Uncovering the Link Between Hypermobility and POTS

Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) are commonly associated with Postural Orthostatic Tachycardia Syndrome (POTS). In fact, a 2020 worldwide survey found that 31% of POTS participants were classified as having hEDS, and 55% met the criteria for being hypermobile.

The Crucial Role of Fascia

The fascia, the connective tissue that permeates our bodies, plays a crucial role in regulating various bodily functions, including autonomic processes. In hypermobile individuals, the extracellular matrix of connective tissues, especially fascia, is organized differently than in non-hypermobile individuals. This altered fascial structure can affect:

• Force transmission: Up to 40% of muscle force is transmitted via fascia, particularly the epimysium.
• Proprioception: Changes in fascial structure can impact the body's ability to sense position and movement.
• Autonomic regulation: Fascia is involved in regulating neurovascular, hormonal, and inflammatory processes.

The Connection to Autonomic Dysregulation

The connection between hypermobility, fascial dysfunction, and autonomic dysregulation in POTS patients can be explained by several factors:

1. Vascular laxity: Connective tissue abnormalities in blood vessels may contribute to inadequate peripheral vascular resistance.
2. Neuropathy: Damage to autonomic nerves can result from altered fascial structures.
3. Proprioceptive dysfunction: Changes in fascial gliding and organization can affect the body's ability to maintain proper posture and respond to positional changes.
4. Inflammatory responses: Altered fascial function may contribute to heightened inflammatory responses, potentially affecting autonomic regulation.

Implications for Treatment

Understanding the relationship between hypermobility, fascial dysfunction, and autonomic dysregulation in POTS patients can inform treatment approaches:

1. Manual therapies: Techniques targeting fascial release and reorganization may help improve autonomic function.
2. Exercise adaptation: Recognizing the impact of hypermobility on fascial function can guide the development of safe and effective exercise programs for POTS patients.
3. Multisystem approach: Treating POTS in hypermobile patients requires addressing not only cardiovascular symptoms but also considering the broader impact on connective tissues and autonomic regulation.

By recognizing the complex interplay between hypermobility, fascial dysfunction, and autonomic dysregulation, healthcare providers can develop more comprehensive and effective treatment strategies for POTS patients with underlying hypermobility disorders.