Kathleen Zonarich, PT
EDNF 2011 Conference
Initial Considerations:Get approval from your doctor or physical therapist
before starting any exercise program.This presentation is meant for those with Classic or
Hypermobility EDS (HEDS). If there are any cardiac/vascular issues, please discuss appropriate exercise levels with your doctor, specific to you.
This presentation is only meant to serve as a general template for an Individual Exercise Program. The specific exercises mentioned are not intended to be used by everyone. (consult your PT/doctor)
Benefits of Exercise for the General Population:
Combats chronic diseases such as:OsteoporosisDiabetesHypertensionHigh cholesterol
Maintains weightIncreases energy levels
Benefits of Exercise for the General Population (cont.):
Improves moodBetter sleepFunDecreases stressBoosts immune systemEnhances physical relationships
Benefits of Exercise for the General Population also apply to the EDS Population!
Recommendations for the General Population:
Aerobic Exercise:2 hours and 30 minutes per week of moderate
intensity aerobic exercise ; or1 hour and 15 minutes per week of vigorous
aerobic exercise
ANDMuscle Toning/Strengthening:
2 or more days a week
(Landr0, 2010)
Exercise Guidelines for the Disabled Population:
Research (Lee, 2003) indicates that individuals with disabilities may have benefits from as little as 30 minutes of slow exercise per day/ 5 days a week
Start out slowly, build your program at your own pace
Over time your body will adapt to your exercise routine, therefore you need to change your program to continue to challenge yourself
(Lee, 2003)
Overall Exercise Goals for the EDS Population:
Increase Function
Limit Disability
Use Appropriate Pacing /Sequencing
Follow “Success before progress” model
(Kerr, 2004)
Specific Goals for Exercising in the EDS Population:
Maintain/Regain normal range of motion
Correct and prevent movement dysfunction by re-training of:Postural controlPostural alignmentProprioceptionBalance
(Kerr, 2004)
Specific Goals of Exercising in the EDS Population (cont):
Achieving joint stability:Neutral joint position is most stable Core stability needs to be developed firstProximal to distal stability should follow
Create and Follow an Individualized Exercise Program
(Kerr, 2004)
Basic forms of muscle action:
Isometric
Istonic
Isokinetic
Types of Exercise:
AerobicAnerobicResistive
Against gravityFree weightsTherabandsBody weight
Components of a Balanced Exercise Program for the EDS Population:
Warm upStrengtheningROM/FlexibilityCardioBalanceProprioceptionCoordinationCool Down
Types of exercise that work well for the EDS population:
Aquatic- warm water better (90 degrees)Tai ChiLow- impact Cardio (aerobic)PilatesYogaWii
Exercise guidelines related to EDS:
Get approval from your doctor/therapist to start a “normal exercise program”
Normal ROM- perform exercise in normal range of motion. AVOID: hyperextension
Resistive exercises- can make joint instability more severe
Isometric ex- if too much force is applied, it can be bad for hypermobile joints
High impact- not recommendedProper form/body mechanics are essential
(Levy, 2010)
Tips for successful exercising:
Do the exercises in front of a mirrorProgress when you have success with current
level“No pain, no gain” – NOT for EDS Okay to have muscle soreness up to two days
after exercise, but you should not feel new pain or an increase in pain
Slow and steady wins the raceHave control throughout movement; if
something doesn’t feel right, stop
Exercise Program Sample 1 (HEDS – 12 year old girl)
12 year old girlNo Physical Education in schoolFrequent joint dislocations, especially at kneesWeak core musclesSevere pronation of feetVarying joint pain throughout body on daily
basis
Exercise Program 1: GuidelinesBegin with no resistance due to joint instability
and frequent dislocationsCore exercise to be the main focus, then
develop exercise for extremitiesLow reps to begin, progress to higher reps
then drop reps down and increase resistance slightly, build back up to higher reps
Focus to be in this order:StabilizationProximalDistal
(Tinkle,2010)
Exercise Program 1: Core(start with 5 reps each)
Pelvic tiltAbdominal crunches with arms crossed over
chestRotational abdominal crunches with arms
crossed over chestProne leg liftsProne opposite leg/arm liftsProne supermanProne plank - 10 secondsSide plank - 10 seconds
Exercise Program 1: Legs(start with 5 reps each)
Short arc quadsWall squatsStraight leg raise (supine)Standing exercises (hold on to kitchen sink as
needed)Hip flexionHip abductionHip extensionHam curlsHeel raises
Exercise Program 1: Arms(Start with 5 reps each)
Standing PositionArm circlesWall push upsBall exercises: (small light weight playground
ball)RowingCircles (clockwise and counter clockwise)Push ball up over headPush ball out in frontFull arc in front overhead and down to hipsBicep curls
Shoulder height abduction/adduction
Exercise Program 1: Balance(stand at kitchen sink/hold on as needed)
Start with 30 second holds if ableStand on one legStand on one leg with eyes closedStanding tree poseStar fish against the wallWarrior Raise up on toes
Exercise Program 1: FrequencyHow Often:
Cardio 2-3 days per weekExercises 3 times per week with one day rest
between each specific exercise type
General Considerations:Exercises do not have to be done in one block of
timeIf you are at a lower level, break up the exercises
throughout the day or alternate arms and legs on different days, etc.
