Book Review – Managing Ehlers-Danlos (Type III) – Hypermobility Syndrome by Isobel Knight

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‘Don’t worry if you end up teaching someone who’s double-jointed.  It just means that they have a different type of collagen in their body.  Make sure they keep their elbows soft in four point kneeling’ and so I was introduced to Hypermobility on a (non-Body Control, I hasten to add) Pilates training course.  I’m sure that anyone with Hypermobility Syndrome (HMS) will read those words and wish ‘if only’.

Isobel has once again written an incredibly readable account of her never ending journey dealing with (HMS) and the effect it has on her body and those of fellow sufferers.

The book is divided into four parts.  The first, ‘The body and the self’ explains why she has written the book as she has in her autoethnographical style and includes a chapter from Professor Howard Bird, her overarching physician and expert in treatment of HMS.  The second covers the physiology of the disease with chapters covering a broad range of conditions from digestion and bowel problems to bladder issues, endometriosis and fatigue showing how HMS can affect all areas of the body and how often pain management is an important part of the regime that will be needed to enable the chronic complex patient to continue with life.  Part 3 covers Psychology and suggests helpful ways for the patient and therapist to support each other, suggestions of therapies that Isobel has personally found helpful and ways to record and review treatment benefits.  Part 4 covers exercise and rehabilitation.  There are separate chapters on Imaging, Pilates, movement patterns and neurology along with alternative therapies such as Bowen, Feldenkrais and birth trauma.

As in her first book, A Guide to Living with Hypermobility Syndrome: Bending without Breaking, Isobel’s descriptions are interesting and intelligent going into much detail to enable the reader to understand the ramifications of living with HMS.  She suggests that we read chapters 1 to 4 and then the sections that are of interest to us personally, but I would recommend taking the time to read the whole book.

As a Pilates teacher who often works with complex patients, not just those with HMS, but those with back issues who may not have all the same physiology as described by Isobel but who have often been passed from pillar to post through the NHS and privately to get a resolution for their back pain, I found every section helpful

Several areas struck a chord with me.  The section on Psychology could be usefully read by any therapist working with complex patients to get new insight on issues that can be faced by the complex patient and it suggests setting up contracts between the client (who can often be needy) and therapist and boundaries that should not be crossed on both parties (such as not contacting the therapist whilst he/she is on holiday and for the therapist to not introduce potentially problematic new exercises just before a holiday)  It suggests goal setting and focussing on those patient goals.  There is also an interesting section on support for the therapist working with complex patient suggesting that the therapist him/herself also needs to be supported which may be difficult for those of us working on our own but is worth bearing in mind that it ought to be possible to build up a relationship between the therapist, client and their other health professionals.

I must say that I also found the ‘professionals viewpoints’ interspersed within Isobel’s text also fascinating to read the story from the other point of view from those who are aiming to help people with HMS improve their lives.  As always, the patient needs to be determined and committed but they also need support from their friends and family who can often be resistant to change.

It is suggested in the book that Pilates is most beneficial for hypermobile people with a very experienced teacher and, certainly initially, on a one to one basis.  I would agree with this wholeheartedly and would suggest that anyone with HMS seeks out a teacher who is actually teaching ‘Pre-Pilates’ rather than the classical version of Pilates, even at beginner level.  (please also see my blog regarding Pilates teacher training)

As with everything, this raises questions about the affordability of treatment for those with HMS and Isobel herself mentions the cost of keeping on top of her HMS paying for physiotherapy and Pilates privately.  In these days of austerity, funding is often an issue for everyone but may be especially problematic for those with complex issues who may find relief and improvement from Bowen or Pilates or other treatments but who, due to those same issues, may find it difficult to work full time or at all.  A vicious circle.

To summarise, a useful resource for anyone working with clients with HMS or other complex patients.  Isobel’s journey is still ongoing and I wish her well and look forward to her next book!

You can buy it on Amazon here

 

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To stretch or not to stretch

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I saw an article from Runner’s World posted by someone on Twitter: TIGHT HAMMIES? Here’s the best stretch for you: http://ow.ly/hYaE9 and I commented that it was bad science partly  due to the initial sample being very small and completely unrepresentative of runners (eight adults without back pain and 17 youths, ages 8 to 18, with back pain) and partly due to the article stating that ‘all test subjects had increased their flexibility by 17 to 22 centimeters’ based on a test which would have equally likely to have shown an increase in back flexibility (i.e. not hamstring length which is generally tested via a passive straight leg raise) hence not necessarily any increase in length in the hamstrings at all.

