Instability: Are you Moving Too Much?

By Jesse Moreton, BSc DC

After convincing you last issue that joints don’t really go “out” as much as they tighten up or get strained, I now have the difficult task of explaining one exception; instability. As the name implies, the problem with instability is the opposite to that of most people. As we discussed before, the vast majority of the population has too little movement. People with instability have too much. The structures that hold the joints together, like the ligaments and capsules, are lax. The joint does move “in and out” somewhat, but still does not dislocate unless there is significant external force.

Both scenarios cause pain and problems; too little movement or too much movement. Often people with instability mistakenly think they belong in the “too little movement” category. They will still describe their symptoms as being tight or stiff. This makes recognition and diagnosis more tricky. For a while I couldn’t make sense of this apparent paradox.

Why would someone with excessive movement in their joints describe themselves as being tight? The answer is actually quite simple once you understand what is happening. Because the ligaments and capsules aren’t doing their job in stabilizing the joints, something else has to compensate. What else crosses joints and holds the body together? Muscles. The muscles start overworking in effort to provide stability. Ongoing involuntary, tonic contraction of muscles make them tight and sore. People with instability really are stiff but it’s not their joints that are stiff, it’s the muscles that are tight from overworking.

Treatment becomes a little more complicated with instability. It’s not just a matter of performing adjustments, and in some cases of advanced instability, adjustments can be counterproductive. It becomes a matter of treating the muscle tension and adding stability. This can be done through muscle release techniques and lots exercises at home. Strengthening the muscles helps them provide better support for the joints, however, in reality many cases require modifying activities and using braces. Even a strong muscle will get stiff and sore from always compensating. Bracing gives the muscles a break and providesmuch needed joint support. Often, I’ll suggest patients with instability use bracing when they’re physically active but refrain from using them all the time. The drawback with bracing is dependency.

Now after reading all this you may be wondering, do I have instability? Probability says likely not. Remember joint instability is far less common than joint restriction. However, if you feel lots of clicking or popping with incidental movement or have every been described as “double jointed”, you may have an instability problem. Populations in which instability is more common are women during and after pregnancy, kids or teenagers and certain family lines where genes code for laxer ligaments.

So do joints really go “out”? Between my last article and this one you can understand now why this is a difficult question to answer. But at the end of the day what is probably more important is something doesn’t feel right and something needs to be done about it. Call it what you may, semantics are secondary to seeking treatment and feeling better.