Hypermobility.
What is hypermobility?
Hypermobility is a generic umbrella term that describes several conditions and syndromes associated with increased flexibility of the joints and soft tissue throughout the body. A hypermobile joint is one that can move beyond the typical range in one or several planes. Hypermobility is common, estimated to affect up to one to three in ten people — with women, children and people of Asian descent being hypermobile more often.
It is important to understand that hypermobility itself is not a diagnosis or a problem. Many people with hypermobile joints have no symptoms at all and some — dancers, gymnasts, musicians and athletes — actually perform better because of their increased range of motion. Hypermobility becomes clinically significant when it causes symptoms that affect quality of life, function or safety.
The hypermobility spectrum
The conditions associated with hypermobility exist on a broad spectrum. At one end sit the specific heritable connective tissue disorders where hypermobility is a feature of a defined genetic condition:
In the middle of the spectrum sit the hypermobility spectrum disorders (HSD) — symptomatic hypermobility after specific heritable conditions have been excluded. This includes what was previously called joint hypermobility syndrome (JHS). For more on this presentation see our joint hypermobility syndrome page.
At the other end, injury or repeated stretching related hypermobility is local to a single or multiple joints. Other conditions where hypermobility is a secondary effect include Down's syndrome and cerebral palsy.
What are the symptoms of symptomatic hypermobility?
About ten percent of hypermobile individuals are symptomatic with what can appear to be an unrelated array of symptoms: joint instability and hyperextension, sprains, strains, subluxations or dislocations. Beyond the joint-specific symptoms, hypermobility is associated with a broader systemic picture that is frequently underappreciated and underdiagnosed.
Widespread pain and fatigue are among the most common and most disabling features of symptomatic hypermobility. Autonomic dysfunction — including POTS (postural orthostatic tachycardia syndrome) and orthostatic hypotension — occurs with significantly higher frequency in people with EDS and HSD than in the general population. Gastrointestinal symptoms, anxiety, proprioceptive impairment, skin fragility and poor wound healing, and sleep disturbance are all recognised associated features.
The proprioceptive impairment in hypermobility deserves specific mention — the same laxity in the connective tissue that allows joints to move further than normal also reduces the quality of sensory feedback from the joint mechanoreceptors, impairing the body's sense of joint position. This contributes directly to joint instability, recurrent injury and the muscle fatigue that comes from having to consciously stabilise joints that would normally be passively restrained.
How is hypermobility assessed?
The Beighton score is the most widely used clinical tool for assessing generalised hypermobility, testing nine sites — little finger passive extension beyond 90 degrees, thumb passive apposition to the forearm, elbow hyperextension beyond 10 degrees, knee hyperextension beyond 10 degrees, and forward trunk flexion with knees straight and palms flat on the floor. A score of five or more in adults indicates generalised hypermobility, though the Beighton score is a screening tool rather than a diagnostic instrument and must be interpreted alongside the full clinical picture.
The Beighton score calculator and criteria are available on the Ehlers-Danlos Society website, which is the leading international resource for hypermobility and connective tissue disorders.
How can physiotherapy help?
Physiotherapy plays a pivotal role in hypermobility management, bringing together musculoskeletal, functional and psycho-social goals and methods into the management plan.
The approach for symptomatic hypermobility is fundamentally different from standard physiotherapy — and getting this distinction right is essential. The instinct to stretch a stiff joint is the wrong approach for a hypermobile joint that already has too much range and too little stability. Passive stretching and end-range loading are generally contraindicated or minimised.
Exercise therapy is key for addressing the majority of hypermobility-associated problems: improving strength and postural stability to stabilise the joints posturally or through movement, and modulating the nervous system with movement and manual therapy to reduce anxiety and autonomic nervous system symptoms.
Progressive, low-load strengthening around each affected joint — building the active muscular restraint that the passive structures cannot reliably provide — is the foundation of hypermobility rehabilitation. Proprioceptive and neuromuscular control training is equally central, retraining the joint position sense that is consistently impaired. Pacing education addresses the fatigue and post-exertional symptom flares that are a consistent and often poorly managed feature of moderate to severe hypermobility. Load management principles guide the progressive return to activity without the boom-bust cycle that many hypermobile patients are trapped in.
Other modalities used in hypermobility management include manual therapy, load management, relaxation techniques, and education to address beliefs and fear. Management of hypermobility is ongoing and often requires lifestyle changes to incorporate exercise.
Clinical Pilates is exceptionally well suited to hypermobility rehabilitation — the emphasis on movement quality, precise muscle activation, and body awareness directly addresses the proprioceptive and stability deficits of symptomatic hypermobility. Load is precisely controlled and progression carefully managed. Real time ultrasound guides deep stabilising muscle retraining where activation is typically impaired in hypermobile patients.
For patients with associated POTS or hypotension, exercise programming is adapted to the cardiovascular and autonomic constraints of these conditions. Hypermobility Connect Australia and the Connective Tissue Disorders Network Australia provide community support and resources for people navigating hypermobility and related conditions.
Our physiotherapist Yulia Khasyanova holds certifications through the Ehlers-Danlos Society and has specialist clinical experience in hypermobility spectrum disorders, EDS and related connective tissue conditions. Exercise Physiologist Ash O'Regan contributes to exercise programming for patients with associated autonomic dysfunction and fatigue. Both are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Hypermobility is a generic umbrella term that describes several conditions and syndromes associated with increased flexibility of the joints and soft tissue throughout the body. A hypermobile joint is one that can move beyond the typical range in one or several planes. Hypermobility is common, estimated to affect up to one to three in ten people — with women, children and people of Asian descent being hypermobile more often.
