If you’re experiencing hypermobility, joint pain, pelvic pain or pelvic floor issues, Ehlers-Danlos syndrome (EDS), or other related syndromes, this episode is going to be really helpful for you. 

I’m really excited to introduce you to Dr. Mamak Shakib. She is a rehab clinician, which means that she helps people with movement and stability in their bodies, especially people with hypermobility and pelvic floor dysfunction. She specializes in hypermobility syndromes like Ehlers-Danlos syndrome. I’m so glad to bring her expertise and insights to How Humans Heal.

This is a very interesting conversation for me because I diagnosed myself with hypermobility syndrome after years of suffering from migraines and various other symptoms.

How Rehab Clinicians Differ from Other Practitioners

When it comes to someone like Dr. Mamak as a rehab clinician, how is that different than a chiropractor, for example, or a physical therapist, or other practitioners that people might be going to when they’re in pain? 

Dr. Mamak clarifies that all these specialties are in the world of rehab, which has to do with posture, mobility, and functionality. 

The issue she sees in all of those fields is that we’re trying to formulate treatments for everyone, when in reality, everything is very specific to the individual. Our lifestyle, habits, injuries, and mindsets are unique to us, and they all impact how well we treat our conditions and prevent injuries.

Hypermobility and Pelvic Floor Dysfunction

Dr. Mamak’s heart is given to her patient population with hypermobility, Ehlers-Danlos Syndrome, and any connective tissue disorder with joint hypermobility. These conditions are associated with having faulty collagen, which is not developed later in life; it is genetically determined. 

Having more flexible collagen effects parts of our body that we use to assist us in functional mobility and posture. It also affects the pelvic floor. 

When Dr. Mamak explains pelvic floor dysfunction, she finds it helps to think of the floor of a house. Stability of the house depends on stability of the floor!

Dr. Mamak warns that an individual can have concurrent symptoms, and addressing just one while forgetting about the others becomes a partial treatment. Dr. Mamak finds that too often, patients with hypermobility are receiving partial treatment or failed treatments for pelvic floor dysfunction because the stability of the pelvis and the posture were not addressed.

Helping Patients Navigate Hypermobility

Often, when someone has been in pain and they’ve been trying to find someone to help them, it can become like an internal battle with their own body. They may ask, “Why is my body like this?” or “Why is my body doing this to me?” It becomes an internal struggle. 

We need to start off by realizing that our bodies want to be serving us. Your body wants to be able to work with you. Our body parts are not against us; they are there for us if we provide the grounds for our body to shine. 

Every part of our body, every part of our existence, is dying to show what they can do for us. This is an important shift in perspective, especially for those who have been in pain and struggling to find help.

Dr. Mamak explains that the body was a gift given to us with all the knowledge and intelligence to solve everything. Once we change our relationship with how we look at pain, then the coexistence with it changes. You’re not working or fighting an enemy; you’re working with an ally. You will get directed naturally by your body when you make that relationship and that connection.

Dr. Mamak emphasizes that we get plenty of warnings from our body, but when we don’t hear the message, that’s when we mess things up. Amazingly enough, the moment we make that realization and we shift our mindset, the body forgives us for all the abuse we put it through, voluntary or involuntary.

Dr. Mamak’s Approach to Treatment

Every hypermobile individual has pelvic floor dysfunction based on the fact that every joint is hypermobile and unstable, including the pelvis. If your pelvis is a bowl with the spine connected to it and the lower extremities connected to it, what makes you think that all of a sudden those joints are perfectly fine? They’re completely interconnected; it’s going to get affected somehow.

Dr. Mamak encourages people to be smarter owners of their own bodies, to understand that we’re not enemies, and to change that mindset of looking at aches and pains and injuries as something bad. Of course, it’s bad – we wish it didn’t happen – but it’s there to serve you, and if you don’t hear it, it’s going to repeat itself because you’re not hearing it.

Pain is a signal to say, “Hey, something needs attention. There’s something I could be doing differently.” And if I only knew then what that was, I would do it differently because I would rather avoid the pain. We need to ask ourselves: “How can I understand this signal that my body is trying to signal to me?” 

