Ultrasound-Guided Regenerative and Orthobiologic Therapy for Hypermobile Ehlers-Danlos Syndrome

Your ability to perform physical tasks and activities depends on a biomechanical lever system, where muscle pulls against bone at the joints to generate rotational torque that produces movement. The architecture of a particular joint dictates its range of motion, supported by tough inelastic ligaments that attach bone to bone, and by biotensegrity – a system of elastic tension generated by muscles and fascia that controls and guides forces that act at the joint.

Despite wide diversity in individual anatomy, most people share similar limitations in joint range of motion, enabling them to walk, run, jump, climb and lift with minimal risk of injury. But for people with hypermobile Ehlers-Danlos syndrome (hEDS), the tissues that provide joint support and dictate range of motion are more fragile and elastic, allowing for supranormal extensibility that makes joints prone to injury and limits participation in everyday physical activities.

At NYDNRehab, we provide specialized hEDS physical therapy combined with evidence-based regenerative and orthobiologic approaches to strengthen fragile tissues, treat injuries, improve joint stability and manage pain symptoms. Learn about hEDS, the benefits of regenerative and orthobiologic therapies for treatment, and the importance of high-resolution ultrasound guidance for precise and gentle interventions.

Characteristics and Prevalence of hEDS

Ehlers-Danlos syndrome is a group of hereditary connective tissue disorders that affect the skin, joints, nerves and blood vessels. Twelve of the 13 subtypes of EDS have clear genetic markers, but hypermobile EDS – the most common type – has no known genetic biomarkers and possesses its own systemic issues.

The most prominent features of hEDS are related to fragile connective tissues throughout the body, leading to a wide array of condition-specific symptoms. Diagnosis is based entirely on clinical criteria, as no genetic cause has yet been identified.

Characteristics of hEDS include some or all of the following:

• Generalised joint hypermobility, where joints extend beyond their functional range of motion.
• Joint instability, with frequent and recurrent subluxations or dislocations, especially in the shoulders, knees, and hips.
• Risk of premature degenerative joint disease.
• Widespread and persistent chronic pain, often out of proportion to physical exam findings.
• Chronic fatigue that interferes with everyday activities.
• Autonomic dysfunction, affecting bodily functions such as heart rate, blood pressure, digestion, and temperature control due to connective tissue abnormalities affecting blood vessels, nerves, and other systems.
• Gastrointestinal issues involving delayed gastric emptying or motility issues.
• Nausea, especially during orthostatic stress.
• Soft, velvety and mildly stretchy skin that easily bruises and scars.
• TMJ pain and instability.

The prevalence of hEDS is not clearly known due to the complexities of diagnostic criteria. Certain people have hypermobile joints but are not affected by other hEDS symptoms. Some sources estimate hEDS to affect one in 3000-5000 people, translating to about .02-.03 percent of the population.

Patients with hEDS face serious quality of life issues affecting multiple facets of daily living. Pain and fatigue can affect consistency and quality of work, and many hEDS sufferers have difficulty maintaining a job. Participation in sports and exercise is limited due to low exercise tolerance and fear of triggering pain symptoms. Patients often suffer from depression and anxiety, and many limit their social interactions for fear of fainting or symptom flare-ups in public spaces.

Conventional vs Holistic Treatment of hEDS

There is no cure for hEDS, and conventional treatments focus mainly on managing symptoms, improving function, and enhancing quality of life. Treatment approaches often include physical therapy, pain relief medications, taping and bracing for joint support, management of autonomic and GI symptoms, patient education, and mental health support.

Holistic therapy for hEDS incorporates some conventional interventions, but it typically steers clear of medications and leverages alternative therapies for pain management. Its whole-body approach emphasizes tissue healing, strength optimization, and restoration and maintenance of biotensegrity, with an emphasis on fascial health.

But symptoms management is not the ultimate goal. The end goal is to help hEDS patients achieve the best possible quality of life. Patients face significant quality of life challenges due to chronic pain, joint instability, fatigue, gastrointestinal issues, autonomic dysfunction, mental health struggles, and social/occupational limitations. These issues create a complex burden that requires personalized multidisciplinary management.