It is important to understand that hypermobility itself is not a diagnosis or a problem. Many people with hypermobile joints have no symptoms at all and some — dancers, gymnasts, musicians and athletes — actually perform better because of their increased range of motion. Hypermobility becomes clinically significant when it causes symptoms that affect quality of life, function or safety.
The hypermobility spectrum
The conditions associated with hypermobility exist on a broad spectrum. At one end sit the specific heritable connective tissue disorders where hypermobility is a feature of a defined genetic condition:
- Ehlers-Danlos syndromes (EDS) — a group of thirteen classified subtypes caused by mutations affecting collagen and connective tissue proteins. Hypermobile EDS (hEDS) is the most common subtype and the one most frequently encountered in physiotherapy practice. Classical EDS, vascular EDS and other subtypes have additional and sometimes serious features beyond hypermobility.
- Marfan syndrome — tall stature, long limbs, hypermobility and significant cardiovascular involvement including aortic root dilation.
- Loeys-Dietz syndrome — similar to Marfan syndrome but with additional vascular involvement and specific craniofacial features.
- Stickler syndrome — hypermobility with ocular, hearing and facial features.
In the middle of the spectrum sit the hypermobility spectrum disorders (HSD) — symptomatic hypermobility after specific heritable conditions have been excluded. This includes what was previously called joint hypermobility syndrome (JHS). For more on this presentation see our joint hypermobility syndrome page.
At the other end, injury or repeated stretching related hypermobility is local to a single or multiple joints. Other conditions where hypermobility is a secondary effect include Down's syndrome and cerebral palsy.
What are the symptoms of symptomatic hypermobility?
About ten percent of hypermobile individuals are symptomatic with what can appear to be an unrelated array of symptoms: joint instability and hyperextension, sprains, strains, subluxations or dislocations. Beyond the joint-specific symptoms, hypermobility is associated with a broader systemic picture that is frequently underappreciated and underdiagnosed.
Widespread pain and fatigue are among the most common and most disabling features of symptomatic hypermobility. Autonomic dysfunction — including POTS (postural orthostatic tachycardia syndrome) and orthostatic hypotension — occurs with significantly higher frequency in people with EDS and HSD than in the general population. Gastrointestinal symptoms, anxiety, proprioceptive impairment, skin fragility and poor wound healing, and sleep disturbance are all recognised associated features.
The proprioceptive impairment in hypermobility deserves specific mention — the same laxity in the connective tissue that allows joints to move further than normal also reduces the quality of sensory feedback from the joint mechanoreceptors, impairing the body's sense of joint position. This contributes directly to joint instability, recurrent injury and the muscle fatigue that comes from having to consciously stabilise joints that would normally be passively restrained.
How is hypermobility assessed?
The Beighton score is the most widely used clinical tool for assessing generalised hypermobility, testing nine sites — little finger passive extension beyond 90 degrees, thumb passive apposition to the forearm, elbow hyperextension beyond 10 degrees, knee hyperextension beyond 10 degrees, and forward trunk flexion with knees straight and palms flat on the floor. A score of five or more in adults indicates generalised hypermobility, though the Beighton score is a screening tool rather than a diagnostic instrument and must be interpreted alongside the full clinical picture.
The Beighton score calculator and criteria are available on the Ehlers-Danlos Society website, which is the leading international resource for hypermobility and connective tissue disorders.
How can physiotherapy help?
Physiotherapy plays a pivotal role in hypermobility management, bringing together musculoskeletal, functional and psycho-social goals and methods into the management plan.
The approach for symptomatic hypermobility is fundamentally different from standard physiotherapy — and getting this distinction right is essential. The instinct to stretch a stiff joint is the wrong approach for a hypermobile joint that already has too much range and too little stability. Passive stretching and end-range loading are generally contraindicated or minimised.
Exercise therapy is key for addressing the majority of hypermobility-associated problems: improving strength and postural stability to stabilise the joints posturally or through movement, and modulating the nervous system with movement and manual therapy to reduce anxiety and autonomic nervous system symptoms.
Progressive, low-load strengthening around each affected joint — building the active muscular restraint that the passive structures cannot reliably provide — is the foundation of hypermobility rehabilitation. Proprioceptive and neuromuscular control training is equally central, retraining the joint position sense that is consistently impaired. Pacing education addresses the fatigue and post-exertional symptom flares that are a consistent and often poorly managed feature of moderate to severe hypermobility. Load management principles guide the progressive return to activity without the boom-bust cycle that many hypermobile patients are trapped in.
Other modalities used in hypermobility management include manual therapy, load management, relaxation techniques, and education to address beliefs and fear. Management of hypermobility is ongoing and often requires lifestyle changes to incorporate exercise.
Clinical Pilates is exceptionally well suited to hypermobility rehabilitation — the emphasis on movement quality, precise muscle activation, and body awareness directly addresses the proprioceptive and stability deficits of symptomatic hypermobility. Load is precisely controlled and progression carefully managed. Real time ultrasound guides deep stabilising muscle retraining where activation is typically impaired in hypermobile patients.
For patients with associated POTS or hypotension, exercise programming is adapted to the cardiovascular and autonomic constraints of these conditions. Hypermobility Connect Australia and the Connective Tissue Disorders Network Australia provide community support and resources for people navigating hypermobility and related conditions.
Our physiotherapist Yulia Khasyanova holds certifications through the Ehlers-Danlos Society and has specialist clinical experience in hypermobility spectrum disorders, EDS and related connective tissue conditions. Exercise Physiologist Ash O'Regan contributes to exercise programming for patients with associated autonomic dysfunction and fatigue. Both are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