How often do we keep pushing ourselves? We see pain cases where the only way that you actually slow down is if the body disables you. Because other than that, you’re just going and going and going. If we don’t pay attention and give our bodies the attention they need, the breaks and the recovery time, they’re going to eventually give us signals, which could be pain and could be taking us out for a day or longer.

It’s a hard lesson, but we need to understand that it’s better to schedule time off and feel good than wait until we feel bad. The more that we can treat our bodies in a loving, compassionate way, the more we will be able to better understand those messages and make those adjustments we need to make. 

Understanding Signals from Our Bodies

When it comes to movement, we should think about it like we’re moving our house from one place to another. Some of our belongings we throw in a box and tape it, some of our belongings we have to bubble wrap. We all have to bubble wrap, but hypermobile individuals are more inclined to bubble wrap. They’re more interested in knowing how to bubble wrap because they have been injured.

We all get injured when we fail to take care of ourselves. Bubble wrapping doesn’t mean putting you in a bubble; it means taking care of your body better when it comes to mobility. 

Dr. Mamak thinks about what she does as helping people to rehab from life. She wants to know what your movement in life looks like and what’s the end result. 

She often puts patients through a series of actions and studies how you behave performing those actions. For example when she’s asking for your legs to perform without any other part of your body helping, just taking their own weight off of their legs to perform, and you can’t do it, then she can see that your movement is off and your methodology is too.

It’s no longer about the hurt hip; it’s about the hip being loud enough to bring you to her office. 

But there’s a lot more happening. Unless we start from understanding your movement patterns, and go to the end, we are going to miss it. If there was a virus on your laptop, you’d take it to someone to fix it. They’re going to first locate the virus, see if the virus changed the language of the software, run it through to the very end, close the laptop, and hand it to you. Why is it that we don’t do that with our bodies?

What we do is we go to the pained joint and we do stuff to it, and we half-ass it. Then pain is not killing us so we call it “okay, I’m good enough.” But good enough is never good enough. Then we say, “Okay, well I guess now it moves from one hip to another hip. Now it’s my shoulder. Oh, it must be my age.” But all your joints are the same age. The reality is, as clinicians, we’re not approaching it holistically or globally. As patients, we don’t even know how to behave.

Many people don’t even know what the principles of movement are. It’s like being a drunk driver in your own body – of course you’re going to injure and damage things. 

When it comes to pelvic floor dysfunction, it’s the same concept. When it comes to hypermobility, it’s the same concept. We cannot change the connective tissue, but we can certainly catch ourselves before we do a dysfunctional movement. Most importantly, we need to know what to replace it with.

How to Know You May Have Joint Hypermobility

Some people with hypermobility get up in the morning and can’t even walk because their ankles are killing them. They don’t understand why they bump into things. They used to be so active, and they shined as children because of their hypermobility. They could do things that no other kid in their group, in dance, in ballet, in gymnastics, cheer, whatever they were involved in, could do.

At first, you might be thinking “Wow, I’m up on the top because I’m doing stuff that other people can’t do.” So then you do a lot more of that, and impose more stress on your joints, which you’ll pay for later. Later on in life, there is a drop in performance because you’re hurting. 

In your 20s and 30s, you’re likely to push and be very active – running and doing this or that. You may even become what Dr. Mamak calls “dopamine junkies.” You get a dopamine release and sense of excitement from workouts. The best natural solution for depression is exercise, so you do a lot of that. And then, at some point, you injure yourself, and think “What the heck happened?”

The challenge is that a lot of times, hypermobility is not diagnosed. So, you might have been struggling with these symptoms and your practitioner may not have put it together. You could be getting symptoms in various parts of your body, including digestive symptoms, and not realizing that it’s all interrelated. 

And then the treatment ends up being more medications and surgeries because if it’s a joint issue, it almost always leads to a surgery in the standard medical approach. 

The Brain’s Adaptation to Dysfunction

Dr. Mamak emphasizes that we don’t need to retrain our brain – our brain is way above us, and we’re way below what our brain knows. Our brain has many functions and goals. The main goal is for us to live a long life and for us to be as pleasant and safe as possible given what we throw at it. 

That means we’re not going to die from any of these issues; we just become highly dysfunctional. That’s because the first goal was for us to live a long life, so the brain is serving us with that main purpose in mind.

