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The purpose of this case report is to examine the benefits of multifaceted physical therapy interventions in a pregnant adult female with EDS.

Publication Date

Summer 2018


St. Augustine, FL


Ehlers-Danlos Syndrome, Physical Therapy Modalities, Pregnancy


Physical Therapy


Presented at the Summer 2018 Research Day on the St. Augustine, FL, campus of the University of St. Augustine for Health Sciences.

References (

1. Tinkle B, Castori M, Berglund B et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical Description and Natural History. Am J Med Genet Part C Semin Med Genet 2017;175C: 48-69.
2. Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for Benign Joint Hypermobility Syndrome: Review of the literature. J Rheumatol. 2007;34:804–9.
3. Mulvey M, Macfarlane G, Beasley M et al. Modest Association of joint hypermobility with disabling and limiting musculoskeletal pain: results from a large scale general population-based survey. Arthritis Care Res. 2013;65(8):1325-1333.
4. Zekry A, Ahmed M, Elsayed Abd Elwahid H. The impact of fatigue on health related quality of life in adolescents with benign joint hypermobility syndrome. Egypt Rheumatol. 2013;35:77-85.
5. Celletti C, Castori M, Camerota F, Morico G. Joint Hypermobility syndrome/Ehlers Danlos syndrome hypermobility type: Constructing a rehabilitative approach. Int J Clin Rheumat. 2014;9(2):103-106.
6. Stacoff A, Diezi C, Luder G, Stussi E, Kramers‐de Quervain IA. Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture. 2005;21:24–38.
7. Fatoye FA, Van der Linden ML, Rowe PJ. Gait kinematics and passive knee joint range of motion in children with hypermobility syndrome. Gait Posture. 2011;33(3): 447-451.
8. Galli M, Cimolin V, Rigoldi C et al. Gait strategy in patients with Ehlers-Danlos Syndrome hypermobility type: a kinematic and kinetic evaluation using 3D gait analysis. Res Dev Disabil. 2011;32(5):1663-8.
9. Calguneri M, Bird HA, Wright V. Changes in joint laxity occurring during pregnancy. Ann Rheum Dis. 1982;41:126–128.
10. Nilsson-Wikmar L, Holm K, Oijerstedt R, Harms- Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3,6, and12 months follow-up postpartum. Spine. 2005;30:850– 856.
11. Nelson P, Apte G, Justiz R et al. Chronic Female Pelvic Pain-Part 2: Differential Diagnosis and Management. Pain Practice. 2011;12:111-141.
12. Sichting F, Rossol J, Soisson O et al. Pelvic Belt Effects on Sacroiliac Joint ligaments: A Computational approach to understand Therapeutic Effects of Pelvic Belts. Pain Physician. 2014;17:43-51.
13. Lind J, Wallenburg H. Pregnancy and the Ehlers-Danlos syndrome: a retrospective study in a Dutch Population. Act Obstet Gynecol Scand. 2002;81:293-300.
14. Rosello JM, Hernandez-Yago J, Pope M. Type III Ehlers-Danlos Syndrome and pregnancy. Arch Gynecol Obstet. 1997; 261:39–43.
15. Remvig L, Jensen DV, Ward RC. Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J Rheumatol. 2007;34:798–803.
16. Gazit Y, Nahir AM, Grahame R, Jacob G. Dysautonomia in the joint hypermobility syndrome. Am J Med. 2003;115(1):33-40.
17. Baeza-Valasco C, Gely-Nargeot C, Bulbena V, Bravo JF. Joint hypermobility syndrome: problems that require psychological intervention. Rheumatol Int. 2011;31(9):1131-1136.
18. Johannessen EC, Reiten HS, Lovaas H et al. Shoulder function, pain, and health related quality of life in adults with Joint Hypermobility Syndrome/Ehlers Danlos Syndrome-hypermobility type. Disabil Rehabil. 2015;14:1382-1390.
19. Scheper MC, Pacey V, Rombaut et al. Generalized hyperalgesia in children and adults diagnosed with Hypermobility Syndrome and Ehlers-Danlos Syndrome hypermobility Type: A discriminative analysis. Arthritis Care Res. 2017; 69(3): 421-429.
20. Boonstra AM, Schiphorst PHR, Renemen MF. Reliability and Validity of the visual analog scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165-169.