At NYDNRehab, our personalized approach to patient care means hEDS patients get the support and care they need to feel seen and validated. We leverage the most advanced energy technologies and orthobiologic procedures for hEDS therapy, supported by evidence from a growing body of research. Our successful adoption of cutting-edge approaches is forging new pathways for holistic hEDS treatment.

Regenerative Therapies and Orthobiologics Ease hEDS Symptoms

Hypermobile Ehlers-Danlos syndrome involves defective connective tissues, leading to joint hypermobility, chronic pain, instability, and tissue fragility. Regenerative therapies and orthobiologics target hEDS symptoms such as joint laxity, tendinopathies, and chronic pain, helping patients to avoid invasive surgery, which can be disastrous for hEDS sufferers.

At NYDNRehab, we guide our regenerative and orthobiologic procedures with high-resolution ultrasonography, to ensure precision targeting of fragile tissues. With our advanced ultrasound equipment, we are able to adjust the wave type and depth to ensure precise and gentle interventions. Without ultrasound imaging, such procedures can be hit-or-miss, potentially doing more harm than good. Dr. Kalika’s expertise in ultrasonography sets NYDNRehab apart from other clinics offering similar services.

Evidence-Based Regenerative Therapies for hEDS

Regenerative technologies use acoustic, electric, magnetic and radiofrequency waves to stimulate tissue regeneration at the cellular level. At NYDNRehab, we carefully select a combination of technologies, based on the needs of the individual patient. Our personalized approach to hEDS ensures that you get appropriate and effective treatment that eases hEDS symptoms and promotes joint stability.

Extracorporeal shockwave therapy (ESWT)

ESWT uses high-energy acoustic waves that stimulate tissue healing. When applied at the appropriate depth, scope and intensity, ESWT can help to restore degenerated tendon tissues, improve ligament stability, enhance proprioception, and reduce chronic pain. It is especially effective for treating overuse injuries, microtears or adhesions in fascial and tendinous tissues. Patients often report relief after one to three sessions.

Extracorporeal magnetotransduction therapy (EMTT)

EMTT uses high-intensity magnetic fields that stimulate cellular repair, reduce inflammation, and promote regeneration in tendons, ligaments and joints. EMTT targets defective collagen that weakens tissues – a core issue in hEDS.

INDIBA therapy

INDIBA uses radiofrequency electromagnetic waves to generate controlled heat deep within tissues. INDIBA operates in two modes – capacitive, for superficial tissues like skin and muscles, and resistive, for deeper structures like tendons, ligaments, and bones. For hEDS, INDIBA enhances circulation, reduces muscle spasms, and supports tissue remodeling, with the goal of improving the stability and function of fragile joints.

Low-Level Laser Therapy (LLLT)

Laser therapy uses low-intensity light to reduce chronic joint and muscle pain, enhance collagen synthesis in tendons and ligaments, improve joint range of motion, and reduce subluxations. It enhances blood circulation, easing symptoms of dysautonomia.

Orthobiologic Procedures for hEDS

Orthobiologic procedures inject biological or neutral solutions into damaged tissues and joints to stimulate tissue repair at the cellular level, targeting symptoms like joint laxity, tendinopathies, and pain without invasive surgery. Dr. Kalika’s expertise in ultrasonography combined with Dr. Brosgol’s skills in orthobiologic procedures ensure that hEDS patients get targeted and gentle treatment that strengthens fragile tissues and reduces instability.

Prolotherapy

Prolotherapy uses a neutral solution – usually dextrose – injected into ligaments, tendons, or joints to irritate tissues, triggering a controlled inflammatory response. For hEDS, Prolotherapy addresses ligamentous laxity and instability, which contribute to recurrent subluxations and pain.

Platelet-Rich Plasma (PRP)

PRP uses a high concentration of platelets, extracted from the patient’s own blood and injected into ligaments and tendons where collagen is defective. It alleviates pain from tendinopathies, strengthens hypermobile joints, and improves stability, potentially reducing subluxations and dislocations.

Stem Cell Therapy

Stem cell therapy injects stem cells extracted from the patient’s body to address chronic pain, joint instability, and tissue fragility. Stem cells are extracted from one of two common sources, depending on their intended use:

• Bone Marrow Aspirate Concentrate (BMAC) is extracted from bone marrow and injected into joints to promote collagen repair in hEDS-related tendon/ligament weakness and joint instability.
• Microfragmented Adipose Tissue (MFAT) is extracted from adipose tissue and has a higher stem cell yield than BMAC. It is less invasive than BMAC, and addresses joint instability, widespread pain, and soft tissue injuries such as rotator cuff tears, Achilles tendinopathy, and skin fragility.

