Understanding Hypermobility Disorders

Understanding Hypermobility Disorders — And How Physiotherapy Can Help!

Hypermobility disorders, including Hypermobile Ehlers-Danlos syndrome (HEDS) and Hypermobility spectrum disorder (HSD), affect the way connective tissue behaves throughout the body.

Connective tissue provides structure and support to joints, tendons, ligaments, skin, and even internal organs.

When it is more elastic than usual, joints can move beyond typical ranges, which can be an advantage in sports like dance, yoga, swimming or gymnastics — but can often cause increased pain, fatigue, or recurring overload issues.

Common Symptoms

People with hypermobility disorders may experience:

• Widespread joint or tendon pain

• Frequent sprains or overuse injuries

• Feeling unstable or “loose” in certain joints

• Fatigue after physical activity

• Slow recovery from increases in training load

It is important to remember that hypermobility does not make your body fragile, but more sensitive to changes in load.

Conditions That Can Present Alongside Hypermobility

Hypermobility doesn’t exist in isolation. Some people may also experience associated conditions such as:

• POTS (Postural orthostatic tachycardia syndrome) — symptoms like dizziness, rapid heart rate or fatigue when standing

• IBS (Irritable bowel syndrome) — digestive discomfort and sensitivity

• Pelvic floor dysfunction

• Temporomandibular joint (TMJ) pain

• Headaches or migraines

• Increased pain sensitivity or central sensitisation

• Chronic fatigue presentations

• MCAS (Mast cell activation syndrome)

Not everyone with hypermobility will have these issues — but recognising them helps guide safe and effective management.

The Role of Physiotherapy

Physiotherapy management is not centered on stretching or increasing flexibility. Rather, it focuses on improving load tolerance, strength, neuromuscular control, and tissue resilience.

Key pillars of physiotherapy for hypermobility include:

Progressive Strength Training

Stronger muscles provide active joint support. This helps reduce reliance on passive structures (ligaments, joint capsules) that may be more lax. Strength training is not just safe — it’s one of the most essential parts of hypermobility management.

Emphasis is placed on:

• Mid-range control

• Controlled tempo

• Body awareness and proper form

• Gradual load progression

• Adequate recovery

Tendon Capacity Rehabilitation

Individuals with hypermobility are prone to reactive tendinopathy when load increases exceed tissue tolerance.

Isometric and slow heavy resistance protocols are frequently utilised to build tendon resilience while minimising flare-ups.

Proprioceptive and Motor Control Training

Joint laxity often correlates with reduced proprioception. This is why hypermobile people are often seen as “clumsy” or may find they knock into things or trip over more easily.

Targeted neuromuscular exercises can help improve joint awareness, coordination, and dynamic stability.

Pain Science Education

Chronic pain in hypermobility is multifactorial and may involve central sensitisation. Education regarding load management, flare cycles, and nervous system regulation forms a core component of care.

With the right load, progression and recovery, people with hypermobility disorders can:

• Lift weights

• Run

• Play sport

• Live active, fulfilling lives

The key is structured, individualised management — not restriction.

If you think you may have hypermobility and are struggling with pain, we can help you build strength, confidence and long-term resilience.

Our physiotherapist Siobhan has a special interest in hypermobility (she is hypermobile herself), and can assist you in creating a plan to help achieve your goals.