25 Sep 2019 Subluxation is a Real Pain in the Joint
And other surrounding tissues! If you’ve ever had a joint sublux or dislocate, you will know how painful this can be. In this article I’m going to share my thoughts on this complex issue that so often impacts the lives of people living with hypermobility or a connective tissue disorder like Ehlers-Danlos Syndrome. I am also sharing my practical approach on how to prevent subluxation. This is based on my personal experience and feedback from my hypermobile clients.
First, let’s clarify the difference between a subluxation and a dislocation. Subluxations are much more common. It means that the two bones that form a joint will partially separate from each other and then return to their normal position. It’s also known as a partial dislocation. A full dislocation is when there is a complete separation between the two bones. Both of these scenarios can be very painful and stressful. Some people experience subluxations occasionally, but for some it is a daily occurrence.
When a joint does sublux, the body is going to attempt a few strategies of its own to attempt to stabilise the joint. It’s going to give out some pain signals to stop you moving that joint anymore. It will cause joint swelling to protect the joint and muscle spasms to protect the surrounding area.
The problem with living with frequent subluxations is that it is likely to create fear around movement in general. This is perfectly normal – if we think we are going to sublux, we are not going to move as much and we will start to avoid actions that we think will cause a subluxation. A fear-avoidance strategy, however, leads to more stress and anxiety in general, together with a decreased muscle tone. Muscle tone is built by regular and appropriate exercise. Research has shown that movement is essential to a hypermobile body. If our muscle tone is not as strong as it could be, it seems to make sense that subluxations could happen more frequently. Due to lack of muscle tone, our postures lean towards what I call ‘hanging in our joints’ as opposed to engaged, resilient muscles supporting the joints. If I’m literally ‘hanging’ in my joints (and believe me, I used to) it makes sense that joints are potentially at greater risk of movement coupled with the force of gravity, pulling them out of alignment.
We end up in a vicious cycle avoiding the very thing that could help prevent subluxations in the future. So what can we do to help prevent these happening in the first place? Here are my thoughts on what could be causing them:
1) Poor muscle tone and posture (as outlined above). Awareness of whole body alignment is going to be key.
2) Moving too fast with lack of control. For example, ever decided to throw a ball for your dog and then feel that shoulder joint ‘pop out’? Nothing wrong with throwing a ball, but we need to prepare the tissue to support this action.
3) Moving with too much load that the joint can cope with (because it does not have the surrounding muscle tone to support it). A classic example would be carrying a heavy shopping bag that is pulling downwards on the shoulder joint. The force of gravity is a big influence on subluxations – but gravity can also help you prevent them when used appropriately.
4) Moving into your end range with lack of control or awareness. Imagine reaching high up into a cupboard and not noticing your joints have locked out in the knees or elbows. Locking joints puts excessive strain on the joint: it could be another cause of subluxation.
5) Twisting actions without awareness. I often hear of hips subluxing when people get out of their cars. If the muscles surround the pelvis were more toned, could this help prevent a subluxation?
6) Accident or trauma to the joint could cause a subluxation.
7) Joint shape or surface – some people are born with shallower joint capsules. This is going to make them more prone to subluxation, but again strength in the surrounding area will help.
Can we identify what could be causing our subluxations? When I work with my hypermobile clients, I can report that I have never had any of their joints sublux. I see around 15 people per week with hypermobility and EDS. Clients who are working on my online courses (so without direct intervention from me) also report they have seen an improvement in their rate of subluxations. I have given a great deal of thought as to why this could be. Here are my thoughts based on my clients’ experiences and feedback:
1) Before we begin to move, we spend time ‘unwinding’ the tissue. This is done with breathing awareness exercises and starting to use gravity to soften the body to release tension. Breathing pattern disorders are common with hypermobility and the tendency to ‘guard’ muscles in the ribcage, diaphragm and abdominals causes the rib cage to literally become a ‘cage’. It does not move at all and loses its natural bounce. From a functional perspective, if the ribcage is pretty immovable surrounded by tense muscles, and then I try to twist and bend, the ribs are going to have a greater chance of subluxation.
2) Breathing awareness builds sensory awareness – we become aware of when we are holding stress and tension in the body. If the body is driven by ‘tension-led’ patterns, we are more likely to move in ways that could cause subluxations. Ideally we want muscles and joints to glide for ease of movement – almost like a bouncy elastic band.
3) All my movement programmes work with gravity, as opposed to guarding and fighting gravity. A lot of time is spent lying supine appreciating the weight of the body. This gives the body natural stability and feedback. An exercise like Knee Rolls (see photo) can really help the body understand where the thigh bone should be sitting in the hip joint. From this supine position, we focus on the weightiness of the pelvis. As the exhale occurs, allow the pelvis to feel heavier. As the body releases into the floor, the thigh bone is allowed to roll into the hip socket. We do not attempt to lift the leg up, but rather roll it in and down into the socket. The head of the thigh bone feels heavy so that the knee feels lighter. We allow the bones to settle.
4) An exercise for the shoulders is very similar – allowing the arm bones to feel heavy into the back of the shoulder joint. To prevent subluxation, our body has to feel what a properly aligned joint feels like first.
5) We therefore work on joint positioning first, before we start to strengthen. That way we are strengthening in the correct place. If we strengthen and build muscle in a poorly aligned body, the muscles are potentially giving force in the wrong place.
6) We never work to end of range – definitely not in the beginning. Before we can work end of range, we need to understand what a stable joint feels like. This can only happen with shorter, controlled movements.
7) Finally, it is calming for the nervous system. My movements are slow, mindful and work on building sensory awareness. It brings you into your parasympathetic nervous system, where you can rest and restore. This will make you less anxious about movement in general and, importantly, more aware of the movements you are making.
Any movement program I design incorporate my six essential principles: Breathing, Relaxation, Proprioception, Stability, Balance and Posture.
I would like to reiterate that these ideas are the result of my own practical experience and are based on feedback from my clients. I appreciate that everyone is different and these ideas may not work for everyone. I know that there are cases where the joints literally sublux when lying in bed or sleeping because the muscle tone relaxes at this time. In cases like this, we need to consider what the ‘resting tone’ of the tissue is so that even in sleep, the joints can be supported. Given that subluxation is such a big topic for our community, I wanted to add my knowledge and input to the discussion. I hope this helps and gives you some ideas on subluxation management.