At NYDNRehab, treatment for hEDS involves a combination of carefully selected therapies, based on the patient’s unique needs. When combined with specialized hEDS physical therapy, our holistic and personalized approach can dramatically improve joint stability and enhance patient quality of life.

Specialized hEDS Physical Therapy Safely Builds Strength and Stability

Conventional physical therapy is not enough to address the peculiar aspects of hEDS, and an inexperienced or underqualified therapist could potentially cause harm. At NYDNRehab, our holistic approach includes alternative interventions not commonly used in mainstream clinics. Our personalized one-on-one approach ensures that your fragile tissues and unstable joints are protected during your physical therapy sessions.

In addition to elastic resistance and body weight exercises, your hEDS physical therapy protocol may include:

• Dynamic Neuromuscular Stabilization (DNS), an evidence-based approach for restoring global stability.
• Blood Flow Restriction Training (BFRT), a muscle-building approach that allows for strengthening with low training volumes, to spare fragile joints.
• KINEO intelligent system in aqua mode, to provide guided resistance with minimal joint stress.

Dynamic Neuromuscular Stabilization (DNS)

Blood Flow Restriction Training (BFRT)

KINEO intelligent system

• Dynamic ultrasonography, to identify and correct load transfer failures with visual feedback.
• Eccentric loading exercises to restore degenerative tendon tissues.
• Focal cryotherapy prior to loading exercises, to slow fibroblast turnover, to better allow for ligament and fascia proliferation.

Dynamic ultrasonography

Eccentric loading exercises

Focal cryotherapy

Lifestyle Guidelines for hEDS Injury Prevention

As with any chronic musculoskeletal condition, lifestyle factors go a long way toward managing and mitigating hEDS symptoms. The 2017 International Classification of the Ehlers–Danlos Syndromes provides the following lifestyle guidelines for hEDS injury prevention, centered on stabilizing joints, reducing strain, and preventing flare-ups. When integrated into daily life, these guidelines can significantly reduce injury risk and improve quality of life for hEDS sufferers.

• Work with a therapist or trainer familiar with hEDS to implement a low-intensity exercise program, with the goal of strengthening muscles and improving proprioception. Swimming or water-based exercises provide buoyancy, to reduce load on joints while building strength.
• Light resistance training with bands or bodyweight can help strengthen the muscles and tissues that provide joint support and stability.
• Supportive devices like braces, splints or kineo taping can help reduce joint stress during physical activity.
• Avoid fatigue by pacing yourself and breaking tasks into smaller segments, with frequent rest breaks.
• Drink 3-4 liters of water daily to maintain blood volume and hydrate connective tissues. Add electrolytes to support autonomic function.

• Eat a high-protein animal-based diet to provide building blocks for muscles and collagenous tissues like fascia, tendons and ligaments. Bone broth is a good source of high-quality collagen.
• Get adequate restorative sleep to reduce fatigue and enhance tissue repair.
• Be mindful of posture and lifting technique, to reduce strain on joints and soft tissues during daily activities.
• Adapt your living and work environments to reduce injury risk by eliminating trip hazards, installing safety bars, and using non-slip mats.
• Consider a scooter, walker, or crutches to use during flare-ups or for walking longer distances, to reduce joint stress and prevent falls.

Get the Most Advanced hEDS Therapy in NYC

Patients with hEDS face multiple daily hurdles that diminish their quality of life. When coupled with personalized hEDS physical therapy and supported by lifestyle modifications, regenerative therapies and orthobiologics can dramatically improve hEDS symptoms and reduce injury risk.

NYDNRehab is one of the few clinics in NYC that specializes in hEDS therapy. Our state-of-the-art clinic features a broad spectrum of technologies and treatment options, equipping us with the best tools for personalized hEDS care. To optimize your joint stability, enhance your tissue quality, and reduce hEDS symptoms, contact NYDNRehab today for holistic hEDS treatment without drugs or surgery.

Get the Most Advanced hEDS Therapy in NYC
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