Some people believe that if their joints don't hurt, they're fine. In fact, the disease can develop painlessly, manifesting itself through another symptom - limited mobility.
In some cases, along with loss of mobility, hot and cold swelling, redness and swelling appear.
Limitation of mobility is divided into two types: reduction of active and passive movements. When active movements are limited, it is difficult for the patient to move the joint independently, but under the influence of a stranger, the joint rotates easily. When passive movements are limited, even with the help of a stranger, the joint is difficult to bend and straighten.
It's all about collagen
By the way, it is believed that this pathology occurs predominantly in female faces. Its prevalence is 5–7% of the total population, but every year the number of gutta-percha women and men is growing. This syndrome is more common among eastern peoples. There are especially many “rubber” people living in Asia, a little less of them in Africa and much less in Europe.
In some families, unusual stretch marks are inherited. But despite the fact that not in all cases people with snake-like flexibility need treatment, sometimes excessive stretchability of the ligaments can lead to problems.
The disease we are talking about today is a consequence of weakness of the ligamentous apparatus. And the reason for this phenomenon lies in molecular changes within the main structural protein of the body - collagen. The same protein is part of the skin, hair, nails, and it also makes up the walls of blood vessels and ligaments that support internal organs (it is due to these “suspensions” that the liver, kidneys, uterus and other organs can occupy the physiologically correct location in the body).
With a gross genetic mutation that disrupts the synthesis of collagen in the body, a person may experience severe, but, fortunately, rare hereditary diseases, in which patients experience excessive flexibility of the joints, and also in the first case, multiple bone fractures, and in the second - very tensile skin and the possibility of spontaneous rupture of blood vessels.
With joint hypermobility syndrome, the situation is less sad, but unpleasant consequences also exist. The altered protein impairs the firmness and elasticity of the ligamentous apparatus, as a result of which the ligament overstretches and becomes flaccid during the movement of the joint. Unfortunately, changes in the molecular structure of collagen in people with joint hypermobility syndrome are inherited and persist for life.
Since almost no system of the body can function without the participation of collagen, there can be many diseases associated with the weakness of connective tissue structures. This includes the early appearance of wrinkles, prolapse of heart valves (excessive sagging of the valves), prolapse of internal organs, and varicose veins. But most often, patients with joint hypermobility have problems with the joints and spine. In particular, this pathology can be considered a risk factor for the development of arthrosis.
Competition “Bio/Mol/Text”-2020/2021
This work was published in the “Own Work” category of the “Bio/Mol/Text” competition - 2020/2021.
The general partner of the competition is the annual biotechnology conference BiotechClub, organized by the international innovative biotechnology company BIOCAD.
The nomination partner is the Russian Science Foundation.
The sponsor of the competition is SkyGen: a leading distributor of life science products on the Russian market.
Competition sponsor: the largest supplier of equipment, reagents and consumables for biological research and production.
"Book" sponsor of the competition - "Alpina Non-Fiction"
In recent years, much attention has been paid to joint diseases in science: this is not surprising, because this problem is becoming increasingly urgent - over the past century, osteoarthritis alone has increased 8 times more [1]! Unfortunately, this figure is growing every year, and patients are getting younger. However, by studying people with already developed joint disease, we lose sight of those who are still healthy! Well, or almost healthy. I wonder if everything is normal with the joints of people in their twenties? What if this is where the reasons lie that decades later force a person to see a doctor?
By measuring and studying joint mobility in 100 people aged 18–23 years, we discovered interesting patterns. Firstly, women's joints turned out to be more mobile than men's. Differences in mobility were noted across the four parameters, ranging from 5 to 17 degrees. The first parameter is the magnitude of the ulnar angle. Perhaps many do not know what this indicator is: it includes extension at the shoulder joint with simultaneous flexion at the elbow joint and placing the hand and forearm behind the back; the hand is located as high as possible between the shoulder blades; in this case, the angle between the shoulder and forearm is measured. The remaining parameters are hip abduction, active and passive plantar flexion of the foot. There are two possible reasons for changes in mobility: one lies in the field of physics, and the other in endocrinology.
