Dislocations and subluxations
Dislocations and subluxations occur when a joint is forced out of its normal position. Hypermobility spectrum disorders increase the likelihood and risk of this happening with varying degrees of frequency. Here we'll discuss the causes, symptoms, and treatment of dislocations and subluxations with hypermobility.
What is the difference between a dislocation and a subluxation?
Dislocations and subluxations are two types of joint injuries that occur when the bones of a joint are forced out of their normal position. A dislocation is where the two bones that form a joint fully separate from each other. A subluxation is also referred to as a partial dislocation. The bones within the joint will still be in partial contact with each other, but not in their normal position.
Both dislocations and subluxations can be incredibly painful. They can occur in any joint in the body, but are most common in the shoulder, elbow, hip, knee, and ankle joints. These injuries are often caused by trauma, such as a fall, car accident, or sports injury. For those with hypermobility, the cause is often due to instability within the joint from abnormal collagen structure and reduced integrity within the connective tissue – the ligaments and tendons that allow for movement and stability within the joint. Whilst those with joint hypermobility are more susceptible to dislocations and subluxations, not everyone will have issues with their joints slipping and sliding out. For others, even rolling over in bed can result in a shoulder popping out.
Causes
Alongside connective tissue causes or trauma, there are several other factors that can cause dislocations and subluxations.
Inappropriate muscle patterning
This refers to a condition in which the normal coordination and sequencing of muscle contractions are disrupted, leading to abnormal movement patterns. This can occur due to various reasons, including neurological conditions, musculoskeletal injuries, or poor postural habits.
When muscles are used inappropriately, it can lead to inefficient movement and compensation patterns, which can result in pain, decreased function, and increased risk of injury. Certain muscles become overactive or underactive, leading to altered movement patterns and increased stress on the joints, including literally pulling the joints out of place. Fatigue and stress can also contribute.
Anatomical anomalies
Some people have shallow joints; the bones that form a joint have a shallower than normal shape, which can reduce the amount of contact between the bones. This congenital presentation can make the joint less stable and more prone to injury, including sprains, strains, subluxations and dislocations.
Proprioception
Some people with hypermobility have impaired proprioception. It refers to the sense of where your body is in space and how it is moving. It is the ability to sense the position, movement, and force of your body parts without looking at them. A basic example would be putting a spoon in your mouth.
Impaired proprioception occurs when this sense is diminished and can increase the risk of joint dislocations as it makes it harder to maintain proper alignment and control of the joint during movements. It can also be difficult to maintain balance, coordination, and body awareness which can result in clumsiness, difficulty with fine motor tasks, and increased risk of falls.
Overstretching
Many people with sympotmatic hypermobilty can move their joints much further than the normal range. It's important to limit the amount of stretching at the end range of motion. This will simply increase the laxity of the ligaments and tendons making them less able to maintain the integrity of a joint. nb. stretching the muscles still has a great deal of value for people with hypermobility disorders, but it's important not to continually reach the extreme end of range.
So, what can be done? Exercise!
Exercise can help reduce the incidence of subluxations and dislocations by improving the strength and flexibility of the muscles and ligaments that support the joint. When these supportive structures are strong and flexible and stable, they are better able to hold the joint in proper alignment, which can help prevent joint slipping occurring.
Builds strength: Strengthening exercises help build muscle mass around your joints, making them more stable and less prone to injury. The muscles engage around the joint to hold it in place and create that stability, rather than the joint just almost 'hanging' in place.
Improves flexibility: Even hypermobile people have joints with limited movement, which is especially true as we age. Mobility exercises help improve joint flexibility and range of motion, which can help prevent joint injuries.
Enhances balance and coordination: Exercise that challenges your balance and coordination can help improve your body's ability to react to sudden movements or unexpected forces, which can help prevent joint injuries. An exercise programme can also improve proprioception, reducing the risk of trips and falls which can ultimately lead to dislocations through accidents and trauma.
Promotes good posture: Exercise that improves posture can help reduce the stress and strain on your joints, making them less likely to become injured.
Maintains a healthy weight: Carrying excess weight puts additional stress on your joints, making them more susceptible to injury. Exercise can help you maintain a healthy weight, reducing the strain on your joints and preventing dislocations.
It's important to note that not all types of exercise are appropriate for everyone, especially if you have a history of joint injuries or underlying medical conditions, which is why it’s important to consult a specialist.
Signs and symptoms
The symptoms of a dislocation or subluxation can vary depending on the location and severity of the injury. The ligaments and other soft tissues in and around the joint may be stretched or even torn.
Common symptoms include:
Pain
Swelling
Bruising
Deformity or misalignment of the joint
Limited range of motion
A feeling of instability in the joint
A popping or clicking sound when moving the joint a feeling of it catching
Numbness or tingling in the affected limb (paresthesia)
A subluxation can be more difficult to identify than a complete dislocation. For some of us with hypermobile joints, the subluxes happen so often we may not even recognise them as such. Some can do it at will (see overstretching above – it’s not a good idea!)
It can be described as if the joint feeling a little off or that it needs to pop back in, and for others the pain can be excruciating. You may be able to feel the bone moving in and out of the socket and in some cases, see the displacement under the skin.
Treatment
First thing - don't panic! Easy to say, but it's the best strategy. Panic = stress = muscle spasm = more pain. Often the joint will find its own way back relatively quickly. Either way, the following can help:
Support the joint
The more comfortable you are and the more supported the joint is, the less the muscle will spasm and the more likely it is to have the room to go back into place. Use a sling if it’s the shoulder or use cushions or pillows.
Use painkillers
Anti-inflammatory medication (NSAIDs) and painkillers will help. Take the recommended dose only.
Massage
This can help relax the muscles which may enable you to gently relocate the joint or it to move back into place by itself.
Use heat
A hot water bottle or a bath can help to relieve the muscle spasms – just be very careful getting in and out!
Breathing techniques
OK, this may sound ridiculous if you’re in agony, but if you’re suffering from repeated dislocations, it’s important to learn how to manage the pain and take control with various strategies that work for you and may be tweaked over time.
If none of these techniques work, or if there is increasing numbness in the limb, a change in colour or it feels cold then seek immediate medical attention.