Physical Therapy for Hypermobility & Connective Tissue Disorders
Joint hypermobility can affect much more than flexibility. At Tailor-Made Physiotherapy, we provide individualized, one-on-one care to help improve joint stability, reduce pain, build strength, and restore confidence in movement.
Understanding Hypermobility
Joint hypermobility means that one or more joints move beyond the typical range of motion. While many people with hypermobility never develop symptoms, others may experience joint pain, recurrent injuries, instability, fatigue, or difficulty tolerating physical activity. Conditions such as Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos syndrome (EDS) often require an individualized approach that focuses on improving movement quality rather than simply increasing flexibility.
Common Symptoms
Musculoskeletal Symptoms
Chronic joint and limb pain — the most common complaint, often early on, becoming constant and generalized locations with age
Recurrent joint subluxations and dislocations
Soft-tissue rheumatism: tendinitis, bursitis, enthesopathies, and nerve entrapment syndromes [1]
Delayed motor development in children [2]
Muscle atrophy, cramps, and muscle pains
Skin and Connective Tissue
Soft, velvety, flexible skin
Easy bruising
Atrophic or widened, thin, scarring, particularly in classical EDS [3]
Stretch marks that start out red or purple and fade white or blue
Autonomic Dysfunction (Dysautonomia)
The most common autonomic profile is postural orthostatic tachycardia syndrome (POTS), present in approximately 20–58% of patients [4].
Symptoms include:
Orthostatic intolerance, dizziness, lightheadedness, presyncope/syncope
Palpitations, exercise intolerance
Dependent acrocyanosis, impaired thermoregulation [5]
Gastrointestinal Symptoms
Over 60% of hEDS/HSD patients report at least one chronic GI symptom [6].
Common manifestations include:
Gastroesophageal reflux disease (41%), heartburn (35%) [6]
Functional dyspepsia, early satiety, gastroparesis [7]
Abdominal pain, bloating [8]
Irritable bowel syndrome, constipation , diarrhea [8]
Functional dysphagia [6]
Neurological and Neuropsychiatric
Chronicfatigue — the most common extraintestinal comorbidity [6]
Migraine headaches [6]
Small fiber neuropathy with earlier onset and more severe autonomic involvement compared to idiopathic SFN [9]
Chiari I malformation, craniocervical instability, tethered cord [7]
Impaired memory and concentration [6]
Anxiety disorders, depression, and attention-deficit/hyperactivity disorder [7]
Cardiovascular
Mitral valve prolapse and/or aortic root dilation [7]
Dysrhythmias [10]
Arterial aneurysm/dissection (particularly in vascular EDS) [2]
Immune and Allergic
Mast cell activation syndrome (MCAS) — reported in ~25–32% of hEDS patients; the clinical triad of hEDS + POTS + MCAS is present in approximately 25% of affected women [4].
Food allergies, atopic features, urticaria, flushing [10]
Urogenital and Pelvic
How Physical Therapy Can Help
Treatment is designed around your specific symptoms, goals, and functional needs rather than a standardized protocol.
Treatment may include:
Joint stabilization exercises
Progressive strengthening
Manual therapy when appropriate
Movement retraining
Balance and proprioceptive training
Activity modification
Pain management strategies
Education for long-term self-management
Is Physical Therapy Right for You?
✔ You experience frequent joint pain or instability.
✔ You've had repeated sprains or dislocations.
✔ Exercise often increases your symptoms instead of improving them.
✔ You've been diagnosed with HSD or Ehlers-Danlos syndrome.
✔ You have persistent pain despite previous treatment.
✔ You want to return to normal daily activities and physical activities with greater confidence.
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Yes, physical therapy is considered one of the primary conservative treatments for symptomatic hypermobility and focuses on improving joint stability, strength, movement control, and long-term function. It is important to look for a therapist experienced with the listed conditions, for significantly better outcomes.
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Not always. While some muscles may benefit from stretching, many individuals with hypermobility already have excessive joint mobility. Treatment often emphasizes improving strength, stability, and movement control rather than increasing flexibility.
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Yes. Exercise is safe but should be introduced progressively and according to your symptoms, fitness level, and joint stability. A structured program can help improve strength, confidence, and tolerance for daily activities.
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Yes. Joint instability, muscle fatigue, altered movement patterns, and repeated tissue stress may all contribute to persistent pain. Treatment focuses on improving the body's ability to support and control movement over time.
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Both HSD and EDS involve joints that are more flexible than normal and can cause pain, but the main difference is how strictly the diagnosis is defined. Ehlers-Danlos syndrome (specifically the hypermobile type, which is the most common) is diagnosed when a person meets a stricter set of criteria — including widespread joint hypermobility plus additional features like certain skin changes, a family history, and involvement of other body systems. [11] HSD (hypermobility spectrum disorder) is diagnosed when someone has painful, overly flexible joints but doesn't check enough of those extra boxes to qualify for an EDS diagnosis. [11] Importantly, both conditions can cause very similar day-to-day symptoms — including chronic pain, fatigue, and digestive issues — and both benefit from the same types of treatment, so having HSD does not mean the symptoms are less real or less serious [12].
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In Maryland, most patients can begin physical therapy without a physician referral through Direct Access. If additional medical evaluation or collaborations are appropriate, we will help coordinate your care.