SACROILIAC JOINT DISORDER causes people to sit like this. In a threadreader I published yesterday I discussed the reason people choose to sit like this.
These are exact postures chosen by hypermobile patients with unilateral sacroiliac joint disorder & low back pain on that side. One leg bolsters the other so as to hold up the hemi-pelvis on side the SIJ is subluxing; because it hurts to sit on that buttock.
Another posture that attends unilateral sacroiliac joint disorder in hypermobile people is the Trendelenberg posture. This is to sit flexed forward with elbows on both knees. When brought to their attention, many are apologetic, “I know I shouldn’t slouch”.
The Trendelenberg posture is in fact the wisdom of the body finding the most comfortable position; in this seated bent over position the femurs leverage each sacroiliac joint into an anatomical neutral station; so joint ligaments are not stretched.
In my threadreader of yesterday, I discussed the variety of postures and movements that persons with chronic low back pain assume to accommodate their bio-mechanical pain disorder.
Within the universe of persons with chronic low back pain, between 16-30% of them have chronic unilateral (usually but not always) sacroiliac joint disorder; wherein one sacroiliac joint subluxes; as reported in the medical literature.
Amongst women with chronic sacroiliac joint disorder there is an high prevalence of Hypermobility Syndromes & Fibromyalgia. Amongst men with this disorder there is some Hypermobility, but the major etiology is bio-mechanical injury.
Women have delicate pelvic bone structures compared to men. The female pelvis is structured for expansion & childbirth & has ligaments rendered more elastic by estrogen. Women can permanently injure their pelvic ligaments merely lifting & in menial slips and falls.
In that women have an higher incidence of sacroiliac joint instability, they are more prone to wobbly & tilted upright body towers. Gravity takes its toll on skewed upright body towers & potentiates Fibromyalgia; reason women have more Fibromyalgia than men.
Men develop unstable upright body towers & sacroiliac joint instability via mechanical injury to ligaments of sacroiliac joints. Forces of injury are generous, like falling off roofs & ladders onto buttocks. Sudden lifting of heavy loads can permanently damage these ligaments.
The modern fads of extreme sports have generated an epidemic of low back pain, & especially in young men. Their injures often go unrecognized by doctors, who assume drug seeking is involved. Doctors are ill equipped to diagnose & treat chronic sacroiliac joint disorders.
Hypermobility is a significant tissue variation in the population. Every school age child should be examined for this tissue variation. Those who have it should be steered from extreme sports toward swimming, fencing, golf, etc.
In this era of widespread public health advocacy, to allow hypermobile children to pursue skateboard, horseback riding, gymnastics, football, soccer, & other sports that include significant falls onto the buttocks is child abuse.
HYPERMOBILE YES! These are exact postures chosen by hypermobile patients with unilateral sacroiliac joint disorder & low back pain on that side. One leg bolsters the other so as to hold up the hemi-pelvis on side the SIJ is subluxing; because it hurts to sit on that buttock.
Another posture that attends unilateral sacroiliac joint disorder in hypermobile people is the Trendelenberg posture. This is to sit flexed forward with elbows on both knees. When brought to their attention, many are apologetic, “I know I shouldn’t slouch”.
The Trendelenberg posture is in fact the wisdom of the body finding the most comfortable position; in this seated bent over position the femurs leverage each sacroiliac joint into an anatomical neutral station; so joint ligaments are not stretched.
COSTOCHONDRITIS is common (mostly women) in Hypermobility syndrome. Costo- means rib (bone). Chondro- means cartilage (connective tissue). Each rib is joined to the sternum by cartilage, which is a place where biomechanical stress is focused. Set up for stress begins in the spine
The spine of most women with Hypermobility I have examined (thousands) has a functional scoliosis: curved when upright & straight when reclined & sitting. This is easily examined in the exam room, but of course better discerned when person is unclothed.
Reason for the functional scoliosis is that spine is, in great part, cartilage; each disk is a specialized ligament. In women with Hypermobility, the pelvic girdle, platform for the upright spine, is commonly unstable & tilted. Gravity evokes the functional scoliosis.
MYTH OF FIBROMYALGIA?
Idea that Fibromyalgia is a myth persists. In 2009, I published (“Practical Pain Management”) announcement of cause. I sent Dr. Tennant, editor, a manuscripts entitled “Fibromyalgia-Finally The Cause”.
Dr. Tennant chose to change title to, “Sacroiliac Joint Disorder”; I was a country doctor without academic credentials. The article continues on-line. Gratefully, Dr. Tennant did not change the article content. He sent me a note, something like, “you will help many”.
I suspect the world medical community continues of one mind that the cause of Fibromyalgia is unknown, & that many doctors continue to question authenticity of such a disorder. Naysayers are simply ignorant.
RESTLESS LEGS: the question becomes, why would the autonomic nervous system evoke involuntary leg movements when people are reclined and drifting into sleep; in those with POTS?
POTS highly associated with connective tissue Hypermobility & manifests as hypotension/tachycardia upon sudden upright posture; as body blood column descends. Perhaps Mitral Valve regurgitation is involved + laxity/sluggishness of autonomic-driven constriction of vein walls.
Blood returns from legs to heart vis superior-directed propulsion of lower blood column by means of leg muscle contractions; restless legs provide such muscle contraction propulsions par excellence.
The model was older, and when people age they lose their youthful ability to do all the hyperextensions. I would say that some of the degrees of the various hyperextensions degrade starting after 30 years old.
Another factor that must be taken into account is that Hypermobility can present as a mosaic in some persons. Their knees well demonstrate Hypermobility, but not the elbows.
An experience I have with patients who have stigmata of hypermobility is that I will comment on their widespread joint Hypermobility & their rejoinder commonly is, “of course I do Yoga”.
When patients tell me that my heart sinks. I was excited to tell them that I think that I have an explanation for several of their seemingly disparate symptoms in several of the dysautonomia & MCAS spheres.