The brain changes the profile of movement depending on what you throw at it. If something is not available, it’s going to grab something else to make the best of that. As a result, we sway farther and farther from that original perfect design that we all have when we’re born until we become running toddlers, until we start going to school, sit for extended lengths of time, play one-sided sports, play video games instead of going out there and being stimulated by nature.

Dr. Mamak gives an example: a leaf falling while you’re walking has a purpose – if you’re not looking at your phone because you’re too busy texting – that falling leaf stimulates your visual field. Your vision plays a huge role in your postural mobility and your postural stability. That’s what neuro kinesiology is about.

Dr. Mamak also believes we fundamentally need to change a lot in how we teach movement and breathing. Jumping jacks are great, but how is that going to serve us in daily life? We don’t fundamentally understand how to move properly. When a patient comes with rib subluxation, which is very common among hypermobile individuals, it’s a sign of this lack of understanding of how we need to move our ribs.

Imagine this happening in every joint in your body. When people can figure out how to move and breathe properly – because the foundation of every exercise is breathing, not just abdominal breathing – things start to change. 

The Need for a Holistic Approach

Why don’t we use these holistic techniques more often? This is not to say there is no room for medication – of course there is – but Dr. Mamak thinks we’re losing the connection with ourselves. We’re not understanding ourselves. We are becoming more distant, and that has to change. 

This body is created to serve us. It will continue doing that until our last breath. Why don’t we make that relationship a much healthier one?

We’re so busy trying to build relationships with outsiders. What’s the relationship you have with yourself? How can you have a better relationship with someone else when you don’t have an amazing one with the closest thing to you, which is you? That’s the message Dr. Mamak wants to get across. All these other things are just techniques, but the essence is that message.

It’s not about making it a choice between medications and surgery versus this approach. We need to first connect with ourselves, and we want to be able to choose treatments that don’t have negative effects whenever possible. So if we can use something like guided imagery and it doesn’t have a negative downside, then let’s choose that as much as we can.

Then if we need to choose, say, a medication or a surgery if it’s necessary, we weigh out the risks. Sometimes we need that, but it’s not to the exclusion of so many other things we can do to help hopefully prevent the need for so many medications and surgeries. Because, of course, pain medications can be highly addictive and lead to so many other issues. So if we can do something other than rely on a medication that’s addictive and harmful, that’s a better solution. 

We also need to invest in learning about ourselves. Invest in believing in yourself and that your body is not against you but for you. The relationship changes drastically when we do this. 

It’s really so simple. Some of our issues and pains are so complicated that we don’t believe that the answer can be simple. We know more about our phones than we know about our bodies – the different features that we don’t know about ourselves. We need to change that.

The Vagus Nerve and Biological Breathing

Everything that happens in our body is so beautifully coordinated. One of the things that Dr. Mamak says to her patients when they have anxiety is we want to activate the vagus nerve. 

The vagus nerve goes through the back of the head, so we want to stimulate it. We want to drop the chin and take a deep breath. Think about or place your hands in your armpits. Take a deep breath in, drop your chin, and push your armpits out with pressure. You want to increase your intrathoracic pressure. When you increase your thoracic pressure, you will actually drop your heart rate because you stimulate the vagus nerve.

Dr. Mamak also talks about “biological breathing.” She made up this name because it describes how we naturally breathe. We can breathe through our mouths, but that’s not how our body prefers to breathe. To understand natural breathing, we can look at how babies breathe. All babies breathe the same way.

Biological breathing is different from belly breathing. When you do it right, your whole middle part of the body expands, not just your stomach. Your core isn’t just your belly – it’s your whole middle area. This part of your body is very important. You can live without arms and legs, but you can’t live without your middle section. It’s that crucial.

There are simple tricks we can use to help with stress and anxiety. One idea is to change how we do everyday tasks. For example, if you usually use your right hand to brush your teeth, try using your left hand instead. If you tend to rush, try moving slower on purpose. When we do things differently, our brain gets confused. This confusion can actually help calm us down. It’s like giving our brain a break from its usual worries.

These tricks are simple, but they can be very helpful. They’re good to know about because they don’t require any special tools or medicine. It’s sad to see young people needing medicine for everyday stress, like being nervous about giving presentations at work. Learning these simple tricks might help people manage stress better in the long run.

