Imagine this scenario: a new female client arrives and completes her medical form. As you review the form you discover your client has described the following medical history:
- Chronic, widespread pain, not resulting from any particular trauma or accident. The pain can often be made worse by exercise.
- Joint pain and muscular tightness
- Very flexible – enjoys yoga
- Headaches and migraines
- Dizziness upon standing or overexertion from exercise
- Heat intolerance
- Chronic fatigue
- Subluxations of the shoulder joint
- Irritable bowel syndrome
- Pelvic girdle pain
- Difficult child-births, with subsequent pelvic floor issues
- Wears orthotics due to pronated feet and frequent ankle sprains
- Frequent chest infections and pneumonia
- Mitral value prolapse in heart
- Poor sleep habits
- Allergies and food intolerances
This list of physical symptoms could be quite unnerving initially for any teacher, regardless of teaching experience.
Where do you start? How do you plan a programme for a client presenting symptoms like these?
Of course your role is not to diagnose your client – unless you are medically trained. But with further questioning, you may discover they have a connective tissue disorder like Ehlers-Danlos Syndrome (EDS). If you notice the list of symptoms, they impact not just the muscular system of muscles, joints and ligaments; there is impact to the digestive system, circulatory system, the autoimmune system, cardiovascular system, endocrine system and nervous system. One of the key aspects of EDS is joint hypermobility – so your client may be particularly flexible in certain joints. (However, it’s important to note that not everyone with hypermobility has a connective tissue disorder – some people are just hypermobile and have no other issues).
Connective tissue is present everywhere in the body. It connects, supports, binds and separates other tissues or organs. If we have a connective tissue disorder therefore, it could make sense that multiple systems in the body are going to be affected. Think of the connective tissue as a cellular glue that keeps everything together and strong. If the glue is not as strong as it should be due to a disorder, it is going to have a far-reaching impact that for many people can be very disabling. Some connective tissue disorders are heritable – known as Heritable Disorders of Connective Tissue (HDCT) and are the result of genetic changes. In all but one of the thirteen types of EDS, the cause of the disorder has been found to be a defect in the collagen.
Connective tissue disorders you may come across are:
- Ehlers-Danlos Syndrome
- Marfan Syndrome
- Osteogenesis imperfecta
- Epidermolysis bullosa
These disorders are not curable, so it is a case of helping your client with management of the symptoms.
The role of the Pilates teacher in management can be invaluable. Recent research into Pilates has proven its effectiveness as a rehabilitation tool:
“From the limited data available, it would seem from the statistically and clinically significant findings that Pilates has demonstrated efficacy as a tool for the rehabilitation of a wide range of conditions”
Byrnes et al, 2017, Is Pilates an effective rehabilitation tool?
“12 weeks of Pilates intervention was effective in reducing pain intensity and improving disability, fear of movement and deep trunk muscle thickness”
Cruz-Diaz et al, 2017, The effectiveness of 12 weeks of Pilates intervention on disability and kinesiophobia in patients with chronic low back pain.
What about EDS?
For a condition such as EDS, there is an overall agreement in the medical community that exercise is key to the health of these clients. A recent quote states;
“People with EDS need to try to retrain or increase their muscle strength and tone as much as possible in order that their muscles can compensate for the effects of defective connective tissue in other supporting structures such as ligaments.”
Understanding hEDs & HSD, Claire Smith
That is where our realm of expertise lies. We have a variety of tools, knowledge and techniques to help with muscle strength and tone. So remember, if you can’t connect the issues, think connective tissues.