|Elasticity, Umberto Boccioni, 1912, Oil on Canvas, Milan, Italy|
by Ram Rao
The Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders that are genetic in nature and are currently classified into thirteen subtypes. While, each type of EDS affects different areas of the body, all share one thing in common: hypermobility. Additionally, there is other significant symptom overlap between the EDS subtypes and other non-genetic connective tissue disorders.
The condition primarily involves the body’s connective tissues—primarily skin, joints, and blood vessel walls. The connective tissue provides strength, structure, and elasticity to the underlying structures in the body and consists of a complex mixture of proteins, cells, and fibrous material. In EDS, the protein collagen is defective and depending on the extent of the structural defect of collagen will result in the varied subtype of EDS. In order to understand the problems associated with having a defective protein, just imagine a cemented structure that is built using poor quality cement. The cement is unable to hold the bricks and beams together thereby weakening the building.
The characteristics of typical EDS include hyper-mobile joints, swan neck deformity (the joint closest to the fingertip bends toward the palm while the nearest joint to the palm bends away from it), skin hyper-elasticity, fragile skin that tears easily, redundant skin folds, eversion of the upper eye lids, the Gorlin sign (ability to touch the nose with the tongue), flat feet, and passive bending of the wrist or thumb to touch the forearm.
Just like a weakened building, individuals with EDS can easily bruise themselves as evidenced by unexplained swelling and ecchymosis (escape of blood into the tissues from ruptured blood vessels) on the palm, hand, eye, thigh, or trunk. What may seem to be a gentle pat on the back for most individuals may result in an internal bruise for EDS individuals. A gentle hit can also produce a blood clot and swelling in the impacted area. Owing to a poor grip due to the soft skin on the palm, EDS individuals have a tough time opening bottle lids and invariably end up bruising their palms. Contact sports will result in a multitude of internal and external bruises together with swollen areas all over the body.
People with EDS who practice yoga need to be extremely careful and go very gradually into poses that require exceptional flexibility. While hyper-flexibility may be a blessing, it can also lead to severe pain in the joints and limbs as well as internal bleeding. These individuals need to focus on poses that strengthen and stabilize major joints. In standing poses including Warrior poses among others, emphasis should be on engaging/contracting the muscles around the circumference of the joints while performing the pose. Placing a block between the thighs in all of the standing poses is a great idea as it requires engaging all the muscles starting from the ankles all the way up to the hips.
The same idea of contracting the muscles needs to be applied to the ankles, knees, hips, shoulders, elbows, and wrists. Instead of going deep into the pose immediately or twist unmindfully, the goal should be to strengthen all the vulnerable joints. While these modifications may limit the depth of the range of movement, they are safer and help reduce the risk of causing symptoms for individuals with EDS.
In standing asanas such as Parsva Uttanasana (Intense Forward Stretch), Utthita Parsvakonasana (Extended Side Angle Pose) or Utthita Trikonasana (Extended Triangle Pose), individuals with EDS need to be aware to not overstretch the front leg hip and knee joints. While leaning into the full pose, it is necessary to contract and firm the muscles around the hip (of the front leg) and knee joint. This feeling of strength needs to be maintained while staying in the pose and even on the way out. By consciously contracting these joints, people with EDS may not go far down, but they get to be in the pose without suffering undue pain and most importantly not hyper-extending.
Being mindful of the body and making suitable modifications not only helps to improve the skill level but also leads to a higher state of positive experience, contentment, and a sense of accomplishment for people with EDS.
Rammohan Rao (Ram) comes from a family of Ayurvedic practitioners and Vedic teachers in India tracing back to the illustrious Vedic-acharya Rishi Kaundinya (although Ram admits he cannot do the Eka pada or Dwi pada Kaundinyasana). With a doctorate in Neuroscience, Ram was a Research Associate Professor at the Buck Institute for Research on Aging. He focused on various aspects of age-associated neurodegenerative diseases with emphasis on Alzheimer’s disease. In addition, Ram completed the academic training at the California College of Ayurveda (CCA) and received his certification as Clinical Ayurvedic Specialist. He has been a faculty member of the California College of Ayurveda and teaches in their Nevada City location. Ram is also a dedicated Hatha yoga practitioner and is a Registered Yoga Teacher from Yoga Alliance USA. In his spare time he offers consultations in YAMP techniques (Yoga, Ayurveda, Meditation & Pranayama). Ram has published several articles in major Yoga/Ayurveda magazines and has been a featured speaker in several national and international meetings and symposia. He is a member of the National Ayurvedic Medical Association (NAMA) and is on the Research Board of the Association of Ayurvedic Professionals of North America (AAPNA).
This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.
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