The first reason is that soft tissues (muscles, tendons, skin) have special biomechanical properties, one of which is stiffness. Stiffness is the ability of tissues and organs to resist changes in shape when exposed to external forces. Stronger muscles have higher stiffness. Muscle strength, in turn, depends on the following components: signals coming from motor neurons, the type of muscle fibers, and the mode of muscle energy exchange. If we consider a muscle in isolation, the strength of muscle contraction directly depends on the number of muscle fibers [2]. With regular physical activity - for example, during training - the ratio of the number of different types of muscle fibers changes, and there is also a general increase in their number and size [3].
However, let's get back to the tough stuff. Tissues with increased rigidity limit the action of antagonist muscles during movement. In this case, to stretch these muscles and overcome their stiffness, it is necessary to perform more work and increase energy expenditure during movement [4].
Agonists are skeletal muscles with the help of which a certain movement is carried out. Antagonists are muscles that oppose agonists. In different situations, the same muscles can act as both agonists and antagonists; binding to a specific movement is necessary (Fig. 1). For example, in the case of forearm flexion, the agonist would be the biceps brachii muscle and the antagonist would be the triceps brachii muscle. If the stiffness of the triceps is increased, the biceps will have to exert more effort to complete the movement.
Figure 1. Agonist and antagonist muscles in the case of forearm flexion and extension.
TardokAnatomy website
Foreign researchers have found that tendon stiffness in men is higher than in women [5]. Thus, women, having lower muscle and tendon stiffness, are able to perform movements with greater amplitude.
In addition, specific estrogen receptors were found in the articular cartilage of women; When the levels of these hormones decrease after menopause, cartilage fragility increases [6].
There are two types of intracellular estrogen receptors, representing two separate genes with different chromosomal locations, called ER-α and ER-β. Both types of receptors have been found in articular chondrocytes [7].
This discovery allows us to look for the reason for the greater mobility of female joints precisely in the area of cyclical changes in female sex hormones throughout life. And if we consider that just after menopause, the incidence of osteoarthritis in women rapidly increases and at the age of 50 it overtakes men, then the relationship between sex hormones and joint health in women becomes quite obvious [8–10]. However, the subtle molecular mechanisms by which estrogens influence joint health have yet to be fully established [7].
Despite the fact that in almost all indicators women's joints turned out to be more mobile, the only parameter - active flexion in the ankle joint - turned out to be more pronounced in men. And if we remember that women prefer high-heeled shoes, the reasons for this difference become understandable.
Ankle injuries are the most common musculoskeletal injury. Injuries to this area occur in 60–70% of people of working age. Post-traumatic arthrosis (destruction of cartilage) of the ankle joint develops in 60% of cases and is irreversible, resulting in frequent disability [11–13].
The ability of cartilage to regenerate is limited by two factors: the lack of direct blood supply and structural features. Cartilage tissue is one of the few tissues in the body that completely lacks blood vessels. Cartilage is nourished by the diffusion of nutrients through the intercellular matrix, in which cartilage cells, chondrocytes, are located, as if in a gel. A feature of cartilage tissue, compared to other types of tissue in the body, is that it has few cells that are surrounded by a large amount of intercellular space. In addition, with age, chondrocytes increasingly lose their ability to divide.
Normally, this system works steadily, but everything changes when cartilage damage occurs. The ability of chondrocytes to divide is reduced; the dense intercellular matrix forms a physical barrier to the migration of existing chondrocytes into the defect, and the absence of blood vessels makes it impossible for stem cells to migrate into the cartilage. Although chondrocytes produce matrix throughout life, this production cannot meet the needs that develop after damage to articular cartilage [14].
With chronic microtrauma, the number of chondrocytes and the matrix components they produce decreases. The amount of synovial fluid in the joints decreases, which leads to disruption of cartilage nutrition and increased friction. As a result, the cartilage is gradually destroyed, and there are not enough reserves for its restoration [15].
In some places, deposits of calcium salts appear in the intercellular substance (“chalking of cartilage”), as a result of which the cartilage becomes cloudy, opaque, and becomes hard and brittle. As a result, an increasing malnutrition of the central areas of cartilage can lead to the ingrowth of blood vessels into them, which, however, only enhances its further degradation [16].
