Neurodivergence, Hypermobility and Exercise

Student PlacementMDT Corner

Authors: Amanda Carey and Holly Graham  

What do hypermobility, neurodivergence and emotional regulation have in common?

More than you may expect.   

Over the last six weeks we have been looking into hypermobility and connective tissue disorders. We have created 3 podcasts:

We have decided to share our fourth and final topic, exploring the link between hypermobility and neurodiversity, with you as a blog post. 

Anxiety and hypermobility 

The association between anxiety and hypermobility is as old as the condition known today as Joint Hypermobility Syndrome. In 1957, rheumatologist J. Rotés first described the condition ‘Joint Laxity’ (Laxité Articulaire) – it’s original namesake. Rotés observed a remarkable degree of nervous tension suffered by patients with hypermobility.

In 2016, Eccles et al demonstrated a ‘mechanistic association between joint hypermobility and anxiety’. This means that the central nervous system does not properly regulate normal bodily functions (breathing, sweating and so-on). This is linked to structural and functional differences in emotional brain regions (amygdala and insula). The Amygdala triggers the brain’s “fight or flight” response. This is a driver of anxiety and panic, making the story of anxiety and hypermobility easy to understand. This alert system stimulates production of hormones adrenaline and norepinephrine. These hormones are released on standing, playing a key role in PoTS symptoms including dizziness and pre-syncope (Dr. Satish Raj, 2025). 

Rejection sensitivity 

Rejection sensitivity is a trait linked to people with ADHD. They may experience a heightened emotional response of sadness, anger or anxiety due to a failure or rejection. For Amanda, this concept was eye-opening, as someone diagnosed with ADHD at age 37, she had previously assumed that other people’s insensitivity was the problem!

Not to say that everyone with HSD or hEDS has ADHD or Autism, or vice versa. But based on research into ADHD and its association with hypermobility, it is worth considering the role of sensory input in ‘emotional regulation’. This is someone’s ability to cope with or respond appropriately to any given situation. This may positively influence management of these conditions. This is promising for future research as emotional regulation may not be part of ADHD diagnosis, but it is one of the most challenging aspects of the condition. When neurodivergent people struggle to regulate their emotions, they may resort to masking. This can have detrimental effects on their health. Not to mention their ability to manage in the workplace or in social interactions. 

Proprioception  

Proprioception is an external sense of where your body is in space. Interoception is your internal sensory system. Both are typically altered in Developmental Coordination Disorder, aka Dyspraxia. Poor emotional regulation and disassociation problems are shown to be related to altered proprioception. This was further influenced by the presence of joint hypermobility. This means, in the future, we could potentially target proprioception training as a way of improving emotional regulation. Rather than relying on conventional management strategies that do not work for everyone. Dr. Alan Hakim, Consultant Rheumatologist criticises the ‘false distinction’ between mental and physical health, which means patients often don’t receive the holistic care they need. 

Neurodivergence and exercise 

Physical exercise increases dopamine and norepinephrine production and affects their regulation. It has been suggested that this may even improve executive functioning. This refers to mental processes that involve organization, planning, and control of goal-directed behaviour and the working memory, underpinning these goals. Studies have suggested that exercise combining cognitive and physical elements is somewhat effective in managing ADHD symptoms. This could help to understand why a hypermobile person would typically require more feedback due to reduced proprioception. 

The fascia (think of it like clingfilm) covers nerves, vessels, muscles, tendons, ligaments and the brain, which is altered in those with HSD and hEDS. The fascia is a body-wide network crucial to all the metabolic, structural, and signalling processes. In hypermobile people, this system can be extremely compromised. So, a movement style that considers this system and the connection between fascia and muscle seems best placed to support bendy bodies. 

The Zebra club App 

Jeannie Di Bon (MA, CIMSPA) is a Hypermobility Movement Therapist and founder of The Zebra Club. She had this to say about her highly specialised movement approach: 

“The Zebra Club is the first ever platform for hypermobility. It has been running since 2019, so we have a great deal of experience in running online platforms now. I have hEDS plus MCAS, POTS and CFS so also have personal lived experience on top of 16 years clinical experience.  Virtual classes give flexibility and convenience to patients as many struggle to get to appointments. Plus, it is affordable and sustainable long-term.” 

Amanda gave the platform a go herself. She has 15 years experience in pilates as well as her physiotherapy training. She found that, from a user perspective it is an accessible movement platform that addresses the range of needs of hypermobile people. The programme starts with the foundations of movement: Breathing, relaxation, proprioception, stability, and balance. And, as Jeannie says, ‘It is hypermobility-specific and can be tailored for each patient’s needs.  It has variety and pretty much a class for every situation’. 

Often, it takes a joint injury or development of new symptoms for people to consider movement therapy. Poorly managed physical therapy can also be very discouraging. So, we asked Jeannie what advice she would give our readers to help motivate them and support long-term management of their condition(s). Jeannie had this to say: 

“I agree, it is very difficult, and part of the issue is the lack of specialists who really get it. It is important to feel seen and understood as part of our journey. That’s why The Zebra Club is so great – there is a whole community who ‘get’ you. I encourage people to embrace pacing and resting constructively. We need to change the narrative about pushing through pain. We build strength slowly and safely with mindful movement and learn to really listen to our bodies. A huge part of what I do is nervous system regulation work – allowing the body to move into a calmer state. And always celebrate the small wins – everything counts.” 

Conclusion/ summary 

Neurodivergent individuals are more likely to experience chronic pain, fatigue and other hypermobility-type issues than those who aren’t diagnosed with a connective tissue disorder. Hypermobility is shown to increase anxiety and emotional dysregulation. This is due to the instability of connective tissues causing the body to go into ‘fight or flight’ mode. Hypermobility can also be linked to neurodivergence through emotional regulation and proprioception issues, due to overlapping symptoms and manifestations. These manifestations can be helped by providing feedback and focussing on aspects such as breathing, relaxation and proprioception work. All of which can be found on The Zebra Club App. 

Useful Links 

SEDS Connective – a charity supporting people living with hypermobility and Neurodivergence for which Eccles is a patron: 

sedsconnective – Ehlers Danlos Support UK – Hypermobility Syndromes Association

The Ehlers-Danlos syndromes (EDS) GP Toolkit
School toolkit for JHS and EDS

References:

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