Hypermobility and Ehlers-Danlos Syndrome: How Physical Therapy Can Help You Move With More Confidence
Being flexible is often considered a good thing. But when your joints move farther than they should—and that extra movement comes with pain, instability, weakness, fatigue, or repeated injuries—being “very flexible” can become much more complicated. For people living with joint hypermobility, hypermobility spectrum disorders (HSD), or Ehlers-Danlos syndrome (EDS), everyday movement may require more effort than other people realize.
You may experience joints that feel loose or unstable. You may frequently roll an ankle, experience joint pain after seemingly simple activities, or feel like your muscles are constantly working to hold your body together. Some people have difficulty exercising because they become sore quickly or because movements that seem easy for others do not feel safe or comfortable. This is where physical therapy for hypermobility and Ehlers-Danlos syndrome can be especially valuable.
Physical therapy does not change the underlying connective tissue disorder. Instead, the goal is to help your body work as effectively as possible by improving strength, joint control, balance, body awareness, endurance, and movement patterns. For many people, the goal is not to become more flexible. The goal is to become stronger and more controlled within the movement you already have.
What Is Joint Hypermobility?
Joint hypermobility means one or more joints move beyond what is considered a typical range of motion. Some people are naturally very flexible and never experience any problems. They may participate in gymnastics, dance, yoga, or other activities where flexibility can even be an advantage. Hypermobility becomes more important when it is associated with symptoms such as pain, joint instability, repeated injuries, or difficulty performing everyday activities. Hypermobility spectrum disorders are connective tissue disorders associated with joint hypermobility along with problems such as instability, injury, and pain.
Think about a joint as having both mobility and stability. Mobility is how much the joint can move. Stability is how well the muscles and other structures around the joint control that movement. If you have more mobility than your body can effectively control, your muscles may have to work harder to stabilize the joint. That can contribute to fatigue, discomfort, or a feeling that a joint is loose or unreliable.
What Is Ehlers-Danlos Syndrome?
Ehlers-Danlos syndromes are a group of inherited connective tissue disorders. Connective tissue helps provide support and structure throughout the body, including the skin, joints, blood vessels, and other tissues. Joint hypermobility occurs in many types of EDS and is a hallmark characteristic of hypermobile Ehlers-Danlos syndrome, or hEDS.
There are multiple types of Ehlers-Danlos syndrome, and they do not all affect the body in exactly the same way. Hypermobile Ehlers-Danlos syndrome is commonly associated with generalized joint hypermobility, joint instability, pain, and recurring soft-tissue or joint problems. Because EDS can involve more than the muscles and joints, medical evaluation and appropriate coordination among healthcare providers are important. Physical therapists do not replace the medical professionals involved in diagnosing EDS. Instead, physical therapy focuses heavily on the movement and functional challenges associated with hypermobility.
What Does Hypermobility Feel Like?
Hypermobility looks different from person to person. One patient may be able to bend a thumb toward the forearm or easily hyperextend the knees. Another person may not think of themselves as particularly flexible but may have ongoing problems with joint stability. Some people have been told their entire lives that they are “double-jointed.” Others begin looking into hypermobility after years of unexplained joint or muscle discomfort.
Common musculoskeletal concerns may include:
- Joints that feel loose or unstable
- Recurring joint or muscle pain
- Frequent ankle rolling
- Repeated sprains or strains
- A feeling that a joint may “give way”
- Difficulty maintaining posture
- Muscle fatigue
- Reduced endurance
- Poor balance
- Difficulty knowing where a joint is positioned
- Clicking or popping sensations
- Difficulty tolerating certain exercises
- Repeated subluxations or dislocations in some individuals
People with hEDS may experience joint instability, soft-tissue injuries, subluxations, or dislocations, sometimes with relatively little trauma. However, having some of these symptoms does not automatically mean you have Ehlers-Danlos syndrome. There are many reasons someone may experience joint pain, weakness, or instability. If EDS or another connective tissue condition is suspected, an appropriate medical evaluation is important.
Why Can Hypermobility Cause Pain?