Obviously, when wearing high-heeled shoes, the likelihood of injury increases significantly - who among the fair sex has not twisted an ankle or broken a heel at least once in their life? It is precisely such a seemingly harmless injury that can radically change a person’s entire future life.
In addition, the ankle joint is subject to the greatest load per square centimeter of articular surface. The height of the heels directly affects the degree of load experienced by the ankle joint, and at a height of 8 cm it almost doubles [17]! When constantly wearing such shoes, a pronounced overload of the ankle joint occurs (the diagram is presented in Figure 2), which ultimately, especially when this area is traumatized, can be the cause of arthrosis of this joint in women.
Figure 2a. Negative consequences of wearing high-heeled shoes. Uneven load.
Figure 2b. Even distribution of body weight.
Figure 3. Ulnar angle. The parameter is interesting because when it is performed, almost all joints of the hand are involved in the movement. Thus, he is able to speak in summary about what is happening with the musculoskeletal system of the upper limb.
SustavLive website
It is worth saying that we did not expect to get such results. The original study design was to examine other factors that may affect joint mobility (some of which are covered in this article). The data on limited ankle mobility in women was an interesting surprise, and there were no similar studies on the relationship between joint mobility and footwear worn by a person. And for a more accurate study of the effect of shoes on the condition of the ankle joint, it would be worth conducting a separate study, moreover, involving older people.
In light of the existing evidence, we can conclude that long-term wearing of high-heeled shoes definitely does not provide health benefits. Between comfortable and beautiful shoes, it is better to choose comfortable ones, which are often beautiful. And in general, with the ever-increasing popularity of sports shoes, high heels have long been out of fashion. By the way, recently Russian researchers used mathematical calculations to determine the safe height of the heel: it turned out to be within 2–4 cm [18], [19].
Let's look at no less interesting facts about the joints of the hands. It turns out that the mobility of the joints of the leading hand is limited compared to its partner. And when studying such an interesting parameter as the elbow angle, this difference was maximally pronounced (Fig. 3).
Dominant hand is a collective term for the right hand in right-handed people and the left hand in left-handed people.
What is the reason for this interesting difference? In students (namely, they were the participants in our study), the leading hand experiences significant overload compared to the non-dominant one. Constant static or low-dynamic loads - for example, writing text, carrying loads and bags, using smartphones and gadgets, a computer mouse - lead to significant overload of the muscles of the leading hand, as a result of which the rigidity of these muscles increases (we discussed this in detail above) - therefore an asymmetry in mobility occurs.
Skeptics may say - why are you dramatizing everything? Perhaps the higher rigidity is due to the fact that we simply use our leading hand much more? And it's not about smartphones and computers! Indeed, perhaps these are just adaptive changes, and there is nothing threatening about them. However, the next time you are scrolling through your social media feed or playing games and suddenly feel aches and numbness in your hand, know that it’s time to stop and do some exercises. It’s better to give your hands a rest and go and do something else. Still, it’s not for nothing that “computer mouse syndrome” and “smartphone syndrome” exist in medicine.
Computer mouse syndrome, otherwise known as carpal tunnel syndrome, occurs for the following reason. Uncomfortable hand position, combined with prolonged bending of the hand at the wrist and a large number of small stereotypic movements, leads to persistent muscle tension and poor circulation, which, in turn, entails hypoxia and swelling of the median nerve, compression of the nerve in the carpal canal [20].
An ultrasound showed that after just 30 minutes of intensive touch screen use, thickening of the carpal ligament and median nerve occurred due to swelling. The indicators returned to normal after a 30-minute rest. In addition, it was found that in individuals with a long history of intensive use of electronic devices, the diameter of the carpal ligament and median nerve is significantly higher than normal values and significantly greater than in individuals who use touch screens and a computer mouse for less than half an hour a day. The diameter of the transverse carpal ligament, median nerve, and the degree of compression of the latter had a strong positive relationship with the severity of pain and dysfunction of the hand [21].
The ulnar angle is a kind of summary indicator of the mobility of the entire arm, so these differences in its case are most pronounced.
