Hypermobility Information
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TABLE OF CONTENTS
Part 1: Hypermobility - What does it actually mean?
Part 2: Hypermobility and Exercise
Part 1 - Hypermobility Education Series: Hypermobility - What Does It Actually Mean?
People who are very flexible or more “bendy” than others around them may be interested in learning more about hypermobility.
This information may also be useful for people who experience chronic musculoskeletal or joint pain, joint instability, repeated sprains or injuries, coordination or balance difficulties, scoliosis, exercise intolerance, or who have been diagnosed with a connective tissue or hypermobility-related condition.
I’m creating this information page to share what I have learned through my training, research, and experience working with people who have hypermobility and related conditions. My goal is to provide information that people may find interesting, useful, and practical when thinking about their own movement and exercise.
What is hypermobility?
At its most basic, hypermobility means that a joint can move through a greater range of motion than is typical.
For example, someone may naturally be more flexible or “bendy” than the people around them without doing anything specifically to become more flexible.
Some people naturally have very mobile joints and experience no pain or other problems at all. Being hypermobile does not automatically mean that something is wrong. Asymptomatic joint hypermobility is recognized as a normal variation for some people.
Children are generally more flexible than adults, and flexibility can also vary with age, sex, activity, and other individual factors.
People can also have hypermobility in different parts of the body. Someone may have one particularly flexible joint, a group of joints in one area, or increased mobility in many joints throughout the body.
For some people, however, hypermobility is accompanied by symptoms or difficulties that affect everyday life and physical activity.
These may include:
joint or musculoskeletal pain
joint instability or a feeling that a joint is loose or gives way
repeated sprains or other injuries
fatigue
difficulty with coordination or balance
difficulty tolerating physical activity or exercise
weakness or difficulty controlling certain movements
spinal curvatures such as scoliosis
and other musculoskeletal or movement-related difficulties
Hypermobility can involve more than joints
For some people, particularly those with certain hypermobility-related or connective tissue conditions, there may also be symptoms involving other systems of the body or conditions that commonly occur alongside them.
These can include things such as:
dizziness or lightheadedness
fainting or feeling like you may faint
exercise intolerance
fatigue or difficulty recovering from activity
POTS and other forms of autonomic dysfunction
low blood pressure
heart palpitations
Raynaud’s phenomenon
certain allergies, skin symptoms, or rashes
gastrointestinal symptoms such as reflux or IBS
pelvic floor problems or pelvic organ prolapse
ADHD, anxiety, and other neurodevelopmental or mental health conditions
and other symptoms or conditions that may occur alongside connective tissue or hypermobility-related disorders
The Ehlers-Danlos Society describes a number of symptoms affecting different body systems in people with HSD, while GeneReviews also describes multisystem features associated with hEDS.
These symptoms can have many different causes and do not, on their own, indicate a connective tissue disorder.
For example, dizziness, fainting, or difficulty tolerating exercise can occur for many reasons. These may include blood pressure changes, low blood sugar, low iron, dehydration, autonomic dysfunction such as POTS, cardiovascular or neurological conditions, medications, and other causes.
This is one reason it is important not to assume that every symptom is associated with hypermobility.
If someone experiences unexplained dizziness, fainting, significant exercise intolerance, or other concerning symptoms, those symptoms should be appropriately assessed.
For people who already know the reason for their symptoms, understanding how those symptoms may interact with movement and exercise can be an important part of developing an appropriate and individualized approach to physical activity.
Hypermobility and connective tissue disorders
Hypermobility can occur on its own, or it can be associated with a number of genetic and connective tissue conditions.
These include:
Hypermobility Spectrum Disorders (HSD)
Ehlers-Danlos syndromes (EDS)
Marfan syndrome
Loeys-Dietz syndrome
osteogenesis imperfecta
Stickler syndrome
and several other, rarer conditions
Joint laxity and hypermobility can occur in many different conditions, and the reasons for increased joint mobility are not necessarily the same from one condition to another.
There is also a great deal of individual variation.
One person may have one particularly flexible joint.
Another may have many hypermobile joints.
Another may have hypermobility as one feature of a diagnosed or suspected connective tissue disorder.
All of these people can have hypermobile joints.
Having hypermobile joints does not automatically mean that someone has a connective tissue disorder. Likewise, having a connective tissue disorder does not mean that every person will have the same degree or pattern of hypermobility.
The important thing is that hypermobility itself describes movement at a joint. It does not, by itself, explain why that movement is present or whether it is causing a problem.
Does everyone with hypermobility need to do something about it?
Not necessarily.
If someone is naturally flexible, has good control of their movement, and has no symptoms or limitations, there may be nothing specific they need to do because they are hypermobile.
Being hypermobile does not automatically mean that someone needs to change how they move, strengthen their joints, or follow a specific exercise program.
For people who do experience pain, instability, repeated injuries, weakness, fatigue, exercise intolerance, or difficulty participating in activities they want or need to do, however, there may be things we can work on that can help.