It can seem confusing. If a joint has plenty of movement, why would it hurt? The answer often comes down to control. Imagine a door hinge that moves much farther than necessary. The extra movement itself is not necessarily the problem. The problem occurs when there is not enough control to consistently guide and support that movement. Your muscles play an important role in providing that control. If the passive structures surrounding a joint allow more movement, muscles may need to work harder to provide stability. Over time, this can contribute to muscle fatigue and increased stress during daily activities. People may also develop compensations. For example, if a hip does not feel stable, the body may change the way it walks.
If a shoulder feels unstable, surrounding muscles may remain tense to provide additional support. If the knees regularly move into hyperextension while standing, the person may rely on the end range of the joint instead of actively using the muscles around it. These movement strategies may help temporarily, but they may also contribute to discomfort over time. That is why physical therapy for hypermobility often focuses less on increasing flexibility and more on improving strength, stability, coordination, and movement awareness.
How Can Physical Therapy Help With Hypermobility and EDS?
Physical therapy can play an important role in helping people with hypermobility-related conditions manage movement and function. Research reviews support therapeutic exercise and motor-function training as useful parts of rehabilitation for people with generalized hypermobility spectrum disorder and hEDS, although researchers continue to study which approaches are most effective. The exact physical therapy program should be different for every person. A licensed physical therapist may evaluate areas such as:
- Strength
- Joint stability
- Balance
- Posture
- Walking
- Coordination
- Joint position awareness
- Functional movement
- Activity tolerance
- Movement habits
- Areas of pain or limitation
The therapist can then create a personalized care plan based on the patient’s specific findings and goals. Here are several areas physical therapy may address.
1. Building Strength Around Hypermobile Joints
Strength is extremely important when joints have more movement than usual. Muscles help provide active support around joints. For example, stronger muscles around the hips and knees may help improve control of the lower extremities during walking, stairs, squatting, or recreational activities. Shoulder and upper-back strengthening may improve control around the shoulder blade and shoulder joint. Core and trunk strength may also help provide a more stable foundation for movement.
The Ehlers-Danlos Society notes that exercise can improve muscle strength, which can help stabilize hypermobile joints. But strengthening does not mean simply lifting the heaviest weights possible. With hypermobility, how an exercise is performed can be just as important as the exercise itself. A physical therapist can help determine the appropriate resistance, range, position, repetitions, and progression.
2. Learning to Control Your Available Range of Motion
For someone with hypermobility, more range of motion is not usually the primary goal. Control is. Many people with hypermobile joints naturally rest at the very end of their available range. Someone may stand with their knees pushed backward into hyperextension. An elbow may lock beyond a typical straight position. A shoulder may move farther than the muscles can comfortably control.
Physical therapy can help patients learn to recognize these positions and develop better muscular control through a comfortable range. The goal is not necessarily to make a hypermobile joint less mobile. Instead, therapy may help you become more stable within your available movement. That distinction is important.
3. Improving Proprioception and Body Awareness
Have you ever tried to perform an exercise only to discover that your knee or shoulder was in a completely different position than you thought? This involves proprioception, which is your body’s awareness of where it is in space. Joint hypermobility can be associated with challenges in joint position awareness for some people. That means someone may need additional practice learning where a stable or neutral position feels.
Physical therapy may include exercises designed to improve body awareness, coordination, and control. Research examining physiotherapy for hEDS has reported potential benefits for proprioception and pain, although larger and stronger studies are still needed. Improved awareness can carry over into walking, exercise, work, sports, and everyday activities.
4. Improving Balance
Balance requires your brain, eyes, inner ear, muscles, and joints to work together. When joints are unstable or joint position awareness is reduced, balance can become more challenging. Your physical therapist may evaluate your balance and determine whether specific exercises should be included in your program. Balance activities can begin at a comfortable and appropriate level before gradually becoming more challenging. The goal is not to throw someone into a difficult balance activity immediately. Progress should be controlled and appropriate for the individual.
