Eccentric rehabilitation for elbow hypermobility

Introduction: Joint hypermobility involves an increased range of motion compared to normal amplitudes for the same age, sex and ethnic group. Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Eccentric muscle strengthening could be very important to protect hypermobile joints.
Case report: An Ehler-Danlos syndrome patient presented pain in the right elbow and the right wrist after a season of tennis. Her physiotherapy (18 sessions, 3 times a week) consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds [30°/s, 60°/s, and 90°/s] within a limited range of motion in flexion and extension, on an isokinetic
device after an evaluation. She was also given an ortheosis restricting the joint range of motion of the wrist. The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified an improvement in maximal torque of 20 to 25% in flexion-extension muscles of the right elbow. She was also given individualized home exercises.
Conclusion: The goal of rehabilitation is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility.