Systemic hypermobility is well known in the human population and is often responsible for recurrent minor injuries such as sprains and strains. It is typical to be seen in females of the same family so there is thought to be a genetic component to the condition. It is often overlooked by the medical profession as they only attend to a single joint injury as it happens without assessing the overall joint mobility in that person. There is a grading system from 1-9 to rate the severity of the hypermobility. Children frequently attend the physiotherapy clinic for treatment of recurrent injuries to a variety of joints and there they will be identified as a systemic hypermobile and a specific exercise program can be designed to deal with this ongoing issue.
Ehlers Danlos syndrome is a more extreme form of systemic hypermobility that also is characterized by fragile and extensible skin. The most common symptom in humans is characterised by joint hypermobility however since connective tissue is found throughout the body the more severe forms exhibit not only severe hypermobility, skin extensibility but as well may have issues with heart, blood vessels, organs and eyes. Ehlers Danlos is graded from I to IV. This is caused by a genetic defect in the production of collagen. Not only is this condition recognized in humans but also dogs, sheep, cattle, mink, pigs and cats.
Ehlers Danlos is a rare condition and it is not clear how many dogs suffer from this syndrome but we do know that English Springer Spaniels are affected more than any other breed. Owners with affected dogs must take care to avoid any injuries. If the condition is severe the puppies do not survive.
If the condition is not diagnosed early there is often a history of frequent visits to the vet for suturing of skin wounds. Even with careful suturing there is often skin break down and scarring is common afterward. Joint hypermobility is not described as often in these dogs.
Another interesting finding in humans is that joint hypermobility is often associated with anxiety disorders some studies dating back to the 1980s. There is now new research that suggests that dogs with joint hypermobility also tend toward higher levels of emotional arousal than other dogs. One study found that in a population of over 5000 dogs (labs, golden retrievers and GSDs) the females and the goldens had the higher hypermobility scores as well as the higher excitability scores. Female dogs were reported to be 3.66 times more likely to have high joint hypermobility scores than males (similar to humans). Golden retrievers were 8.58 times more likely to score higher than the labs or the GSDs.
In the clinic I have never seen any dogs with the extreme skin extensibility that is reported in English Springer Spaniels. In fact, all the cases I have seen have been mixed breeds – some rescue, some suspected puppy mills and some specifically bred mixes. These dogs are usually referred for some specific issue such as medial patellar luxation or carpal hypermobility. Often the owners have been given an option of surgery to these specific areas. There has, however, been no examination of the whole dog to discover that this is a multi-joint problem rather than one specific joint. My concern in these cases would be that doing surgery on one joint will only throw more stress on the rest of the already compromised joints in the body.
We do know from studies as far back as the 1980s and 1990s that light resistance training can have an effect on the collagen in the ligament and tendon tissue. If we use this as a basis for developing an exercise program for these dogs we can achieve a good outcome.
I have found that the most success with these clients has been achieved by correcting any specific spinal joint dysfunctions especially in the pelvic girdle followed by an intensive exercise program to improve neuromuscular control over joint motion. We have used a variety of balance and proprioception exercises as well as underwater treadmill. One of my new favourite exercises is using the whole-body vibration platform incorporating movements such as sit to stand and three leg stands. Some eager owners have purchased their own unit to continue the program at home.
The little boy in the video was a rescue, possibly puppy mill, who fortunately was adopted by a wonderful owner. The suggestion for him was bilateral patellar stabilization surgery. After correcting the SIJ dysfunction we have gone on with an extensive exercise program that is also carried out at home. I am happy to say he is doing well.
These cases are fun to treat since the exercise program you design is limited only by your imagination. They are usually able to live a very functional life.