Physiotherapy for hypermobility (Pay no attention to the image you houldn't exercise in just socks) written over an image of a lady using a gym ball against a wall with a physiotherapist assisting

Physiotherapy for Hypermobility

Being hypermobile can cause symptoms that may mean more than just being flexible. The term hypermobility basically means being able to move a joint beyond normal range of movement (ROM) basically meaning that your joints can over bend and stretch. You may be ‘double jointed’ and flexible.

For some people, this is totally normal and it doesn’t trouble them. Many people who have asymptomatic hypermobility can function very well with their bendiness and thrive by using their ‘talents’ to excel in many sports and activities such as the swimmer Micheal Phelps. This however differs quite a considerable amount from the symptomatic hypermobility which can affect your life to various degrees.

 Hypermobility Spectum Disorders (HSD), previously known as Joint Hypermobility Syndrome or hypermobile Ehlers-Danlos syndrome (hEDS) is a group of  conditions that present with injury, pain and other symptoms which can affect multiple body functions and systems. Tissue are made of collagen which form muscles, ligaments, skin. This collagen is more flexible and stretchy which may  result in instability and injury for some people. Getting the right healthcare professional who understands your condition and symptoms is paramount in getting the right diagnosis, treatment and management. Self advocating for your condition is also a really important part of being able to self-manage, by understanding the condition yourself and telling others about it.

What is physiotherapy?

Physiotherapy is not often associated with hypermobility usually due to the thoughts about why do ‘bendy’ people need to exercise? But just like any condition that effects, joints, muscle or tissues, movement is a really important factor that needs to be addressed correctly. Finding the right physiotherapist and exercises can be tricky as many physiotherapist aren’t specialised in this field of work.

There can be a lot of misunderstanding when it comes to giving hypermobile people exercises and advice. In particular practitioners might not know much about how the condition impacts daily life. Telling them about how the condition affects you and things that work and don’t work is really important in getting the right management. As you know your body the best, only you will know what works well and what doesn’t. If the therapist doesn’t know much about the condition, it’s best if you find a  therapist in this specialist area who is knowledgeable about the condition or allow the therapist to learn more about the condition.  This way, management will be better tailored to work with you.

How it can help in hypermobility?

Physiotherapy can help with hypermobility as it can help with injuries and  pain. It works with the tissues in the body to help with strength, endurance, posture and balance. Physiotherapy is also about education and modifying behaviours to help better self manage the condition.

Working with a physiotherapist can help to facilitate returning to normal activity levels and prevent deconditioning. Physiotherapy can help to promote an active lifestyle. This can help with daily activities and improves functional capacity to reduce the reliance on others. This enables you to take control of your symptoms rather than your symptoms taking control of you.

Physiotherapy will help you to prioritise what issues are most important to get the most out of your life. Physiotherapy cannot treat and cure everything but will work through the issues and tackle the setbacks. There are often barriers which can prevent you from doing activity due to pain, injury or fatigue. A physiotherapist  will help to  create an individual plan with you taking into account your  current level of fitness and will work with you and other healthcare professionals to set realistic goals. 

Pain in hypermobility is complex. There is acute pain which you get straight after an injury and then there’s the chronic pain which is often more complicated to understand. Exercise can be really helpful in managing both acute and chronic pain but you will need to be careful about it. This is when pacing comes in to help avoid flare ups and doing too much. You also want to avoid having a setback which may make you become reluctant to exercise, meaning you become deconditioned.

What does it involve?

Physiotherapy can offer a range of methods and techniques to help with the condition. There is an educational part and a physical part. The educational part is about understanding pain, fatigue and injury. It’s also about understanding what’s best for you as everyone’s symptoms and ability is different. There is also psychological aspect of which can help to reduce the fear of movement or exercise (kinesiophobia)

The physical side of physiotherapy helps with muscle weakness and pain works on proprioception (ability to judge position of your joints and limbs) , posture and balance. Muscle strength can help with joints stability by strengthening the surrounding tissue. Muscle are often weaker due to the laxity (stretchiness)  of the tendons which can make it harder to produced force. Strength exercises can therefore reduce  the likelihood of dislocations/ subluxations by helping the ligaments get stronger and more stable..

Physiotherapy also works on physical/ aerobic activity. This can help your muscles to fatigue less which can help overall with being able to do more and tire less.

