Being hypermobile means your joints move beyond the normal range of motion. You might be able to bend your thumb to your forearm, push your knees or elbows past straight, or place your palms flat on the floor with ease. Roughly 10% to 30% of adults have some degree of generalized joint hypermobility, and for many it causes no problems at all. But for others, that extra flexibility comes with chronic pain, frequent injuries, and a surprising range of symptoms that extend well beyond the joints.
Why Some Bodies Are More Flexible
Joint flexibility is largely determined by collagen, the protein that gives structure and strength to ligaments, tendons, and other connective tissues. In people who are hypermobile, genetic variations alter how collagen is built or assembled, producing connective tissue that is weaker and more elastic than usual. Because collagen exists throughout the body, not just in joints, hypermobility can affect skin, blood vessels, the digestive tract, and other organ systems.
Several well-known conditions are rooted in these collagen differences. Ehlers-Danlos syndromes involve mutations in genes responsible for collagen types III and V. Marfan syndrome stems from a different protein involved in maintaining elastic fibers. But most people with hypermobility don’t have a rare genetic syndrome. They simply inherited stretchier connective tissue, often from a parent who could do the same party tricks with their fingers.
How Hypermobility Is Measured
The standard clinical tool is the Beighton score, a nine-point system that tests five movements: bending the little finger back past 90 degrees, touching the thumb to the forearm, hyperextending the elbows, hyperextending the knees, and placing the palms flat on the floor with straight legs. Several of these are tested on both sides, which is how the total reaches nine points. A score of 4 or higher in adults generally indicates generalized joint hypermobility.
Children and teenagers naturally score higher because flexibility decreases with age. About 35% of children and adolescents meet the threshold, compared to a much smaller percentage of older adults. In one study of people over 70, no one scored higher than 2. The probability of being classified as hypermobile drops roughly 5.5% for every year of age. Women are consistently more likely to be hypermobile than men across all age groups.
When Flexibility Becomes a Problem
Hypermobility on its own is not a disorder. It becomes one when it causes symptoms. The most common complaint is pain in the joints and muscles, particularly after activity. Frequent dislocations, subluxations (partial dislocations), and sprains are hallmarks. Shoulders and kneecaps are especially vulnerable. If you scored 4 or more on the Beighton scale and have had pain in four or more joints for at least three months, that pattern is typically described as joint hypermobility syndrome.
People with hypermobility also tend to have poorer proprioception, which is your body’s ability to sense where your joints are in space without looking at them. Research shows that hypermobile individuals make significantly larger errors when trying to match joint angles at the knee and elbow, compared to non-hypermobile people. This reduced body awareness isn’t limited to holding still. It extends to dynamic movements like walking and changing direction, which helps explain why injuries are so common. Over time, many hypermobile people unconsciously avoid physical activity or adopt protective movement patterns, which can lead to deconditioning and further functional limitations.
HSD and hEDS: The Diagnostic Spectrum
Since 2017, clinicians have distinguished between two main diagnoses for symptomatic hypermobility. Hypermobile Ehlers-Danlos syndrome (hEDS) is the more restrictive diagnosis, requiring not only joint hypermobility but also specific skin findings, family history patterns, and musculoskeletal features. Hypermobility spectrum disorder (HSD) is the diagnosis for people who have symptomatic hypermobility but don’t meet the full criteria for hEDS.
Neither condition has a genetic test. Diagnosis is based entirely on clinical evaluation. Importantly, HSD is not a “lesser” diagnosis. People with HSD can experience the same severity of pain and disability as those with hEDS. Much of the existing research was conducted before 2017, when the two conditions were grouped together, so the evidence base largely applies to both.
Symptoms Beyond the Joints
One of the most confusing aspects of hypermobility is how many seemingly unrelated symptoms can accompany it. Because collagen is a building block found throughout the body, the effects of altered connective tissue are widespread.
A well-documented cluster involves autonomic nervous system dysfunction, known as dysautonomia. The most common form is postural orthostatic tachycardia syndrome (POTS), where your heart rate spikes abnormally when you stand up, causing dizziness, fatigue, and sometimes fainting. Mast cell activation syndrome (MCAS), which involves excessive release of chemicals that trigger allergy-like reactions such as flushing, hives, and gastrointestinal distress, also overlaps significantly with hypermobility. This triad of hypermobility, dysautonomia, and mast cell issues appears frequently enough in clinical practice that many specialists screen for all three together. Migraine is another common comorbidity, sharing pathways with all three conditions.
Exercise and Strengthening
The most effective long-term strategy for managing hypermobility is building the muscular strength and control that your loose connective tissue can’t provide on its own. Physical therapy programs for hypermobility typically start with neuromuscular exercises, which teach your muscles to activate properly and stabilize joints before adding resistance or load. This means learning to engage deep stabilizing muscles, like the small muscles of the feet or the deep neck flexors, using careful cueing and controlled positions.
Progression follows a deliberate sequence: starting with isometric holds (contracting a muscle without moving the joint), then moving to controlled range-of-motion work, then adding resistance. Exercises move from bilateral to single-limb, from non-weight-bearing to weight-bearing, and from mid-range positions to fuller ranges. Gentle warm-up movements before strengthening sessions help reduce pain and injury risk. General cardiovascular conditioning is also important, since many people with hypermobility become less active over time and lose aerobic fitness as a result.
Proprioception training, such as balance exercises and joint position awareness drills, is a core component. Because the sensors in lax ligaments and joint capsules send less reliable signals to the brain, deliberately training balance and coordination can partially compensate for that deficit.
Braces, Splints, and Daily Support
Supportive devices play a practical role for many hypermobile people, but the goal is to assist joints without replacing muscle function. Proprioceptive braces, made from flexible neoprene or similar materials, provide light compression that improves body awareness through pressure on the skin. They don’t restrict movement, which means muscles continue to work while wearing them. Kinesiology tape can serve a similar purpose, though skin sensitivity is worth considering.
For fingers that hyperextend during everyday tasks like writing or gripping, ring splints limit the joint’s range while still allowing functional movement. These small, often silver-colored bands sit at the finger joints and prevent them from bending backward. Ideally, a hand therapist or occupational therapist should fit them. Ankle braces that allow walking but correct movement patterns can reduce overload injuries in the feet and lower legs. In-shoe orthotics, recommended by a podiatrist, address foot mechanics that contribute to pain further up the chain.
Rigid resting splints are reserved for periods of significant instability or pain, such as after a dislocation, and are sometimes prescribed for nighttime use to maintain joint alignment during sleep. Extended daytime use of rigid braces can lead to muscle wasting, so they’re typically a short-term tool rather than a permanent solution. Continuing to exercise alongside any bracing is essential to prevent the muscles from weakening further.