Exercise Program Sample 2 (HEDS – 40 year old female)
40 year old femaleChronic dislocations of hipsBilateral knee painPronation of both feetUpper extremity weaknessSub-luxing right shoulderDesk jobUnsuccessful attempts to exercise in the past
with increased pain
Exercise Program 2: GuidelinesBegin with no resistance due to joint instability
and frequent dislocationsCore exercise to be the main focus, then
develop exercise for extremitiesLow reps to begin, progress to higher reps,
then drop reps down and increase resistance slightly, build back up to higher reps. Begin with 5 reps.
Focus to in this order:StabilizeProximalDistal (Tinkle, 2010)
Exercise Program 2: Core
SupinePelvic tiltBridgingKnee rollArm reach between kneesArm reach to opposite knee
Exercise Program 2: LegsSupine
Quad setsHam setsGlut setsHeel slidesHooklying hip abduction/adductionHip abduction
ProneKnee flexion
SidelyingHip extension
Exercise Program 2: ArmsSupine
Shoulder FlexionShoulder abductionBicep curlsInternal/external rotationHorizontal shoulder abduct/adduction
Sitting Same as above will make it more challengingBall catch (closer to center of body is easier)
Prone Elbow extension with arm hanging off bed
Exercise Program 2: BalanceSitting balance unsupported
Balloon tossBall toss (more challenging)
Standing balance (holding on to sink as needed)Static stand
Eyes open/closedUnilateral stand
Eyes open/closedLow level yoga pose
Standing tree with toe on floor rather than at knee
Exercise Program 2: FrequencyHow Often:
Cardio: 2-3 days per weekExercises: 3 day per week with 1 day of rest
between each specific exercise type
General Considerations:Exercising does not have to be done in one block
of timeIf you are at a lower level, break up the
exercises throughout the day or alternate arms and legs on different days, etc.
General Exercise Progression Guidelines: (in order of easiest to hardest)
AbdominalsSitting on ball or chair reclinedOn floor against gravity
Arms crossed over chest Arms at side of head Arms over head extended Medicine ball at chest Medicine ball with extended arms
General Exercise Progression Guidelines: (in order of easiest to hardest)
Arms/LegsSupported by surface (gravity eliminated)
Partial range of motion Full range of motion
Against gravity range of motionUse of body weight for resistanceLight weight resistance Heavier weight resistanceMachines
General Exercise Progression Guidelines: (in order of easiest to hardest)Balance
Sitting Sitting balance supported Sitting balance unsupported Dynamic sitting balance
Standing Static
Supported Unsupported Hard surface to soft surface
Dynamic Hard surface to soft surface Bilateral to unilateral
Resources on the Internet
Exerciseismedicine.orgProvides exercise videos and self assessment
tool for individuals with diseasesHealth.gov/paguidelines
2008 Physical Activity Guidelines for Americanswww.myrafitkit.com
Provides personalized exercise program with demonstration (For the EDS population- flexibility should be only within normal range)
Works Cited: Kerr, PT, Rosemary. "Management of the Joint Hypermobility Syndrome: the
Therapist's Contribution." Jointandbone.org. Joint and Bone: Musculoskeletal Disease Online, 30 Sept. 2004. Web. 3 July 2011. <http://www.reumatologia-dr-bravo.cl/para%20medicos/HIPERLAXITUD/www_jointandbone_org_RODGRAH.htm>.
Landro, Laura. "The Hidden Benefits of Exercise - WSJ.com." Business News & Financial News - The Wall Street Journal - Wsj.com. Wall Street Jounal, 5 Jan. 2010. Web. 03 July 2011. <http://online.wsj.com/article/SB10001424052748704350304574638331243027174.html>.
Lee, Thomas, and P. Skerrett. "ViewNewsletter." Harvard Heart Letter. Harvard Health Publication Newsletter, 15 Aug. 2003. Web. 03 July 2011. <http://harvardhealth.staywell.com/viewNewsletter.aspx?NLID=2>.
Levy, MD, Howard. "Ehlers-Danlos Syndrome, Hypermobility Type - GeneReviews - NCBI Bookshelf." Ncbi.nlm.nih.gov. National Center Biotechnology Institute: National Institute of Health, 14 Dec. 2010. Web. 03 July 2011. <http://www.ncbi.nlm.nih.gov/books/NBK1279/>.
Tinkle, Brad T. Joint Hypermobility Handbook: a Guide for the Issues & Management of Ehlers-Danlos Syndrome Hypermobility Type and the Hypermobility Syndrome. Greens Fork, IN: Left Paw, 2010. 94+. Print.
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