#61 Virtaj Singh, MD: Physiatry Treatments for the Hypermobile Body

Dr Virtaj Singh, MD, gives us the physical medicine and rehabilitation perspective of the hypermobile body. We start out talking about how 'hypermobility' presents, starting with the various joints that can get hypermobile (spoiler alert: it's all of them). He explains how lax ligaments may trigger muscles to tighten in order to protect a vulnerable joint which is why sometimes treatment is to loosen muscles and sometimes treatment is to tighten ligaments as a way to address a root cause of pain. We review the various stages of dysfunction including acute, subacute and chronic stages and how to look for microscopic injuries that might not be visible on imaging. Dr Singh explains looking for the what, the how and the why- the cause- of pain and dysfunction versus just trying to dull pain with opiates. He walks through a broad range of treatment options top to bottom- medications (anti-inflammatories vs muscle relaxants vs tricyclic antidepressants like amitriptyline/nortriptyline, low dose naltrexone, opiates), physical and occupational therapies, steroid injections, prolotherapy (injections to tighten ligaments as some say 'scar it down'), IMS (Intramuscular Stimulation which is sort of like 'if acupuncture and massage therapy had a baby'), trigger point injections, PRP (platelet rich plasma), stem cell injections into joint spaces, and surgery (fusion/ fixation). We discuss CCI, craniocervical instability, as one possible trigger for many of the global symptoms of neuroinflammation and that it's a very dangerous area from an interventionalist standpoint; Dr Singh refers to the Centeno-Schultz Clinic in Colorado for injection treatments Sprinkled throughout are tips and pearls for understanding the different joints and their role in supporting your full body. Dr Singh walks through various conditions, placing imaging studies like MRI in their proper context- not as diagnostics, but as supports for the physical evaluation of the patient. We finish with a discussion about fixation & fusion surgeries and then recap what is hypermobility and how to think about it when trying to address pain. Jump on board- this is a thorough discussion about physical treatments for the hypermobile body that you don't want to miss. 

Find Dr Virtaj Singh at Seattle Spine & Sports: http://seattlespine.com/seattle

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