The elbow angle can serve as a simple, reliable, and most importantly, free test of the condition of the musculoskeletal system of the hand. You can try this test for yourself right now! Bend your arm at the elbow joint, place your hand and forearm behind your back and try to raise your hand as high as possible towards the shoulder blade. Have you reached the maximum? Do you remember the distance your hand reached? Now return it to its original position and do the same with the other hand. Well, right-handers and left-handers, have you felt the difference? By the way, I wonder what the results would be if this experiment was carried out on ambidextrous people.
Thus, there are many factors that influence joint health. Some of them are congenital and genetically determined, but a significant part of them are related to our lifestyle. The shoes we wear, the laptop and smartphone we use to study, work, communicate - even such everyday occurrences can affect our joints. And determine what will happen to them in decades. Let's remember this - and influence each risk factor with the appropriate prevention method, of which there are now a great many. After all, the future is taking shape today. And it is in our hands.
Pull-pull
Most often, with this syndrome, the first complaints occur during the period of most intensive growth, that is, at approximately the age of 14–18 years. “Gutta-percha” teenagers begin to be bothered by pain in the joints (usually the knees, ankles, small joints of the hands) or in the spine. The pain can range from moderate to very severe. Often, such teenagers have scoliosis, chronic foot fatigue, and flat feet. Patients with this syndrome have a high tendency to frequent injuries (sprains, subluxations of joints). By the way, these symptoms (especially if they appeared at a young age) can disappear as spontaneously as they appear. Therefore, they were previously mistakenly classified as “growing pains.”
A simple screening test using the Beighton method helps the doctor determine whether a teenager has joint hypermobility syndrome. The doctor asks the young patient to do 5 different types of movements and evaluates their performance. But there are 9 exercises in total (since our limbs are paired).
Each movement that demonstrates increased flexibility is worth 1 point. We can talk about the presence of the syndrome if, in addition to joint pain, young people score 4 points or higher, and those over 50 score from 1 to 3 points. And here are the test exercises (all except the last one are performed for both right and left limbs):
1. Bend the little finger back (1 point – if the angle of deviation is more than 90°). 2. Bend the thumb of the hand (1 point - if it easily touches the inside of the forearm). 3. Straighten the arm (1 point – for hyperextension at the elbow joint by more than 10°). 4. Straighten the leg (1 point – for hyperextension in the knee joint by more than 10°). 5. Bend the torso forward with straight legs (1 point for touching the palms to the floor).
However, in the absence of complaints from the musculoskeletal system, excessive joint mobility in comparison with the average can be considered as a constitutional feature and even an age norm. Before prescribing treatment, it is necessary to carry out a differential diagnosis, its purpose is to exclude other diseases that may also affect the joints (arthrosis deformans, rheumatoid arthritis, etc.). The patient will have to take an x-ray of the joints (necessarily symmetrical, on both arms or legs), CT or MRI and take a general clinical blood test.
Causes of limited joint mobility
Arthritis
A group of inflammatory diseases that lead to thinning of the articular cartilage, deformation of the joint capsule and ligaments. Arthritis most often affects the knees, elbows, fingers and toes. It is difficult for the patient to bend and straighten the affected joints; in the later stages, with knee arthritis, it is difficult to walk; with arthritis of the elbows and fingers, it is difficult to hold even light objects.
Bursitis
Inflammation of the joint capsule occurs due to injury, prolonged excessive load, as a complication of arthritis. The joint is very painful, swollen, and limited in mobility.
Arthrosis
Premature aging of the joint, which is accompanied by thinning and cracks of the cartilage of the head of the bone. At an early stage, the joint hurts and often crunches, then mobility decreases and the joint becomes deformed. At a later stage, the cartilage completely disappears. There is no inflammation or swelling with arthrosis.
Physical education, but not any
Treating pain in joint hypermobility with non-steroidal anti-inflammatory drugs (NSAIDs), as is done, for example, with arthrosis, is pointless, since the pain in this case is not caused by inflammation, but by another reason. It is preferable to use analgesics, although drug treatment in this case is far from the main thing. For persistent pain, it is rational to use elastic orthoses (knee pads) and bandages.
The patient will also have to eliminate loads that cause pain and discomfort in the joints, especially for team sports. Jumping, gymnastics and wrestling are prohibited. But swimming is very useful - it harmoniously develops muscles, but most importantly, it does not overload the joints, since body weight is less in water.