Let’s just discover. Let’s just pretend our bodies are that one super interesting person that we want to spend the rest of our lives with, and we have so much interest in trying to learn more and more about this person. 

Let’s pretend our body is that person. Let’s start paying attention to our body and invest in ourselves. Fall in love with ourselves. It’s not cocky, it’s not anything bad. You are a precious, wonderful, amazing organism, and your brain would love to hear you say that to it. 

We’re so quick at giving compliments to other people, and yet we forget to give that to ourselves. That’s just not right. That’s not correct. So let’s change that.

Closing Thoughts

Some key takeaways from this discussion:

1. Our bodies are not our enemies, but allies trying to help us.

2. Pain and discomfort are often signals that something needs attention.

3. Hypermobility can affect multiple body systems, not just joints.

4. The connection between mind and body is crucial in healing.

5. Simple techniques like guided visualization and proper breathing can have profound effects.

6. We need to invest time in understanding our own bodies.

7. A holistic approach considering structure, nutrition, and emotions is essential for true healing.

When we talk about health, we often use words like “good” and “bad.” For example, people say there’s “good cholesterol” and “bad cholesterol.” But this isn’t really true. All parts of our body have a purpose, even the things we call “bad.” What’s really important is balance. When things in our body are out of balance, that’s when we have problems. So instead of thinking about “good” or “bad” parts of our body, we should focus on keeping everything in balance.

We should be careful about how we treat our bodies and how we think about them. Sometimes, without realizing it, we say or think negative things about our bodies. These thoughts can actually harm us. It’s important to understand that this isn’t helpful. Instead, we should try to change how we think about our bodies. This might not be easy, but it’s worth trying. If we can be kinder to our bodies in our thoughts and actions, it can really help us feel better overall.

When we think about our health, it’s important to remember that there are three main parts to consider. First, there’s how our body is built and works. Then, there’s what we eat and drink. And finally, there’s how we feel emotionally. These three things all work together to keep us healthy or make us sick. No matter what health issue we’re looking at, all three of these parts play a role. To be as healthy as we can be, we need to pay attention to all of these areas, not just one or two.

When we think about health, we need to look at the whole picture. This means thinking about our body, what we eat, and how we feel. If we only focus on one of these things, we’re not seeing the full story. It’s like trying to solve a puzzle with some pieces missing.

Health care workers should help people understand this big picture. They should explain that being healthy involves more than just one thing. It’s about how everything works together.

Most importantly, people need to know that they have a big role in their own health. We can make choices that affect how healthy we are. Understanding this can help us take better care of ourselves.

We have more control over our health than we often realize. By changing our mindset, learning about our bodies, and adopting practices that support our overall well-being, we can make significant strides in managing conditions like hypermobility and pelvic floor dysfunction.

For those struggling with these issues, remember that there is hope. Resources are available, and practitioners like Dr. Mamak are dedicated to helping you understand and work with your body. Don’t be afraid to seek help and explore different approaches to find what works best for you.

I’m so grateful to Dr. Mamak for her work and our connection. If you would like to learn more about how she can help you check out her website here. You can also check out her blog here and her clinic here. You can find her on Instagram @irvinespine and Facebook @Core Pelvic Floor Therapy.

I am living proof that it is possible to not feel pain while having hypermobility and to heal from migraines and eliminate the effects of stress, trauma, anxiety and depression by resetting our stress hormones and helping our body and mind to recover. I help patients with to do this in my practice every day – by phone and zoom, anywhere in the world. You can set up a one-on-one appointment here.

To learn more about my approach to healing from all of this using my Stress Recovery Protocol which involves optimizing cortisol and adrenaline levels to heal the adrenals, as well as neurotransmitters, using nutrients, herbs and C.A.R.E.™ – my proprietary program to support clean eating, adequate sleep, stress recovery and exercise – I encourage you to read all about it in my latest book Master Your Stress Reset Your Health.

Thank you so much, Dr. Mamak for sharing your brilliance and your work. I can see so many people are going to be able to benefit just from this conversation. And thank you all for listening in to How Humans Heal. Make sure to subscribe so you don’t miss the next episode. I look forward to connecting with all of you very soon.

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