Appropriately selected and monitored exercise can help develop:
strength
joint control
coordination
balance
confidence with movement
tolerance for physical activity
and the ability to participate in activities that are important to the individual
It may also help reduce pain and improve how well someone is able to manage the physical demands of their daily life.
The goal isn't simply to strengthen or stabilize a joint.
It is about helping people move well, stay active, become more active, and do the things they want and need to do.
Sometimes those are things they weren't sure they could do.
Sometimes they are activities they had stopped because of pain, injury, fatigue, dizziness, or uncertainty about what their body could handle.
And sometimes they are simply the things that bring joy and fulfillment to their lives.
That is what I love to do — help people live their lives the best way they can, doing the things they need to do and the things that bring them joy, with less pain and, hopefully, sometimes no pain at all.
Part 2 - Hypermobility Education Series: Hypermobility and Exercise
The benefits of specific exercise
Regular exercise and active living are important for everyone, including people with hypermobility. Physical activity supports both physical and mental health, but some hypermobile people find it difficult to find activities and exercise that work well for their bodies.
I have seen the difference that specific exercises done consistently can make for many hypermobile people, including those who are bendy and those with suspected or diagnosed conditions such as Ehlers-Danlos syndromes (EDS), Hypermobility Spectrum Disorder (HSD), Marfan syndrome and others.
In my personal and work experience, I have seen positive changes that include reduced joint and muscle pain, increased stability and strength, reduced fatigue, improved coordination and balance, fewer injuries, and work and activities becoming possible or easier, among others. I have also seen improvements in overall quality of life.
These are some of the reasons I pursued additional training, including the Hypermobility: Exercise as Medicine course. I want people to know that specific exercise can make a meaningful difference, and that help is available, whether through me or another professional with appropriate training and experience working with hypermobile people.
Starting point and progression
Exercise for someone with hypermobility may need to begin at a considerably lower level than they, or others, expect.
For one person, a starting point might be a 30-second walk. For another, it might be just one or two repetitions of an exercise rather than three sets of ten.
This isn't a measure of how far someone can eventually progress. It is about finding an appropriate starting point for that individual.
Not every joint or area of the body is necessarily hypermobile, unstable or weak. Some areas may be strong and stable, while others need more attention. An exercise that involves several areas working together may need to start at a level that the least stable or least capable area can manage.
The goal is to build gradually from there. Many people are surprised by how far they can progress with consistency, although the time and progression will be different for everyone.
Quality over quantity
How an exercise is performed matters, not just whether someone can complete it.
Sometimes a person can perform an exercise and it looks correct from the outside, but they are relying on different muscles or movement strategies than intended. There may also be differences between the two sides of the body.
Individualized exercise can help work on movement control, stability, strength and coordination. Sometimes an exercise needs to be adapted or broken into smaller parts before it can be performed successfully.
Consistency, adaptation and the individual
Consistency is vital, but that doesn't mean every day will look the same.
Some days may be progression days. Other days may be maintenance days, gentler days or rest days. Exercise selection, repetitions, resistance, range of movement and other factors may need to be adapted to the person and how they are doing.
Progression is not always a straight line. The aim is to find a sustainable approach that allows someone to keep building their ability over time without continually pushing beyond what they can manage.
Working together
Building an appropriate exercise toolkit is a team effort.
It involves understanding the individual, finding an appropriate starting point, making adjustments when needed, and gradually building toward the activities and daily tasks that matter to them.
The goal isn't simply to complete a set of exercises. It is to help people develop the strength, stability, coordination and confidence to do more of what they want and need to do.
The information I share is based on my training, research, and personal and work experience. It is for informational purposes only and is not medical advice. Medical clearance may be required.
More information coming
This page will continue to grow as I add more information about hypermobility and related topics, including:
More information on connective tissue conditions and hypermobility
Joint Stability and Control
POTS and Exercise
Dizziness, Fainting and Exercise
Other co-existing conditions often seen with hypermobility and their affect on exercise
Exercise Intolerance
Hypermobility, Pain and Activity
and other topics related to movement and living well with hypermobility.
Sources & Further Reading
The Ehlers-Danlos Society — What is HSD?
A reader-friendly overview of joint hypermobility, HSD, symptoms, associated conditions, and management.GeneReviews — Hypermobile Ehlers-Danlos Syndrome
A detailed medical reference covering hEDS, clinical features, differential diagnosis, and conditions associated with joint laxity. And a clinical reference discussing individualized exercise to improve muscle strength, proprioception, joint stability and physical function.International Perspectives on Joint Hypermobility: A Synthesis of Current Science to Guide Clinical and Research Directions
A peer-reviewed overview of current concepts and terminology surrounding joint hypermobility.Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review
A peer-reviewed review of the available evidence regarding exercise and rehabilitation in EDS/HSD.The Ehlers-Danlos Society — Physical Therapy
A practical overview of exercise for EDS and HSD, including strengthening, movement control, individual adaptations, and the principle of starting low and progressing slowly. And further resources.
This information is intended for education and general information. It is not intended to diagnose a medical condition or replace assessment or care from an appropriate healthcare professional.
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