Elastigirl or Is It Just Ehlers-Danlos Syndrome?

Helen Parr is peculiar. She leads a double life as a wife, a mom of three, and a crime-fighting superhero from Disney Pixar’s animated movie The Incredibles. Her leading superpower is elasticity, which allows her to stretch far and wide and be incredibly hypermobile. However, this idea of hypermobility can’t help but raise the question of whether Helen Parr has Ehlers-Danlos syndrome. I chose to research Ehlers-Danlos syndrome for my STEAM project because it relates to the objective of “relating the interaction of muscles and the skeletal system.” This disorder essentially affects the entire body as it is a connective tissue disorder that affects not only the muscle and the skeletal system but also the gastrointestinal, integumentary, and nervous systems. 

Ehlers-Danlos syndrome (EDS) is a complex hereditary connective tissue disorder that often causes generalized joint hypermobility, skin hyperextensibility, atrophic scarring, and chronic pain (Guerrieri et al., 2023). This disorder may also cause gastrointestinal (i.e., heartburn or irritable bowel and reflux esophagitis), urinary (i.e., incontinence), cardiovascular (i.e., increased heart rate), and central nervous issues (i.e., fatigue). However, the diagnosis and precise criteria of EDS have yet to be identified, as there are 14 subtypes of EDS, the most common being hypermobile (hEDS), classical (cEDS), and vascular (vEDS). Common EDS  and vascular EDS are caused by mutations in the COL5A1/COL5A2 and COL3A1 genes. The molecular cause of hypermobile EDS is still under further research. However, a deficit in collagen synthesis causes connective tissue disorders. Collagen is vital in the skin, joint capsules, and ligaments; therefore, a deficit can cause joint hypermobility, tissue fragility, and skin hyperextensibility (De Beats et al., 2023). 

Hypermobile Ehlers-Danlos syndrome can cause precarious joint stability, which may result in frequent sprained ankles or dislocations. Integumentary issues may range from highly stretched skin to easily bruised or scarred skin. In addition, because EDS patients have very loose connective tissues that cannot stabilize joints and various bones (like the ankle or knee joint), this disorder also affects an individual’s muscle tone. According to Daspar et al. (2022), motor developmental delay is frequently reported due to muscle weakness in younger children. However, this is mainly in newborns and infants with musculocontractual EDS (mcEDS), a rare autosomal recessive connective disorder. 

This muscle weakness may also restrict individuals from frequent resistance training or high-impact activities (Zabriskie H. et al., 2022). An eight-year study by Coussens et al. (2021) presented the question of whether the strength of knee flexion of patients with hypermobile Ehlers-Danlos syndrome changes over time. They had thirty female participants with hEDS, seventeen controls, complete muscle and endurance tests of the knee flexors and extensors, and two lower extremity posture maintenance tests to judge posture and static stability strength. In addition, to track muscle mass and density, the researchers utilized x-ray absorptiometry and peripheral quantitative computed tomography. The conclusion was that there was a significant decline in maximal muscle strength and strength endurance over the eight years with the women with hEDS in this study. 

Furthermore, according to Borsch et al. (2024),  “approximately 90% of patients with EDS suffer from chronic pain.” Due to these unfortunate circumstances with this disease, many people are faced with chronic pain from not only physical pain but also neurological pain as well. Some neuropathic pain may be nerve compression syndromes, carpal tunnel syndrome, or ulnar nerve syndrome (Borsch N. et al., 2024). Individuals can also experience frequent migraines and dizziness, such as cervicogenic headaches, which start at the base of soft neck tissues with unilateral pain and neck stiffness, limiting the range of motion (Al Khalili Y et al., 2024). This joint instability may lead to spondylolisthesis, atlantoaxial or craniocervical instability, and muscular tension (Borsch et al., 2024). The combination of all of what has been discussed can lead to a decreased quality of life. Unfortunately, there is no cure for Ehlers-Danlos syndrome, but what can be done are treatment mechanisms to help cope with these symptoms. These treatments are physical and occupational therapy aimed at teaching individuals how to move their bodies correctly and strengthen their muscles without further hurting themselves. For instance, participating in low-impact activities like swimming or non-weight-bearing exercises is favored over an activity like gymnastics that is hard on joints (De Baets et al., 2022). 

All discussed in this short essay only scarcely encapsulates what this disorder is. As much as Elastigirl can stretch, the conclusion seems that she does not have Ehlers-Danlos syndrome and is just that incredible.

References

Al Khalili Y, Ly N, Murphy PB. Cervicogenic Headache. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507862/

Brad Bird. 2004. The Incredibles. Pixar 

Börsch, N., Mücke, M., Maier, A., Conrad, R., Pantel, J. T., Sellin, J., Mani, K., & Chopra, P. (2024). Treating pain in patients with Ehlers-Danlos syndrome : Multidisciplinary management of a multisystemic disease. Schmerz (Berlin, Germany), 38(1), 12–18. https://doi-org.uaf.idm.oclc.org/10.1007/s00482-023-00778-7

Coussens, M., Calders, P., Lapauw, B., Celie, B., Banica, T., De Wandele, I., Pacey, V., Malfait, F., & Rombaut, L. (2021). Does Muscle Strength Change Over Time in Patients With Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder? An Eight-Year Follow-Up Study. Arthritis care & research, 73(7), 1041–1048. https://doi.org/10.1002/acr.24220

Daşar, T., Donkervoort, S., Kiper, P. Ö. Ş., Göçmen, R., Utine, G. E., Boduroğlu, K., Bonnemann, C., & Haliloğlu, G. (2022). A Life-Threatening Complication in a Patient with Ehlers-Danlos Syndrome Musculocontractural Type. Journal of Pediatric Research, 9(3), 297–301. https://doi-org.uaf.idm.oclc.org/10.4274/jpr.galenos.2022.51482

De Baets, S., Cruyt, E., Calders, P., Dewandele, I., Malfait, F., Vanderstraeten, G., Van Hove, G., & van De Velde, D. (2022). Societal participation in ehlers-danlos syndromes and hypermobility spectrum disorder, compared to fibromyalgia and healthy controls. PLoS ONE, 17(6), 1–15. https://doi-org.uaf.idm.oclc.org/10.1371/journal.pone.0269608

Guerrieri, V., Polizzi, A., Caliogna, L., Brancato, A. M., Bassotti, A., Torriani, C., Jannelli, E., Mosconi, M., Grassi, F. A., & Pasta, G. (2023). Pain in Ehlers-Danlos Syndrome: A Non-Diagnostic Disabling Symptom?. Healthcare (Basel, Switzerland), 11(7), 936. https://doi.org/10.3390/healthcare11070936

Zabriskie H. A. (2022). Rationale and Feasibility of Resistance Training in hEDS/HSD: A Narrative Review. Journal of functional morphology and kinesiology, 7(3), 61. https://doi.org/10.3390/jfmk7030061