in management, yet many
practitioners fail to recognise the complexity of these patients and
that inappropriate treatment may be detrimental to their management
[7,12]. Existing studies have highlighted the psychological impact
of this condition and recommend early detection to assist optimum
management [9,13]. Health care practitioners therefore need
increased awareness of hEDS.
Dynamic Movement Orthoses (DMOs)® are fabric elastomeric orthotic
garments that have strategic reinforcement biomechanical panelling
[14] and are a type of Dynamic Elastomeric Fabric Orthoses (DEFO)
[15]. Therefore, they may help people with hEDS by exerting a
customised paratonic torsional, compressive and supportive effect that
could positively influence alignment biomechanics, and neuromuscular
activity specific to the individual and their body segments [14].
DEFOs are different to traditional braces which may restrict movement
and prevent muscle activity [15]. They can also be individually
tailored to the patient’s needs with specific . Case reports have shown
their successful use in improving form and/or function in a variety of
patients with movement control problems [15,16]. A study of six hEDS
patients and six matched controls demonstrated that postural control
impairment was partially offset by wearing somatosensory orthoses
[17]. Simmonds et al [18] suggested pain, fatigue and fear of
injury are common barriers to exercise. Therefore, in the hEDS patient
who commonly suffers with pain, impaired proprioception, poor muscle
control, increased tissue elasticity [19, 20], and reduced function;
DMOs® could be considered as a first line of treatment.
PoTS, a co-morbidity found in EDS [21], is defined as a clinical
syndrome lasting at least 6 months that is characterized by: 1) an
increase in heart rate ≥30 beats per minute within 5 to 10 min of quiet
standing or upright tilt (or ≥40 beats per minute in individuals 12 to
19 years of age); 2) the absence of orthostatic hypotension
(>20 mm Hg drop in systolic blood pressure); and 3)
frequent symptoms that occur with standing such as light headedness,
palpitations, tremulousness, generalized weakness, blurred vision,
exercise intolerance, and fatigue [22]. Compression garments have
been highlighted as a tool in the management of PoTS [23, 24],
therefore the compressive effects of DMOs® might help to reduce
symptoms. The management of hEDS must focus on treatment interventions
that allow these patients to function, addressing “injury prevention
and symptom amelioration rather than a cure” [25].