21. Netter F. Atlas of Human Anatomy. 5th ed. Philadelphia, PA: Saunders; 2011.
22. Holmgren U, Waling K. Inter-examiner reliability of four static palpation tests used for assessing pelvic dysfunction. Man Ther. 2008; 13(1): 50-57.
23. Rozenfeld E, Moran U, Damri E, Kalichman L. Test-Retest reliability of myofascial trigger point detection in hip and thigh areas. J Bodyw Mov Ther. 2017;21(4):914-919.
24. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10 :207-218.
25. Yeung TS, Wessel J, Stratfort P, Macdermid J. Reliability, validity and responsiveness of the lower extremity functional scale in patients of an orthopaedic rehabilitation ward. JOSPT. 2009; 39(6):468-477.
26. Goodman C, and Snyder T. Differential Diagnosis for Physical Therapists. 5th ed. St. Louis, MI: Elsevier; 2014.
27. International Classification of Diseases, Tenth Revision, Clinical Modification. American Physical Therapy Association. Published 2015. Accessed June 24, 2018.
28. Guide to Physical Therapy Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014. Available at: Accessed July, 2 2018.
29. Aredo JV, Heyrana KJ, Karp B, Shah J, Stratton P. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Semin Reprod Med. 2017;35(1):88-97.
30. Cantu R, Grodin A, Stanborough R. Myofascial Manipulation: Theory and Clinical Application. Austin, TX: Pro-Ed c2012; 2012.
31. Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 4th ed. Philadelphia, PA:F.A. Davis;2002.
32. Hwang JY, Ahn WY, Kim HJ et al. Effects of performing hip abduction and adduction during bridging exercise on trunk and lower extremity muscle activity in healthy individuals. Phys Ther Rehabil Sci. 2017;6(1):14-19.
33. Kushion D, Rheaume J, Kopchitz K et al. EMG activation of the Vastus Medialis Oblique and Vastus Lateralis During Four Rehabilitative Exercises. GVSU. 2012;5:1-7
34. Distefano LJ, Blackburn T, Marshall S, Padua DA. Gluteal Muscle activation during common therapeutic exercises. JOSPT. 2009;39(7): 532-540.
35. Jonely H, Brismee JM, Desai M, Reoli R.Chronic Sacroiliac Joint Pain and Pelvic girdle dysfunction in a 35-year-old nulliparous women successfully managed with multimodal and multidisciplinary approach. J Man Manip Ther. 2015;23(1):20-26.
36. Martins RF, Silva JL. Treatment of pregnancy-related lumbar and pelvic girdle pain by the yoga method: A randomized controlled study. J Alter Complement Med. 2014;20 (1):24-31.
37. . Jung H, Jeon H, Oh D, Kwon OY. Effect of the pelvic compression belt on the hip extensor activation patterns of sacroiliac joint pain patients during single leg stance: A pilot study. Man Ther. 2013;18:143-148.
38. Gutke A, Sjodahl J, Oberg B. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled, clinical trial. J Rehabil Med. 2010;42(10):929-935.
39. Sahin N, Baskent A, Cakmak A, et al. Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome. Rheumatol Int. 2008;28:995–1000.
40. Rombaut L, Malfait F, De Wangele I et al. Medication, Surgery, and Physiotherapy Among patients with hypermobility type of Ehlers-Danlos Syndrome. Arch Phys Med Rehabil. 2011;92:1106-1112.
41. Unsgaard-Tondel M, Vasselijen O, Woodhouse A, Morkved S. Exercises for women with persistant pelvic and low back pain after pregnancy. Glob J Health Sci. 2016;8(9): 107-120.
42. Kordi R, Abolhasani M, Rostami M et al. Comparison between the effect of a lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic pain: a randomized control trial. J Back Musculoskelet Rehabil. 2013;26:133-139.
43. Palmer S, Manns S, Cramp L, Lewis R, Clark EM. Test-Retest Reliability and smallest detectable change of the Bristol Impact of Hypermobility questionnaire. Musculoskelet Sci Pract. 2017;32:64-69.

Effect of Comprehensive Physical Therapy on a 25-Year-Old Pregnant Female with Ehlers Danlos Syndrome: A Case Report



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