Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) are complex, multi-systemic connective tissue disorders. While physical therapy is universally recognized as the cornerstone of management, effective patient outcomes rely on a coordinated, multidisciplinary care pathway.
The physical therapist often acts as the primary rehabilitation expert, interpreting the musculoskeletal limitations and systemic symptoms, and facilitating timely referrals to key specialists. Developing clear communication protocols with these providers is essential for creating a comprehensive, non-fragmented approach to care.
1. Collaboration with Rheumatologists and Geneticists
These specialists are primarily responsible for the official diagnosis, ruling out other connective tissue diseases, and managing systemic medications.
| Specialist Role | PT’s Role in Collaboration | Key Information to Share |
|---|---|---|
| Geneticist/Rheumatologist | Confirms the Diagnosis (hEDS is a diagnosis of exclusion) and rules out other conditions (Marfan, other EDS types). Manages inflammatory flares and medications (e.g., pain relievers). | Functional Status & Red Flags: Documented Beighton Score, patient’s self-reported fatigue/pain levels (e.g., VAS), and the presence of any non-musculoskeletal red flags (POTS-like symptoms, easy bruising, skin fragility). |
| Value of Collaboration: | The PT’s thorough musculoskeletal and systemic history helps the specialist confirm the diagnostic criteria and tailor systemic medication to the patient’s actual level of functional disability. |
2. Collaboration with Occupational Therapists (OT)
While PT focuses on gross motor function, strength, and balance, OTs specialize in fine motor control, energy conservation, and adapting the environment to maximize independence in daily life.
| OT Focus | PT Focus | Collaborative Goal |
|---|---|---|
| Energy Conservation & Pacing: Detailed activity analysis, fatigue management, and work/home scheduling. | Exercise Pacing: Setting activity thresholds and building physical endurance for therapeutic movement. | Protecting the Small Joints: OTs prescribe adaptive equipment (pen grips, jar openers) and splinting to protect the hypermobile hands and wrists, allowing the PT’s stability work to progress the larger, proximal muscles. |
| Sensory Regulation: Addressing sensory processing issues (common in hypermobility) that impact focus and pain tolerance. | Nervous System Regulation: Integrating breathing and low-level core work to calm the autonomic nervous system. |
3. Collaboration with Primary Care and Cardiologists (Dysautonomia)
For patients presenting with symptoms of Dysautonomia (POTS, Orthostatic Intolerance), collaboration is essential for pharmacological management.
| Specialist Role | PT’s Role in Collaboration | Key Information to Share |
|---|---|---|
| Cardiologist/PCP | Confirms POTS diagnosis via Tilt Table Testing and manages pharmacological interventions (e.g., Midodrine, Florinef) and dietary recommendations (salt/hydration). | Objective Vitals: Share results from the PT-administered Standing Heart Rate Test (Poor Man’s Tilt Table Test), documenting the HR increase upon standing. |
| Value of Collaboration: | The PT modifies exercise intensity and position (recumbent/aquatic exercise) to safely accommodate the patient’s autonomic limitations, ensuring exercises do not trigger fainting or severe symptom flares. |
4. Collaboration with Mental Health Professionals
Given the high rates of chronic anxiety, depression, and pain catastrophizing in this patient group, psychological support is often necessary for physical recovery.
| Specialist Role | PT’s Role in Collaboration | Collaborative Goal |
|---|---|---|
| Psychologist/Counselor | Addresses pain catastrophizing, kinesiophobia, medical trauma, and comorbid anxiety disorders. | Graded Exposure Planning: The PT and mental health professional coordinate the patient’s exposure to feared movements (graded activity) to ensure it is therapeutically challenging yet psychologically safe. |
| Value of Collaboration: | Psychology addresses the cognitive barriers to movement; PT executes the physical strategy. This unified approach breaks the fear-avoidance cycle, making functional gains possible. |
The PT as the Integration Hub
The Joint hypermobility physiotherapist Gold Coast is ideally situated to document the complex physical findings and communicate these needs to the entire team. By maintaining open lines of communication and respecting the scope of each specialist, the PT ensures that the hypermobile client receives comprehensive, interconnected care that addresses the whole body—from the smallest joint to the nervous system.
Leave a Reply