Hypermobility syndrome is a connective tissue condition where your joints move beyond the normal range of motion, causing pain, instability, and often a wide range of symptoms throughout the body. An estimated 255 million people worldwide (about 3% of the population) live with some form of symptomatic hypermobility. While loose joints on their own are common and harmless, hypermobility syndrome means that flexibility is actually causing problems: chronic pain, frequent injuries, fatigue, and difficulties with everyday activities.
How Hypermobility Differs From Being Flexible
Plenty of people have joints that bend further than average. Dancers, gymnasts, and children are often naturally flexible without any issues. Joint hypermobility only becomes a “syndrome” or disorder when that excessive range of motion leads to symptoms like joint pain, recurrent dislocations or subluxations (partial dislocations), soft tissue injuries, and fatigue. The distinction matters because being hypermobile is a physical trait, while having hypermobility syndrome means that trait is interfering with your quality of life.
HSD vs. Hypermobile Ehlers-Danlos Syndrome
The terminology around hypermobility can be confusing, partly because it changed significantly in 2017. Before that year, most people with symptomatic hypermobility received a diagnosis of “joint hypermobility syndrome” or “hypermobility type Ehlers-Danlos syndrome,” and the two were used almost interchangeably. A 2017 international reclassification created stricter criteria for hypermobile Ehlers-Danlos syndrome (hEDS) and introduced a new umbrella term, hypermobility spectrum disorder (HSD), for people who are symptomatic but don’t meet every hEDS criterion.
In practice, the line between HSD and hEDS can feel arbitrary. People with either diagnosis report the same types of physical and mental health challenges, and research has found no meaningful clinical difference in the level of impairment between the two groups. Because the genes behind hEDS haven’t been identified yet, there’s no genetic test for either condition. Diagnosis relies entirely on a clinical evaluation.
What Causes It
Connective tissue is the structural scaffolding of your body. It holds joints together, gives skin its elasticity, and supports blood vessels and organs. In hypermobility syndrome, that scaffolding is looser and more fragile than normal. The core issue involves collagen and other proteins in what scientists call the extracellular matrix, the mesh of fibers that gives tissues their strength and shape. Mutations in genes that produce or process these proteins lead to tissue that stretches too easily and doesn’t spring back the way it should.
This explains why hypermobility isn’t just a joint problem. Collagen exists in nearly every tissue in the body, so when it’s structurally different, the effects can show up in your skin, gut, blood vessels, and nervous system.
Symptoms Beyond the Joints
Joint pain and instability are the hallmarks, but most people with hypermobility syndrome experience a much broader set of symptoms. Fatigue is one of the most common complaints, often severe enough to interfere with work and daily routines. Skin tends to be softer and more stretchy than average, bruises easily, and heals slowly.
Gastrointestinal symptoms are surprisingly common: nausea, stomach pain, bloating, and alternating diarrhea and constipation. These likely stem from the same connective tissue laxity affecting the structures of the digestive tract. Many people also report feeling lightheaded or dizzy when standing up, along with heart palpitations. These are signs of autonomic dysfunction, where the nervous system that controls involuntary functions like heart rate and blood pressure doesn’t regulate itself properly.
The POTS and Mast Cell Connection
A cluster of overlapping conditions frequently appears alongside hypermobility. Postural orthostatic tachycardia syndrome (POTS), where your heart rate spikes abnormally when you stand, is one of the most recognized. Lax blood vessels may allow blood to pool in the legs, forcing the heart to compensate. One study found that 66% of patients with both POTS and Ehlers-Danlos syndrome also had symptoms suggestive of a mast cell disorder, a condition where immune cells release excessive amounts of chemical signals, triggering flushing, hives, GI symptoms, and sometimes anaphylaxis-like reactions. The connection among all three conditions is still debated, but clinicians increasingly screen for them together.
How It’s Diagnosed
Diagnosis starts with a physical assessment called the Beighton score, a nine-point scale that measures joint flexibility at five sites on the body. You receive one point for each of the following you can do:
- Bend forward and place your hands flat on the floor without bending your knees (1 point)
- Hyperextend each elbow past straight (1 point per elbow)
- Hyperextend each knee past straight (1 point per knee)
- Bend each pinky finger back beyond 90 degrees (1 point per finger)
- Bend each thumb back to touch the forearm (1 point per thumb)
A score of four or more, combined with joint pain in four or more joints lasting at least three months, points toward hypermobility syndrome. For a formal hEDS diagnosis, doctors look for additional features: signs of widespread connective tissue involvement (such as unusually soft or stretchy skin, unexplained stretch marks, or dental crowding), a family history of the condition, and musculoskeletal complications like recurrent dislocations. At least two of three broader categories of features must be present alongside the hypermobility itself. Because there’s no blood test or imaging study that confirms the diagnosis, many people wait years before getting an answer.
Exercise and Physical Therapy
Strengthening the muscles around hypermobile joints is the single most effective long-term strategy. When ligaments and tendons are too lax to stabilize a joint on their own, muscles have to pick up the slack. Physical therapy for hypermobility follows a specific progression: exercises typically start with isometric holds (contracting a muscle without moving the joint), then gradually move through larger ranges of motion as control improves. Programs progress from non-weight-bearing to weight-bearing positions, from bilateral to single-limb exercises, and from the core outward to the arms and legs.
Neuromuscular and proprioceptive training, exercises that improve your brain’s awareness of where your joints are in space, are recommended at least five days a week. This might include balance work, posture drills, and activities that challenge body alignment. Gentle dynamic warm-ups before strengthening sessions help reduce pain and injury risk. High-impact activities like running and exercises with sudden stop-and-go movements are generally discouraged if you have joint pain or arthritis in the lower body, since the repeated force can accelerate joint damage in already-unstable joints.
Braces, Splints, and Daily Adaptations
Supportive devices can make a significant difference in day-to-day function. Ring splints, small metal or plastic supports worn on the fingers, are one of the most common tools. They allow normal finger movement while preventing the hyperextension that causes pain during tasks like writing, typing, or gripping. Ankle braces serve a similar purpose for walking. The key is that these supports should be functional and non-immobilizing: they limit dangerous ranges of motion without locking the joint in place, so your muscles keep working and don’t weaken from disuse.
Kinesiology tape can offer proprioceptive feedback and pain relief, though skin fragility is a consideration since some people with hypermobility bruise or react to adhesives more easily. Proprioceptive braces, which provide compression and sensory input rather than rigid support, can be worn daily or during specific activities. For some people, a wheelchair or other mobility aid becomes appropriate for longer distances or flare days, allowing them to conserve energy and protect their joints.
Managing Chronic Pain
Pain in hypermobility syndrome tends to be widespread, fluctuating, and often poorly understood by clinicians unfamiliar with the condition. Over-the-counter anti-inflammatory medications and acetaminophen are typically the first line for mild to moderate pain. When pain becomes more persistent or involves nerve-related symptoms like burning or tingling, medications that target the nervous system’s pain-processing pathways are sometimes used. Muscle relaxants can help with painful spasms but carry a trade-off: they may increase joint instability by relaxing the very muscles that are compensating for loose ligaments.
Because hypermobility pain is driven by both structural instability and changes in how the nervous system processes pain signals, medication alone rarely provides adequate relief. The most effective approach combines consistent strengthening exercise, joint protection strategies, pacing of daily activities to avoid boom-and-bust energy cycles, and targeted pain management when needed.