Hypermobility
What Is Hypermobility or hEDS?
Hypermobility isn’t just about being “super flexible.” For many, it’s a complex and often misunderstood condition that extends far beyond bendy joints.
There are different types of hypermobility, ranging from benign joint hypermobility (where flexibility is present but doesn’t cause issues), to Hypermobility Spectrum Disorder (HSD) and to more complex connective tissue disorders like hEDS.
This is a lifelong condition that comes with joint instability, chronic pain, fatigue, and even cognitive and emotional challenges. It can affect daily function, performance, and overall well-being. Early recognition, individualised treatment, and a multidisciplinary approach are key to long-term management (Podcast: Understanding Hypermobility and Performance).
Symptoms of Hypermobility
Hypermobility can present throughout the entire body and isn’t limited to just one joint or area. Some of the most common physical and systemic signs include:
-
Joint pain, frequent sprains, or injuries that take longer to heal
-
Muscle fatigue and a sense of being “floppy” or unstable
-
Poor balance or lack of body awareness (proprioception)
-
Dislocations or subluxations (partial dislocations)
-
Stretchy skin, easy bruising, or slow tissue recovery
-
Anxiety, sensory overload, brain fog, and fatigue
Because these symptoms often overlap and influence one another, we approach hypermobility through a whole-body, MDT approach, supporting physical, neurological, and emotional health together. ( Podcast: Understanding Hypermobility and Performance )
Types of Hypermobility Movement-Related Issues
Hypermobility presents differently in each individual, but common movement-related presentations include:
-
Pelvic instability and low back pain
-
Knee, shoulder, or ankle joint instability
-
Recurrent sprains or tissue injuries without clear trauma
-
Postural compensation and overuse patterns
How Is Hypermobility Assessed?
Assessing hypermobility involves looking at joint range of motion across several body areas and determining whether the range of motion falls outside the expected norm. This is typically done through a combination of physical tests, scoring systems, and clinical history.
The Beighton Score (0–9 Scale)
The Beighton Score https://www.fmphysio.com/post/hypermobility-asset-or-liability is the most commonly used screening tool to assess generalised joint hypermobility. It tests 5 specific movements across the body, with a total score out of 9. A score of ≥5 in adults (or ≥6 in children) suggests generalised joint hypermobility (GJH).
Treatment Approach to Hypermobility
Effective care for hypermobility doesn’t mean “pushing through” pain or fatigue. It means meeting your nervous system where it is, building strength, control, and resilience step by step. Treatment may include graded movement programs to build joint control and muscular stability, fatigue management and pacing strategies, proprioceptive retraining, and body awareness work, tools for flare-up prevention, nervous system regulation, and onward referrals to allied professionals as needed (e.g., psychology, dietetics, rheumatology).
For many hypermobile individuals, integrating psychological approaches to pain care, especially in cases of chronic pain and central sensitisation-driven symptoms, helps to manage the symptoms. Effective care for hypermobility means meeting the nervous system where it is, retaining it gradually and not pushing through pain.
The Goals of Hypermobility Rehabilitation
Rehabilitation for people with hypermobility is to improve joint stability, reduce pain, and support safe, efficient movement. Because hypermobile joints move beyond the typical range, the surrounding muscles must work harder to provide control and support. Strengthening key stabilising muscles, especially around the core, hips, shoulders, and spine, is essential to prevent injury and manage symptoms.
A major focus of rehab is improving proprioception, your body’s awareness of joint position in space, which helps reduce the feeling of joints “giving way.” Posture and movement re-education are also important, especially for those who rely on extreme ranges to feel stable. Learning to control movement through the mid-range can improve endurance and reduce overuse injuries.
Pain management strategies often include pacing, graded exercise, and avoiding joint positions that cause strain or instability. Rather than restricting movement, rehab supports safe mobility and confidence in daily activities or sport. Education around load management, fatigue, and joint protection empowers individuals with hypermobility to stay active and reduce flare-ups.
The ultimate goal is to build a strong, resilient body that can handle daily demands, support long-term joint health, and reduce the risk of recurrent pain or injury.
.png)