Layman Abstract of CINK

Hypermobile Ehlers Danlos Syndrome (hEDS) is a genetic connective tissue disorder that creates laxity and increased fragility in the soft tissues. In the ligaments this laxity leads to excessive range of motion, subluxations, and even frequent dislocations. The Brighton test, the current standard for hEDS classification, lists “recurrent joint dislocations or frank joint instability, in the absence of trauma” as part of its second criteria for hEDS classification Beyond instability, hEDS patients frequently experience pain in the joints and vertebrae. Long-term pain is so common that the Brighton test also includes “musculoskeletal pain in two or more limbs, recurring daily for at least three months” and/or “chronic pain widespread pain for at least three months” as part of its second criteria for classification of hEDS.[1]

Despite the widespread problem of joint instability and musculoskeletal pain in the hEDS community, there is a lack of evidence on therapeutic rehabilitative treatments. A recent comprehensive study in 2018 that aimed to conduct a systematic review about evidence-based rehabilitation treatment of hEDS concluded that “at the present time, there is no Evidence Based Medicine literature on hypermobile Ehlers-Danlos Syndrome rehabilitation.”[2] Unfortunately, due to the lack of evidence based medicine literature on hypermobile Ehlers-Danlos Syndrome rehabilitation, and because nearly all literature on the matter relates to case reports, they could not provide a scientific comparison between the therapeutic approaches. This shows a need for more studies on different approaches to rehabilitation of hEDS/HDS patients and later comparative studies between traditional physical therapy and different approaches.

Corrective Integrated Neuro-Kinetics, (CINK) offers a novel approach to rehabilitation. While most rehabilitative approaches to hEDS focus on hypermobility (extreme range of movement in the joints and vertebrae), the CINK method targets standing reflexes that underuse certain large muscle groups leaving them slack and overuse different small muscle groups to the point of stiffness. This dysfunctional movement pattern leaves the body under-supported with points of the body vulnerable to strain, compression, and injury. By teaching the body to use functional standing reflexes, CINK alters the body back to a healthy, supportive structure. The strength and coherence of this structure reduces pain and improves stability without reducing range of motion. By not limiting range of motion, CINK offers a method of rehabilitation that allows hEDS patients to still engage in activities that require extreme movements like dance and sports. The novelty of the CINK method combined with the dearth of available medical research on hEDS rehabilitation leads to the obligation for a full medical study on the efficacy of the CINK method in reducing pain and instability in the low back and hips of hypermobile Ehlers Danlos Syndrome patients.

"Hypermobile Ehlers–Danlos Syndrome (a.k.a. Ehlers–Danlos Syndrome Type III and Ehlers–Danlos Syndrome Hypermobility Type): Clinical Description and Natural History." American Journal of Medical Genetics Part C: Seminars in Medical Genetics 175.1 (2017): 48-69

https://www.ncbi.nlm.nih.gov/books/NBK1279/

[1] Corrado, Bruno, and Gianluca Ciardi. "Hypermobile Ehlers-Danlos Syndrome and Rehabilitation: Taking Stock of Evidence Based Medicine: A Systematic Review of the Literature." Journal of Physical Therapy Science 30.6 (2018): 843-47.

[1] Tinkle, Brad, Marco Castori, Britta Berglund, Helen Cohen, Rodney Grahame, Hanadi Kazkaz, and Howard Levy. "Hypermobile Ehlers–Danlos Syndrome (a.k.a. Ehlers–Danlos Syndrome Type III and Ehlers–Danlos Syndrome Hypermobility Type): Clinical Description and Natural History." American Journal of Medical Genetics Part C: Seminars in Medical Genetics 175.1 (2017): 48-69

https://www.ncbi.nlm.nih.gov/books/NBK1279/

[2] Corrado, Bruno, and Gianluca Ciardi. "Hypermobile Ehlers-Danlos Syndrome and Rehabilitation: Taking Stock of Evidence Based Medicine: A Systematic Review of the Literature." Journal of Physical Therapy Science 30.6 (2018): 843-47.