Understanding Tissue Creep in Hypermobility: Grab a Gummy Worm
When it comes to managing hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), it’s crucial to understand how connective tissues respond to stress. One key concept regarding connective tissue movement is called "tissue creep," which can be explained with a simple analogy: the gummy worm. I first encountered this analogy during an advanced yoga training with Jules Mitchell, Yoga Teacher, Author of “Yoga Biomechanics: Stretching Redefined” and an unbelievably wonderful teacher.
So What is Tissue Creep?
Tissue creep refers to the gradual stretching of soft tissues—like muscles, tendons, and ligaments—when exposed to constant force. Imagine gently pulling on a gummy worm. Initially, it stretches quickly, then slowly continues to elongate under the sustained force. This mimics how connective tissues behave under prolonged stress.
For most people, their connective tissues resist stretching easily, like a firmer gummy worm. But in those with HSD or hEDS, tissues are more extensible, causing the tissues to stretch more easily and quickly, like a softer gummy worm. The ability for tissues to creep is not a bad thing, but people with hypermobile tissues just tend to creep a little faster than others.
The Role of Receptors in Tissue Creep:
Connective tissues contain receptors that help monitor changes in tissue length, tension, and pressure and manage how fast our tissues undergo creep. If you have a gummy worm in hand, look closely at the little air bubbles inside, think of those as the receptors found in your tissues. The receptors include:
Nociceptors: Pain receptors alert the brain to potential tissue damage.
Mechanoreceptors: Respond to pressure and stretch, regulating muscle tone and joint stability.
Proprioceptors: Provide information on joint position and movement, aiding balance and coordination.
In typical tissues, these receptors work in harmony sending frequent messages to the brain. In those with individuals with HSD or hEDS, having more extensible tissues can cause these receptors to respond less typically.
Receptor Miscommunication:
People with firmer connective tissue, like stretching a firmer gummy worm, the receptors are able to send clear, consistent signals to the brain. But in people with more extensible connective tissue, like a softer gummy worm, the rapid stretch can confuse the receptors, leading them to overreact or under react to the stimulus. This miscommunication IS NOT due to faulty receptors or brain processing; it’s because of the altered tissue properties causing inaccurate brain/nervous system responses.
For example:
Nociceptors might send pain signals even when there isn’t significant damage because the tissue is stretching faster than expected.
Mechanoreceptors might struggle to maintain muscle tone and joint stability, leading to feelings of instability or even frequent subluxations (partial joint dislocations).
Proprioceptors might send confusing signals about joint position, leading to poor coordination or a sense of imbalance.
How Do We Work on Tissue Creep?
Knowledge is power! Your body isn’t flawed or broken—you just need the right support to help your receptors communicate more effectively. This is a process I can guide you through, using movement and awareness to help you better understand and manage your body's symptoms.
Manual Therapy: I use hands-on techniques to alleviate excessive tension in overactive muscles, such as the upper trapezius and scalenes, which often accompany joint instability. This approach improves soft tissue mobility and helps reduce pain and inflammation.
Progressive Resistive Strengthening: To improve the messages sent to the brain, your receptors need input! We use resistance bands, sandbags, or other forms of resistance to engage your muscles productively, helping to build lasting strength and stability.
Proprioceptive Training: We’ll focus on functional movement patterns to recalibrate your proprioceptors, enhancing nervous system regulation and ensuring more accurate signaling to the brain.
For those with HSD or hEDS, understanding tissue creep is essential. Just like a gummy worm that stretches more quickly, your connective tissues are prone to faster elongation, leading to mixed signals from your body’s receptors. By incorporating targeted physical therapy techniques, we can work together to improve your stability, manage symptoms more effectively, and enhance your quality of life.
And I know that we’re called “Zebra’s”, but here is my plug to add “Creepers” to the nicknames for those of us with HSD/hEDS.
REFERENCES:
Daens, S. (2022). Transforming Ehlers-Danlos Syndrome. Handspring Publishing.
Mitchell, J. (2018). Yoga Biomechanics: Stretching Redefined. Handspring Publishing.
Abboud J, Rousseau B, Descarreaux M. Trunk proprioception adaptations to creep deformation. Eur J Appl Physiol. 2018 Jan;118(1):133-142. doi: 10.1007/s00421-017-3754-2. Epub 2017 Nov 8. PMID: 29116380.