Being flexible can be useful. It may help with dancing, gymnastics, yoga or reaching that awkward spot between the couch cushions. However, there is an important difference between simply being flexible and experiencing pain, instability or other symptoms related to hypermobility.
Hypermobility means that a joint moves beyond its expected range. For some people, this causes no problems at all. For others, it may contribute to persistent pain, repeated injuries, fatigue and difficulty trusting their body during movement.
Understanding this difference is the first step towards receiving the right support.
Hypermobility becomes more clinically significant when it is associated with symptoms such as:
• Joint pain
• Joint instability
• Recurrent sprains
• Subluxations or dislocations
• Poor balance or body awareness
• Fatigue
• Reduced strength or exercise tolerance
• Difficulty completing daily activities
A person can be very flexible and completely symptom free. Another person may appear only mildly flexible but experience significant pain and instability. This is why assessment should consider the whole person, not just how far their joints can move.
Hypermobility can present in several ways.
This affects one joint or one area of the body, such as a shoulder, thumb or section of the spine.
This mainly affects the hands or feet, including flexible fingers, thumbs, toes and ankles.
This involves several areas of the body, such as the elbows, knees, fingers, spine and ankles.
Some people were clearly hypermobile when they were younger but may no longer demonstrate the same flexibility. Age, pain, surgery, stiffness and reduced activity can all change how flexible someone appears during an assessment.
Hypermobility Spectrum Disorder, commonly known as HSD, describes symptomatic joint hypermobility that is not explained by another connective tissue disorder.
People with HSD may experience:
• Persistent joint or muscle pain
• Recurrent injuries
• Joint instability
• Subluxations or dislocations
• Reduced proprioception
• Headaches
• Fatigue
• Digestive symptoms
• Autonomic symptoms, such as dizziness or difficulty regulating heart rate
HSD should not be dismissed as a minor diagnosis. Symptoms can have a significant effect on physical function, confidence, work, exercise and quality of life.
Ehlers Danlos syndromes are a group of inherited conditions that affect connective tissue.
Connective tissue provides support and structure throughout the body. It is found in the skin, joints, blood vessels, organs and many other tissues. When connective tissue is affected, symptoms may extend beyond joint flexibility.
Common features of Ehlers Danlos syndromes can include:
• Joint hypermobility
• Tissue fragility
• Unusually elastic or soft skin
• Easy bruising
• Delayed wound healing
• Unusual scarring
• Persistent musculoskeletal pain
There are several different subtypes, each with its own features and potential risks.
Hypermobile Ehlers Danlos syndrome, known as hEDS, is the subtype most commonly seen in musculoskeletal and exercise settings. It is currently diagnosed through clinical assessment because a single causative gene has not been identified for most people with hEDS.
Other forms may require genetic testing and specialist assessment.
A clinician may consider HSD, hEDS or another connective tissue disorder when someone presents with a broader pattern of symptoms, including:
• Widespread hypermobility with significant pain
• Frequent sprains, subluxations or dislocations
• Persistent joint instability
• Pain that appears greater than expected for the activity or injury
• Soft, stretchy or unusually fragile skin
• Easy bruising or unusual scarring
• Hernias or pelvic organ prolapse
• A strong family history of similar symptoms
• Significant fatigue
• Digestive concerns
• Pelvic floor symptoms
• Dizziness, faintness or heart rate regulation difficulties
• Symptoms affecting several body systems
The joints are only one part of the picture. Looking beyond flexibility is essential when symptoms are widespread or complex.
People with symptomatic hypermobility often present with repeated minor injuries or unexplained pain in different parts of the body.
They may report:
“I have always been bendy.”
“Everything feels unstable.”
“I keep hurting myself without doing anything major.”
“My scans are normal, but I am still in pain.”
Some people are treated for each injury separately without anyone recognising the wider pattern. Others are told that they simply need to stretch more or become stronger.
In reality, these clients often need a more individualised approach that considers joint control, fatigue, pain sensitivity, recovery and confidence with movement.
There is no single test that diagnoses every hypermobility related condition.
Assessment may include:
• A detailed history of flexibility and previous injuries
• Episodes of joint instability, subluxation or dislocation
• Family history
• Childhood flexibility
• Pain patterns
• Fatigue and recovery
• Skin, digestive or autonomic symptoms
• The Beighton score
• A validated five part hypermobility questionnaire
• Strength and endurance testing
• Balance and proprioception testing
• Movement control
• Functional loading tolerance
Referral to a general practitioner, rheumatologist, geneticist or another specialist may be recommended when symptoms suggest a broader connective tissue disorder.
Usually, the answer is no.
A joint that already moves excessively does not generally need more range. The priority is often improving control, strength and stability within the range that is already available.
Repeatedly pushing into end range positions may increase irritation or reinforce instability in some people.
Treatment should focus on helping the body feel more supported and capable, rather than simply making it more flexible.
Exercise can play an important role in managing symptomatic hypermobility, but the program needs to be appropriately paced.
The goal is not to avoid movement. The goal is to build the body’s capacity to tolerate movement safely and confidently.
A suitable program may focus on:
• Strength around vulnerable joints
• Controlled movement
• Balance and proprioception
• Muscular endurance
• General cardiovascular fitness
• Gradual exposure to daily and recreational activities
• Improved confidence with movement
• Managing fatigue and recovery
Progress may need to be slower when pain, fatigue or autonomic symptoms are prominent. Consistency is usually more valuable than occasional bursts of intense exercise followed by a significant flare.
Stability and control should be established before heavier or more complex loading is introduced.
Strength training is often helpful, but strengthening alone may not address every concern.
Management may also involve:
• Education and validation
• Pain science education
• Activity pacing
• Gradual conditioning
• Proprioception training
• Movement retraining
• Fatigue management
• Support for fear of movement
• Strategies for work, school or daily activities
• Referral to other health professionals when appropriate
Some people may also benefit from support from pain specialists, psychologists, occupational therapists, dietitians, pelvic health physiotherapists or medical specialists.
A coordinated approach is especially valuable when several body systems are involved.
More stretching is rarely the main solution for a joint that already moves beyond its expected range.
Deconditioning may contribute, but pain, instability, altered proprioception, fatigue and connective tissue differences can also affect performance.
Scans are useful for identifying certain structural changes, but they do not measure joint control, proprioception, fatigue or the wider effects of a connective tissue disorder.
Not every flexible person has a medical condition. However, hypermobility that is associated with pain, instability, fatigue, repeated injuries or broader symptoms deserves thoughtful assessment.
Physiotherapists and exercise physiologists can play an important role in recognising patterns, building strength and confidence, guiding safe exercise and referring for further investigation when required.
At PhysioHealth Corrimal, our focus is not simply on how far your joints can move. We look at how your body controls movement, tolerates load and manages the demands of everyday life.
Because when it comes to hypermobility, the goal is not to become less bendy. It is to become stronger, steadier and more confident in your body.