I also went on to say that it’s not enough to just ‘stretch the hamstrings’ if they’re short but you need to determine why they’re short and remedy the reason.

As an example (although this is far from being the only reason for tight hamstrings):

The glutes are notoriously lazy muscles particularly, I’ve noticed, in runners.  Any excuse and they’re relaxing down the pub with a pint.  One of their functions during gait is to stabilise the pelvis.  So, if the glutes aren’t working, either the pelvis is swinging around as you walk and run (possibly leading to back pain?) or something else is going to try stabilising the pelvis, perhaps those hamstrings, tightening them up as they do the extra work that they weren’t designed (or haven’t evolved) to do.

So, while you stretch them faithfully after every run (and doesn’t it feel good?) it won’t make the slightest bit of difference in length as you’ll undo it all when you run again.  Besides, if they did stay stretched what would stabilise the pelvis for you?  The glutes won’t just suddenly start working because the hamstrings are longer.

For those runners with an injury I would suggest a visit to a qualified physio or sports therapist to determine any muscle imbalances (whether in the glutes or elsewhere) and to take away an exercise plan to resolve those issues. Runners without injuries would do well to consider adding some Pilates exercises into their weekly regime as a preventative measure.

My favourite exercise for those with lazy glutes?  Stand in front of a mirror with legs together, pelvic floor and abs gently engaged.  Slowly lift one leg and watch your pelvis.  You want to be able to move the leg without the pelvis twisting, dropping or hiking and without locking the knees.  Try the other leg and keep breathing.  When you can do it perfectly at a slow speed make it faster and take the legs to hip width apart still ensuring that that your pelvis stays stable.

 

 

Video

The Pilates Wunda Chair

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I have bought a chair! It’s not an ordinary chair, it’s a Wunda Chair to join my Reformer/tower (Cadillac). I trained on it several years ago and it’s the only course I’ve done where the next day absolutely everything ached, including bits that I didn’t know could ache!

Those wonderful people from Bluebird Pilates in Munich have produced a beautiful video demonstrating some of the exercises that can be done on the Wunda Chair. Have a look and enjoy.

Snow!

I do apologise, but I’m having to cancel the morning classes on Monday (21st January 2013) as the roads are not good for driving.  I will look at the weather conditions at lunchtime to decide whether to run classes in the evening.  I ring everyone if I need to cancel so please check your phone before leaving.

A Guide to Living with Hyper-Mobility Syndrome – Book Review

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I’ve been teaching more and more people who, although maybe not diagnosed as hypermobile, have joints that can often easily move through a greater range than perhaps we would wish.  This has left me with lots of questions about how best to help these people as they often report aches and pains and find stabilising difficult.

I saw a workshop on hypermobility advertised at The Laban Centre and, whilst I couldn’t make the date, I saw that the lecturer, Isobel Knight, had written a book – A Guide to Living with Hyper-mobility Syndrome and, on a whim, I ordered it.

I was worried that it may be too technical for my knowledge but I found it very easy to read.  Isobel has written it using her own experiences and it took us through from her early years, diagnosis and progress up until 2011.  I am obviously interested in the sections on Pilates which didn’t work for her in ‘a larger group’ although she found one-to-one sessions helpful, along with various other holistic treatments including Bowen and physiotherapy.  These helped her get back to her great love – ballet classes.

I knew that hypermobility in the joints is often caused by a different type of collagen (connective tissue) but I had not realised the effect that this would have on the rest of the body such as the nervous system and digestive system which was enlightening in itself, but I was also very interested to read about the psychology related to the syndrome.

This book has given me more ideas of how to work with hypermobile people plus a much greater appreciation of the difficulties faced.  Isobel has also been blogging about her experiences here

I would highly recommend this book for anyone with hypermobility and for bodyworkers working with those with hypermobility

Supervising teaching

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I loved my training with Body Control – we had some great teachers with so many years of experience and I learnt so much during the course.  It was fascinating to see the different styles of teaching from each of the teachers, some were chilled and taught a much more relaxed style of Pilates, some were much more technical, building on their own backgrounds in other worlds such as osteopathy, some brought their experience from high level sports, others from dance and so on.

As part of our training we have to do a minimum of 50 hours of supervised teaching.  So we have to go into a Pilates studio with another Body Control teacher who gives us the opportunity to practise our teaching skills and who then gives us feedback on how to improve.

A couple of years ago I trained to be one of those supervising teachers so I often have a trainee teacher in class with me.  The trainee will teach some exercises under my close supervision and will go round checking clients are aligned and performing the exercises correctly.  It’s great having an extra pair of eyes and, as there are only ever 6 clients in each class anyway, there are no hiding places!