5. Improving Movement Patterns
Sometimes pain is not only about how much a joint moves. It is also about how you use that movement. Your therapist may observe how you:
- Stand
- Walk
- Sit
- Bend
- Squat
- Reach
- Lift
- Climb stairs
- Exercise
- Perform work activities
Small changes can sometimes make movement feel more controlled. For example, a patient may need to learn how to use the hip muscles more effectively during a squat rather than allowing the knees to move into a less controlled position. Someone else may benefit from improving shoulder blade control during reaching. The specific correction depends on the person. This is one reason individualized physical therapy can be so valuable for someone with hypermobility.
6. Learning How to Exercise Without Constantly Overdoing It
A common challenge for people experiencing chronic joint symptoms is finding the right amount of activity. You may feel good one day and do much more than usual. Then you may become extremely sore or fatigued afterward. That can create a frustrating cycle:
Feel better → do too much → symptoms increase → stop activity → feel better → repeat.
Physical therapy may help create a more gradual approach. Rather than trying to accomplish everything at once, your therapist can help build exercise tolerance progressively. Research on exercise and rehabilitation in people with EDS suggests that rehabilitation programs may improve various physical outcomes, but the available research is still developing. For many patients, consistency is more useful than repeatedly moving between extreme activity and complete rest.
Should People With EDS Stretch?
This is an important question because people often assume that tightness means they need more stretching. With hypermobility, that may not always be the case. A person can feel tight while still having joints that move excessively. Why? Muscles sometimes become tense because they are working hard to provide stability. That means repeatedly pushing farther into an already excessive range may not address the real problem. This does not mean everyone with hypermobility must avoid every stretch. It means stretching should be individualized. A physical therapist can evaluate whether an area truly has restricted mobility and whether stretching is appropriate. For some people, stability and strength may deserve far more attention than flexibility.
Does Physical Therapy for EDS Need to Be Different?
It often needs to be more individualized. There is no single exercise program that is appropriate for every person with EDS or hypermobility. One person may primarily struggle with shoulder instability. Another may have difficulty with the knees and hips. Someone else may have widespread symptoms, poor endurance, balance problems, or difficulty tolerating activity.
The Ehlers-Danlos Society recommends adapting exercise according to each person’s abilities and limitations. This is especially important because progressing too aggressively may not be appropriate for some patients. Physical therapy may need to begin with relatively simple activities and increase gradually based on how the patient responds.
What Should You Expect During a Physical Therapy Evaluation?
At Hohman Rehab & Sports Therapy, your physical therapy care begins with an evaluation by a licensed physical therapist. For someone experiencing hypermobility-related concerns, the therapist may discuss:
Your symptoms: Where do you have discomfort, weakness, instability, or fatigue?
Your history: Have you experienced repeated sprains, strains, joint problems, or other injuries?
Your activities: What movements, jobs, sports, hobbies, or everyday tasks are difficult?
Your goals: What would you like to be able to do more comfortably or confidently?
Your therapist may also evaluate your strength, balance, movement control, posture, walking, coordination, and functional activities. Joint hypermobility may sometimes be assessed using tools such as the Beighton Score, a nine-point scoring system that examines hypermobility at several joints. However, a Beighton score alone does not diagnose Ehlers-Danlos syndrome. Your physical therapist uses the evaluation to identify movement and functional problems that may be appropriate for physical therapy and develops a personalized care plan based on those findings.
What Are the Goals of Physical Therapy for Hypermobility?
The goal is not to turn a flexible person into an inflexible person. And it is not necessarily to eliminate every symptom. The goal is to help you function better. Depending on the individual, physical therapy goals may include:
- Improving joint stability
- Increasing strength
- Improving balance
- Improving body awareness
- Improving posture and movement habits
- Building activity tolerance
- Improving confidence with movement
- Returning to work, recreation, or exercise
- Reducing repeated aggravation of sensitive areas
- Helping you better understand how to manage your body
The long-term goal is to give you tools you can use beyond the physical therapy clinic.
Why One-on-One Physical Therapy Can Be Especially Important
Hypermobility is a good example of why physical therapy should not be a one-size-fits-all experience. Two patients with the same diagnosis may need completely different programs. One person may need more strength. Another may need better joint awareness. Another may need to modify the way they perform everyday tasks. A therapist working closely with you can watch how you perform each movement and make adjustments as needed. That can be especially helpful with hypermobility because an exercise can look very different depending on whether the patient is controlling the movement or simply moving into the end range of a joint.
