Dislocations and DNA 🧬

The post below was sent as an issue of my newsletter, Ready for Rain.

During my high school years, the YMCA was the place for pickup basketball games. When I arrived one afternoon, a game was finishing up and I sat along the sidewall of the gym to wait. I had recently made it a goal to dunk a volleyball and took every chance I could to practice my jumping. Once the game ended, I eyed the rim and tried to summon my strength to reach it. 

After a quick stutter step, I took a few long strides and planted my left foot for take-off. At that moment, the full weight of my body and downward momentum caused my left ankle to roll to the inside. It was one of the most painful experiences of my life. Within a few minutes, my ankle was the size of a softball and I called my mom to take me to the ER. It was a very bad sprain, but nothing was broken. The nurses were very impressed. 

I didn’t realize it at the time, but this was the start of a lifetime of joint problems that I eventually discovered are connected to my DNA. 

My left ankle was never the same and I’ve sprained it innumerable times since then. In fact, it no longer hurts for more than a few minutes when I roll it. It’s like the ligaments are so stretched they can no longer be injured. It helps, too, that I’ve become so used to the feeling of it starting to roll that I can often prevent it by voluntarily crumpling onto the ground when I sense it happening. I’m not sure which is worse, the flailing or the fleeting pain.

As an adult, my right shoulder started to dislocate, or pop in and out quickly, causing pain and the indelible grind of irregular joint movement. It happened at unpredictable times, like rolling over in bed or reaching to a top shelf. Soon, I learned that any time I raised my right arm over my head, it could easily dislocate momentarily. I never had the skill to play competitive basketball, but this and my ankle were decisively career-ending. Volleyball, rock-climbing, etc. were now also out. 

Eventually, I had surgery on my right shoulder to prevent the dislocations. In fact, the surgery happened just as I started dating Sachi. Our first few weeks together saw me in a sling and consistent pain. It was a bonding experience for us both. 

I’m grateful my shoulder recovered and has not been a problem since. I can’t say the same for my other joints. In the years after the surgery, I developed occasional lower back pain. When it hit, I walked with a limp and felt shooting pain in my hip. I saw specialists and did physical therapy. I had a cortisone injection and nothing seemed to help. For years, it was a mystery. 

In 2010, I discussed it with my doctor and he suggested something I didn’t expect: a DNA test. A few days after a blood draw, I received an email from the hospital saying that the test showed I may have a disease called Ankylosing Spondylitis, which is severe arthritis that causes lower back vertebrae to fuse together. The prognosis was terrifying. 

I met with a rheumatologist, who fully reviewed my condition and ordered an MRI. It was time to learn my fate. Turns out, I didn’t have the terrible disease but did have arthritis and inflammation in my SI joints. 

The most fascinating part of this scenario is the DNA test. It showed I had a genetic marker that is highly correlated with a number of disorders. Along with arthritis, people with this marker have problems related to eyes, heart valves, bowels, and skin. The research says about 8% of Caucasians have the marker. I only have the arthritis side, thankfully. 

On my next visit, he tested my movement and noticed the looseness of my joints, which he said could be connected to the genetic marker. He asked if I practiced yoga, and I said no. He then said something I’ll never forget. “Well, if you start, don’t get a superiority complex, because your joints don’t work like other peoples’.” Noted.

Since then, I’ve been fascinated by the genetic dimension of this. My oldest brother has problems with his shoulders dislocating and so does his son. I recently reconnected with a first cousin who explained his family suffers from debilitating back pain. The genetic marker has probably been a part of our family for generations without anyone recognizing it. 

Today, my right shoulder is still in great shape, but my left one continues to be an occasional problem. I dislocated it a couple of years ago while indoor skydiving and had to go to the emergency room to have it reset. It was the first time my shoulder remained out of joint for more than a moment. I was amazed at how easily the doctor returned it to its socket and I made a mental note for future reference.

Unfortunately, an opportunity arose a few days ago. We had friends coming over in the evening and I was casually cleaning a mirror backsplash under a shelf. To reach the top of the mirror, I raised my left arm in a weird position. Before I knew it, my shoulder was out of socket. I gasped a string of profanity as Sachi came to help. My arm drooped off my shoulder and the slightest movement shot pain through my arm. 

I immediately broke into a cold sweat and tried to stay calm. I sat down and worked with Sachi to remove layers of sweaty clothes. She draped a cool wet towel across my neck that felt like such a relief. Then my ears lost fidelity, my vision blurred a bit and I decided to move to the floor before the floor moved to me. 

As long as I was still, the pain was minimal. Suddenly, the whole day looked different. Neither of us wanted to get on a ferry to get it reset. Would we have to cancel our dinner plans? 

Sachi searched the web for the doctor’s method of resetting the joint and eventually found videos that matched my experience in the ER. It’s called the Cunningham Technique. I sat across from her and put my dislocated arm on her shoulder. Relaxation is key, so I took deep breaths and she massaged my shoulder muscles. She then put a little weight on my elbow and started to pivot it back. I felt it slip right back into the joint with almost no pain, like magnets pulling it into place. The joint wanted to be there. What a relief!

Within a few minutes, it was like nothing had happened. Dinner was back on and no one needed to board a ferry. The biggest lesson here is that I can’t clean those mirrors anymore. It’s simply too dangerous. At least that’s what I told Sachi. 

Like my ankles, the pain from this shoulder injury was fleeting. Within days, I was back on the rowing machine and splitting wood. I’m not sure it classifies as a silver lining, but I’m thankful that my body allows me to recover easily. As I get older, I assume this superpower will wane. 

If you’re curious about the clinical side of this, the genetic marker is called HLA-B27. The current research is showing a connection between the marker and hypermobility syndromes like Ehlers-Danlos Syndrome.