Hypermobility, Posture and Back Pain

I have had hypermobile joints all my life! Of course, I didn't know what that was 67 years ago, when cute, baby me stood in a pool with my protruding belly and super lumbar lordosis. 

This condition is common in individuals who are on the autism or sensory processing disorder spectrum. 

I am sharing my personal story and nothing I write should be construed as advice, nor even correct. My expertise is in the areas of child development, developmental disabilities and sensory processing disorders. Check out my books!

What is Lumbar Lordosis?

The lumber region of the spine is below the thoracic chest level and the term lumbar lordosis refers to the  curvature of the lower spine.  If I lay supine on a flat surface, there is extra space between my back and the surface. In fact, it forms a visible C-like arch when I stand and my abdomen and buttocks stick out.

This condition is also called Swayback and involves  an increase in posterior pelvic tilt .

Hypermobility, Low Muscle Tone and Posture

I grew up in NYC and family recreation centered on visiting museums which involved painful slow walking and standing in place. My mother's favorite nag was  "stand up straight".  But it is not that easy when you have hypermobility and low muscle tone!

I especially related to the Degas ballet dancer because she seemed to also have this back curvature and protruding abdomen!

I have always loved to dance but my parents didn't expose me to hiking, biking, martial arts, swimming or other movement activities. Children with low muscle tone greatly benefit from these types of fun activities and I discovered all of these after heading off to college.

Poor posture due to hypermobility and low muscle tone seems to run in families. My son shown below is now an adult with back pain. My father had the same body build as us and when I was a child he wore a body brace and did floor exercises to strengthen his trunk muscles.

Children and adults seek sitting positions that help compensate for hypermobility and low muscle tone (resistance to passive stretch). Unfortunately, this usually drives adults nuts because its distracting and looks weird. We therapists strive to find acceptible alternative seating. My favorites positions shown in the graphic below are the "frog" and " picnic".

.....and here is one that I made up to use when my back is hurting. It feels really good and also activates abdominal and trunk muscles.

Notice how I wedged the ball between furniture to make sure it didn't roll away causing me to fall!

Hypermobility and W-Sitting 

I was the kid who W sat (like my son in the above photo) and slouched at my school desk with my head on my arm. I still don't like to stand in place, preferring to be moving or lying down.

W-sitting is when a person sits on their bottom with their knees bent and feet positioned outside of their hips. The angle of the hips and legs looks like the letter W.  People with low muscle tone may find it easier to W-sit because the base of support is greater and they are not required to activate the trunk muscles. There is some controversy over how bad this posture is, but it is considered undesireable because it

•  increases the likelihood of hip dislocation
• prevents strengthening core muscles
•  makes it difficult to rotate the body and cross midline
• does not contribute to developing a hand preference and;
• may increase muscle tightness in hips, knees and ankles.

How Physical Therapy Helped!

I shared in a previous blog post about how to strengthen and stretch in the outdoors.  But even more important is to know how to move safely and effectively by maintaining a straight back, looking straight ahead with shoulders down and scapula being pulled downward and inward toward the vertebral column. This latter position is called retraction. I had to work really hard to hold that flatter back position while doing squats.

The video above demonstrates how to do a manual muscle test on retraction. When the PT pushed slightly downward on my arm, it quickly sank!

Now I understand why body builders have a certain posture that reminds me of  superhero comics! Minimal pelvic tilt and no slouching shown below.....

I have to keep repeating to myself-

• shoulders down/retracted,
• stomach in and
• straight lower back.

I find it helpful to lay on my back with flexed knees to take the pressure off my spine and also do back stretches with yoga positions such as a bridge or shoulder stand.

The exercise shown below at PT is meant to strengthen my leg muscles so that my knees ache less. Working hard to keep my back straight was exhausting!

I'm trying to be mindful of my body's posture while simply

• standing and walking,
• during daily livings skills such as washing dishes.
• 
• performing self care such as drying my hair with a towel while in half-kneel position
• 
• sitting on a balance ball while fixing my pony tail.

