Hypermobility and Anxiety

Nerve and connective tissue have not so surprising links

Posted Jun 24, 2018

Wikimedia Commons
Source: Wikimedia Commons

Ever have a friend who can straighten his arm past 180, do all the yoga poses without any practice, and bend his thumb all the way back to his wrist? Maybe you are that friend. Congratulations, you are 10-25% of the general population with joint hyper mobility and colleagues with yoga class envy. Folks with this inherited condition are extra-flexible, with stretchy skin and sometimes easy scarring, but there may be other health consequences. Though Hippocrates first described the symptoms in 400BC, Ehlers and Danlos are credited with the diagnosis and elucidation of this condition in 1901 and 1908.

There are a number of subtypes, some with extreme vulnerability to aortic rupture or complications of pregnancy. What has been largely ignored, however, is a link between these disorders and mental health and neurologic problems.

Turns out those with Ehlers-Danlos tend to have a higher risk of fibromyalgia, chronic pain, migraines and other headaches, and anxiety disorders. Why? Well, no one really knows for sure, but these patients have higher perceptions of environment along with pain perception and increased somatosensory amplification. This means that folks with joint hyper mobility may feel more pain and more sensation with the same stimulus than those of us without the disorder. Since chronic pain and anxiety are driven by overstimulation of the pain or stress response without compensatory recovery and repair, the link between Ehlers-Danlos and anxiety becomes more clear.

So what can we do about this link? First, we have to learn about and recognize the connection. According to this Current Psychiatry article, people with joint hyper mobility and ehlers danlos are also more likely to have side effects to medications, especially gastrointestinal. They recommend using very low doses of the old fashioned tricyclic antidepressants, which can help pain, headaches, and are constipating. These meds are not as useful for anxiety, but anxiety can be successfully treated with cognitive behavioral therapy along with other stress-reduction techniques, such as exercise or (hey) yoga.

Wikimedia Commons
Source: Wikimedia Commons

To me the most interesting part of this whole joint hyper mobility and anxiety/fibromyalgia/chronic pain connection is the tissue itself. This may seem way too basic, but fascia and nerves and the base layers of skin from an anatomy perspective are all relatively similar. They have similar embryonic origin. They are mostly white, compared to surface skin which has melanin, or muscle and organs which tend to be red, green, yellow, or brown. They are all stringy yet tough. It makes a crude sort of sense that hyper motility of joints related to tendons and ligaments and stretchy skin would be related to pain and nervous system conditions. I’d love to see the link studied better and really figured out.

Copyright Emily Deans MD

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