At Hohman Rehab, we believe that personalized, one-on-one attention allows us to focus on those details. Your therapist can modify the exercise, resistance, range, position, or difficulty based on how your body responds. As you improve, your program can progress with you.
Can You Still Be Active With Hypermobility or EDS?
For many people, the goal is absolutely to remain active. Physical activity and exercise can be important parts of maintaining strength and function. The key is finding activities and exercise levels that are appropriate for your body. That may involve gradually building:
- Strength
- Endurance
- Balance
- Coordination
- Cardiovascular fitness
- Activity tolerance
Some people may need to modify certain movements or activities. Others may need a slower progression than they are accustomed to. The right approach depends on your individual symptoms, medical history, and goals. Rather than thinking: “What exercises are people with EDS allowed to do?” A better question is: “What type and amount of exercise is appropriate for me right now?” That is something your healthcare team and physical therapist can help you determine.
Hypermobility Does Not Mean You Have to Stop Moving
Pain and instability can make movement intimidating. If an activity has caused symptoms before, it is understandable to become cautious. But avoiding movement altogether can lead to loss of strength and conditioning, which may make everyday activities even harder. The goal of physical therapy is not to force you through painful activities. It is to help find an appropriate starting point and gradually build from there. For some people, that starting point may feel surprisingly basic. That is okay. Building a strong foundation can be more useful than rushing ahead to advanced exercises before your body is ready.
When Should You Consider Physical Therapy?
You may benefit from speaking with a physical therapist if joint hypermobility is affecting your ability to participate in normal activities. Examples include:
- Repeated joint or muscle discomfort
- Difficulty exercising because joints feel unstable
- Recurring sprains or strains
- Frequent balance problems
- Difficulty standing or walking for longer periods
- Trouble returning to sports or recreational activities
- Weakness that affects everyday tasks
- Difficulty controlling hypermobile joints
- A diagnosed hypermobility spectrum disorder or EDS with movement-related limitations
If you have unexplained symptoms or suspect you may have Ehlers-Danlos syndrome, speak with an appropriate healthcare provider about whether additional medical evaluation is needed. Certain types of EDS, including vascular EDS, can involve serious complications outside the musculoskeletal system, which is another reason appropriate medical diagnosis and coordinated care are important.
Physical Therapy for Hypermobility and EDS in Central Florida
Living with hypermobility can sometimes feel like your body has plenty of movement but not enough control. Physical therapy can help shift the focus from simply being flexible to becoming stronger, more stable, and more confident with movement. At Hohman Rehab & Sports Therapy, our licensed physical therapists provide personalized evaluations and develop individualized care plans based on each patient’s needs and goals. We work with patients experiencing hypermobility and EDS-related movement challenges to help address strength, stability, balance, movement control, activity tolerance, and everyday function.
There is no one perfect exercise for EDS. There is no single treatment plan that works for everyone. And progress does not always happen in a perfectly straight line. That is why individualized care matters. Our goal is to understand what is limiting you, determine which areas may be contributing to the problem, and help you build a plan for moving forward.
Take the Next Step
If hypermobility, joint instability, weakness, or recurring discomfort is making it harder to exercise, work, participate in sports, or enjoy everyday life, physical therapy may be able to help. Start with an evaluation by a licensed physical therapist. Together, you can identify the movement problems affecting you and develop a personalized plan designed around your goals.
Hohman Rehab & Sports Therapy
Clermont
236 Mohawk Rd.
Clermont, FL 34715
(352) 404-6908
Ocoee
11095 W. Colonial Dr.
Ocoee, FL 34761
(407) 347-8936
Apopka
125 S. Park Ave.
Apopka, FL 32703
(407) 410-3200
Visit www.hohmanrehab.com to learn more or schedule an appointment.
Let us help you on your path to wellness—with personalized physical therapy focused on helping you move better, feel stronger, and become more confident in what your body can do.
Written By:
Dr. Katie Hohman, PT, DPT, CLT
Physical Therapist, Certified Lymphedema Therapist, Founder