• Pressing my back flat against the wall while turning the crank on a 1925 Edison  phonograph; and

• while pressing my back against a wall while pulling resistive cord. It is wrapped around a treadmill, so it's not going anywhere....

Seating Considerations

Maintining sitting posture is challenging when you have hypermobility and low muscle tone! 

I typically have the worst posture when reading and writing. I do most of my writing in front of a computer. However, here I am trying my best to have a straight back  while writing "get out the vote" postcards. The lap clip board is helpful!

Vision

Whether I am reading or writing, it is critical that I avoid bringing my face close to materials.

I am very nearsighted so I can either

• wear contact lenses and cheap readers (because Im over 40 years old) OR
• wear prescription reading glasses

The prescription reading glasses are Ideal to have good acuity while sitting at a distance from the computer or tablet screen. I am wearing them now as I sit in front a humongous monitor.

Using the proper glasses and a bookstand that holds my tablet frees up my hands to tend to my body and my straight neck will prevent or minimize pain.

The photo above shows me sitting at a wrought iron porch set my parent's bought in the 1950s. The chairs are very heavy so its easier to pull the table closer to my body rather than drag the chair to fit under the table. I use a large pillow and lumbar cushion to keep my back as straight and  comfortable as possible. It is recommended that knees and ankles are positioned at 90 degrees, so use a box under the feet to improve positioning/comfort.

Here is a link to how to achieve good unsupported and supported sitting posture.

Notice that the book stand is raised using a  baking pan so that I am able to read looking straight ahead, thus protecting my neck. In addition, I am able to adjust reading distance by moving the baking pan closer or further away.

Sensory Considerations

Therapists know that we need movement!  I tend to read for short amounts of time before standing up to stretch. I also stretch while reading since my hands are free when using the bookstand. I have many sensory challenges, so I appreciate the option of moving on a chair that bounces or rocks. However, I discovered that too much bouncing on a ball can cause knee pain!

I seem to crave acupressure pads, rolls and cushions. It decreases my anxiety. My hubby says that these spikey objects are painful, but I love them.  Its important to figure out our own sensory needs. When I place the spikey cushion behind my lower back and press into it, I need to straighten my back in order to feel and enjoy the accupressure, just where I need it.

I also like to rest my hands on cushions on my lap while rubbing my hands across a large Mermaid cushion.

In any case, frequent position changes and movement are important in keeping me calm and painfree throughout the day. Now let's take a look at sleep.....

 Sleeping Considerations

I have always LOVED sleeping on my stomach, wrapping my arms around a soft pillow. I have done this despite having read repeatedly that sleeping on the back is better for posture 

This is a complex subject with many professional and layperson opinions. However, I have decided to put effort into changing my sleeping habits and it has paid off. I have less back pain!

When I started writing this blog post 3 weeks ago, I decided to sleep on top of an accupressure mat and neck pillow and with a large pillow under my knees. I found sleeping supine unpleasant but each day gets a bit easier as I get used to it. The soft head pillow is just above the neck pillow.  I have the option of wrapping my hands above my head under the soft pillow.   I also like to place my arms by my side and under the mat and my butt, giving myself deep pressure. The weighted blue blanket shown in the photo also helps me to avoid rolling back onto my stomach.

According to the accupresure mat and pillow directions, I should not sleep on them!  They recommend starting out using them 10 to 20 minutes and working up to 45 minutes. There is this warning: 'Do not use this product in ways not intended by its manufacturers. Failure to do so may result in severe injury or death." 

So.... I am risking my life sleeping on an accupressure mat. However, I am an advanced user who craves this type of deep pressure stimulation.  I would love to hear your thoughts on hypermobility, low muscle tone, lordosis,  back pain and posture. Hopefully, I will have survived my new sleeping habits and be involved in the discussion....