Exercise and management advice

  • Strength exercises may involve using body weight, resistance equipment, weights and gravity. The aim of strength training is to muscular strength and endurance to help with coordination balance and stability. These effects will help with everyday functional activities. It will also teach you how to control movement a better.
  • Aerobic exercise can include walking, swimming, cycling, for example. For people with POTs, which can present alongside with Eds,  recumbent exercises are best to start with such as swimming or recumbent cycling. As you may be deconditioned, you may feel tired and breathless easily. But over time, your tolerance will improve and you’ll be able to gradually increase to time and intensity of the exercise. Particularly if you find walking difficult due to pain and injury, swimming may be a better option.
  • Proprioception: You may notice that you have poor proprioception when you bump into things or are clumsy. Improving proprioception will be about becoming more aware of your joints and limbs during movement. Some activities that can help this is gym balls, Pilates and biofeedback such as wearing tight/compression clothes, watching yourself in front of a mirror or video.
  • Flexibility and stretching – this might sound counterintuitive, stretching already overstretched tissues but this can alleviate  stiffness and pain in your muscle. Tight muscles can contribute to instability and looseness around the joint. Be careful as your body will stretch where it’s most stretchy first and you will want to avoid over doing this. So it’s important to stabilise those hypermobile joint first. Working with a physiotherapist can help to establish safe and effective stretches for you.
  • Hydrotherapy or Aquatic physiotherapy is also another exercise modality that can also help. Being in the water means that it’s non-weight bearing and eliminates gravity. For this reason it’s great if you have joint pain or injury as the water help with relieving this symptoms whilst moving.

Getting the most out of physiotherapy:

Communication with the physiotherapist is essential to getting the most out of the sessions. Helping the  therapist understand how the movement feels, any symptoms or pain and whether it’s too easy or hard will help with setting the right prescription and exercises. The therapist will also help you to understand how to move correctly and what muscles to use appropriately. They should be aware of any injuries, what movement creates injury and pain and how you move. This will help establish a better movement pattern to reduce and prevent further injuries.

Just because you can over stretch doesn’t mean you should. Physiotherapy will help you to understand the better way of move and improving techniques to get the most gains.

Depending on your current level of activity and health, you will probably first start with a slow and low approach to exercise. This means you start at a slow pace and a low intensity and gradually build up over many sessions. This is important to not irritate the joints and muscles which will mating calls injury and pain.

You may think that doing more is better but especially for people who have EDS and/or hypermobility it may take a while to feel better and to build up your tolerance to exercise. It’s important to not push yourself and to pace your activity to avoid flare ups.

Be realistic

It may seem all exciting to start working with a physiotherapist and to be able to start exercise again. However it’s important to understand, particularly after injury or a long period of inactivity, that it may take a little longer than someone without hypermobility/EDS to recover and see any benefits.

You won’t see any major benefits in the first few session. Generally it may take 6 weeks to start improving but small improvements may be seen before this. Physiotherapy, as mentioned previously, is not just about the physical part. It can really help self esteem and confidence. Alongside education, reassurance from the therapist, involvement of friends and family can really help adherence and motivation.

The therapist may set homework. This can be a set of exercises, stretches or other aspects. Homework doesn’t have to be a chore. It can be easily incorporated into your daily activity, for example when brushing or teeth or waiting for the kettle to boil. Small simple bouts can help you get to the bigger goal. Physiotherapy essentially is about giving you back the control of your health and condition, to better care for yourself. Physiotherapy essentially enables you to gain the knowledge, skills and strategies. This will help you to take control of your condition and symptoms to better manage and care for yourself.

About the Author:

I’m Katie and 24 yrs and, a 2nd year undergraduate physiotherapy student at University of Brighton. I am currently doing a diverse placement with Jo Southall. This is my second degree, the first being Sports and Exercise science. Following an ankle fracture and the rehabilitation involved, I become fascinated about what physiotherapist do and the detail involvement. I have always enjoyed exercise and learning about the mechanisms of the body but wanted to take this knowledge further and apply it to helping people. I am thoroughly enjoying my degree and the scope I have to learn and discover new things and ways to helping.

Further reading

Simmonds, J.V., 2022. Masterclass: Hypermobility and hypermobility related disorders. Musculoskeletal Science and Practice, 57, p.102465.(Accessed 18 March 202)

Engelbert, R.H., Juul‐Kristensen, B., Pacey, V., De Wandele, I., Smeenk, S., Woinarosky, N., Sabo,

S., Scheper, M.C., Russek, L. and Simmonds, J.V., 2017, March. The evidence‐based rationale for

physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility

syndrome/hypermobile Ehlers Danlos syndrome. In American Journal of Medical Genetics Part C:

Seminars in Medical Genetics (Vol. 175, No. 1, pp. 158-167).  (Accessed 15 March 2022)

Simmonds, J.V., Herbland, A., Hakim, A., Ninis, N., Lever, W., Aziz, Q. and Cairns, M., 2019.

Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers–Danlos

syndrome–hypermobility type. Disability and rehabilitation, 41(4), pp.445-455. (Accessed 7March 2022)

What is physiotherapy? The Chartered Society of Physiotherapy. (Accessed 16 march 2022) (accessed 16

march 2022 (accessed 17 march 2022)

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