Special exercise therapy (isometric gymnastics) is also necessary. Although, unfortunately, it cannot be used to remove excessive stretchability of the ligaments, it can strengthen the muscles surrounding the painful joint or area of the spine. A strong muscle frame will take over the function of the ligaments, helping to stabilize the joint. Depending on the area of the body that hurts, you should choose the distribution of the load: either strengthen the thigh muscles, or work on the muscles of the shoulder girdle, back, etc.
Yoga can help with hypermobility syndrome, namely: static fixations of the body shape (asanas), which improve blood circulation in the joint capsule and strengthen the connective tissue of the joint, eliminating its excessive looseness, but without limiting normal mobility.
If any orthopedic abnormalities are detected, the patient is prescribed special gymnastics, orthopedic insoles, and in advanced situations, surgical treatment.
If the pain is accompanied by inflammation in the periarticular tissues, ointments and gels with NSAIDs will be needed, as well as local or injection administration of drugs that suppress inflammation.
Treatment of limited joint mobility
If you regularly feel stiffness in your joints for no apparent reason, do not self-medicate: you can accelerate the development of the disease. For some diseases, increasing physical activity will help, while for others it is better not to put stress on the joints.
Make an appointment with an orthopedic traumatologist. The doctor will clarify the symptoms, perform palpation and assess the degree of limitation of mobility. After which he will refer you for examination to clarify the diagnosis. The examination may include ultrasound, MRI, and laboratory tests.
In the early stages of diseases, complex conservative treatment is prescribed, which includes medications, physiotherapy, and therapeutic exercises. In advanced cases, injections of medications are made into the joint cavity. In later stages, partial or complete joint replacement is performed.
By the way
With the syndrome of “loose” joints, the issue of professional guidance arises especially acutely. Work associated with physical overexertion, long walking or long standing is dangerous for the patient. In these cases, the weak, stretched connective tissue part of the joint (ligaments, capsule) cannot withstand the load, and it “looses,” which contributes to the development of arthrosis. Despite the natural amazing flexibility, which seems to naturally push a person to practice choreography, you should categorically not become a dancer or ballerina with this syndrome - otherwise you may remain disabled.
The key to healthy joints and ligaments
- avoid hypothermia, dress appropriately for the weather;
- for women to minimize walking in heels and uncomfortable shoes;
- do not ignore your doctor’s recommendations on wearing orthopedic insoles;
- control body weight (obesity is the main enemy for joints);
- lead a healthy lifestyle and eat well.
It is important to know! Scientists have long proven that reducing body weight by 5 kg reduces the risk of developing joint diseases by 35-45%. And if you spend one week in bed, the strength of joint tissue decreases by 15%.
To improve bone, cartilage, and joint tissue, rheumatologists recommend consuming vitamins, for example, Calcium - D3 Nycomed. The vitamin is vital for the health of the muscular, circulatory and digestive systems; essential for normal bone growth, supports the synthesis and function of blood cells.
Healthy food for joints
- seafood;
- seaweed;
- gelatin;
- currant;
- rose hip;
- aspic (jelly).
To prolong joint health, you should avoid the following foods:
- smoked and fried;
- coffee;
- chocolate;
- pickled vegetables.
It is recommended to introduce the use of foods or dietary supplements containing ascorbic acid. Vitamin C is an essential nutrient involved in tissue repair, is necessary for the functioning of enzymes and is important for the functioning of the immune system, and has an antioxidant effect.
Products for joint health
Regarding diet, you can find a lot of advice here. Some advise reducing or completely eliminating the consumption of animal and dairy fats. It has been found that such products increase inflammatory processes in joint tissue.
If a patient has diseases of the joint tissue, the treatment complex must include the use of omega-3 - polyunsaturated fatty acids. The positive effect of omega-3 is associated with the ability of fatty acids to reduce the severity of the inflammatory process. With regular consumption of a certain set of foods high in omega-3, it is possible to obtain an effect similar to that of NSAIDs. First of all, these are sea fish (salmon, mackerel), vegetable oils (peanut, olive, soybean), red caviar, walnuts.
To prevent joint diseases, it is recommended to drink 100-150 ml of carrot, cabbage or beetroot juice daily.