Joint Hypermobility Syndrome.
What is joint hypermobility syndrome?
Joint hypermobility syndrome (JHS) — now more accurately classified within the hypermobility spectrum disorders (HSD) framework — describes a clinical condition in which joint hypermobility is accompanied by symptoms that significantly affect quality of life. It is the diagnosis of exclusion within the hypermobility spectrum: after specific heritable connective tissue disorders such as Ehlers-Danlos syndrome, Marfan syndrome and Stickler syndrome have been considered and excluded, patients with symptomatic hypermobility are classified within the HSD framework.
The terminology in this field has evolved significantly in recent years and can be confusing for patients and clinicians alike. Joint hypermobility syndrome — the older term — corresponds most closely to what is now called generalised hypermobility spectrum disorder (G-HSD). The 2017 international classification replaced the Brighton criteria for JHS with the updated hypermobility EDS (hEDS) criteria and the HSD framework, distinguishing between the specific heritable connective tissue disorder hEDS and the broader spectrum of symptomatic hypermobility. For a more detailed overview of the hypermobility spectrum, see our hypermobility page.
What causes joint hypermobility syndrome?
Joint hypermobility syndrome results from variations in the connective tissue that makes up ligaments, tendons and joint capsules. These variations — often genetic in origin — alter the composition or structure of collagen and other connective tissue proteins, producing tissues that are more elastic and less stiff than normal. The result is joints that move through a greater range than typical but with less passive restraint — meaning the muscles must work harder to provide dynamic stability that the passive structures would normally contribute.
Hypermobility is heritable — it tends to run in families — and is more common in women, children and people of Asian or African descent. Many people with hypermobile joints have no symptoms at all. Symptomatic hypermobility — where the hypermobility causes pain, instability, fatigue or other complaints — is what defines JHS and HSD.
What are the symptoms?
The symptom profile of joint hypermobility syndrome is broad and often underappreciated. Musculoskeletal symptoms are the most prominent — widespread joint and muscle pain, recurrent joint sprains and strains, joint instability and subluxations or dislocations, and chronic fatigue that is often disproportionate to activity level. Individuals with joint hypermobility syndrome frequently experience joint pain and discomfort, particularly after physical activity or periods of sustained posture.
Beyond musculoskeletal symptoms, autonomic dysfunction is increasingly recognised as a significant feature of symptomatic hypermobility — POTS (postural orthostatic tachycardia syndrome) and hypotension occur with greater frequency in people with HSD and hEDS than in the general population. Gastrointestinal symptoms, anxiety, proprioceptive impairment, skin findings and sleep disturbance are all associated features that can significantly affect quality of life. Proprioceptive impairment — a reduced sense of joint position — is a particularly significant finding as it contributes to joint instability and injury risk.
How is it diagnosed?
Diagnosis is typically based on clinical evaluation, medical history, and assessment of joint hypermobility using the Beighton score and other criteria. The Beighton score assesses hypermobility at nine sites — little finger passive extension, thumb passive opposition to the forearm, elbow hyperextension, knee hyperextension and forward trunk flexion with palms flat on the floor — producing a score out of nine. A score of five or more is the threshold for generalised hypermobility in adults, though the Beighton score alone is not sufficient for diagnosis and must be interpreted alongside the clinical history and symptom pattern.
Referral to a clinical geneticist or specialist with experience in connective tissue disorders is appropriate where a specific heritable condition is suspected. The Ehlers-Danlos Society and Hypermobility Connect Australia provide comprehensive patient resources and clinician directories for those navigating a diagnostic pathway.
How can physiotherapy help?
Physiotherapy is the cornerstone of management for joint hypermobility syndrome and hypermobility spectrum disorders — there is no medication that addresses the underlying connective tissue laxity, but there is strong evidence that targeted exercise programs significantly improve pain, stability and quality of life.
The physiotherapy approach for JHS and HSD is distinct from that for non-hypermobile musculoskeletal conditions in several important ways. Passive stretching — which would be appropriate for a stiff joint — is contraindicated or minimised in hypermobile patients who already have excessive range and need stability rather than more flexibility. End-range loading — exercises that take joints to their limits — is approached cautiously, with proprioceptive and neuromuscular control training prioritised over range of motion work.
The rehabilitation focus centres on building active muscular stability around hypermobile joints through progressive, low-load strengthening programs, proprioceptive training to improve the joint position sense that is consistently impaired in symptomatic hypermobility, pacing strategies to manage the fatigue and post-exertional symptom flares that are a consistent feature of HSD, and education on joint protection strategies for daily activities and sport.
Orthotics and assistive devices — custom orthotic insoles, braces or splints — may be prescribed to provide joint support and stability where passive stabilisation is needed to allow the active rehabilitation program to progress. Taping provides similar short-term joint support and proprioceptive benefit.
Clinical Pilates is particularly well suited to hypermobility rehabilitation — the emphasis on movement quality, body awareness and controlled loading at submaximal ranges is directly appropriate for the proprioceptive and stability deficits of JHS. Load can be precisely controlled and progression carefully managed. Real time ultrasound guides deep stabilising muscle retraining — particularly the deep cervical flexors, lumbar multifidus and transversus abdominis — 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, beginning with recumbent exercise and progressing very gradually toward upright activity.
Our physiotherapist Yulia Khasyanova holds certifications through the Ehlers-Danlos Society and has specialist experience in hypermobility spectrum disorders 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.
Joint hypermobility syndrome (JHS) — now more accurately classified within the hypermobility spectrum disorders (HSD) framework — describes a clinical condition in which joint hypermobility is accompanied by symptoms that significantly affect quality of life. It is the diagnosis of exclusion within the hypermobility spectrum: after specific heritable connective tissue disorders such as Ehlers-Danlos syndrome, Marfan syndrome and Stickler syndrome have been considered and excluded, patients with symptomatic hypermobility are classified within the HSD framework.
The terminology in this field has evolved significantly in recent years and can be confusing for patients and clinicians alike. Joint hypermobility syndrome — the older term — corresponds most closely to what is now called generalised hypermobility spectrum disorder (G-HSD). The 2017 international classification replaced the Brighton criteria for JHS with the updated hypermobility EDS (hEDS) criteria and the HSD framework, distinguishing between the specific heritable connective tissue disorder hEDS and the broader spectrum of symptomatic hypermobility. For a more detailed overview of the hypermobility spectrum, see our hypermobility page.
What causes joint hypermobility syndrome?
Joint hypermobility syndrome results from variations in the connective tissue that makes up ligaments, tendons and joint capsules. These variations — often genetic in origin — alter the composition or structure of collagen and other connective tissue proteins, producing tissues that are more elastic and less stiff than normal. The result is joints that move through a greater range than typical but with less passive restraint — meaning the muscles must work harder to provide dynamic stability that the passive structures would normally contribute.
Hypermobility is heritable — it tends to run in families — and is more common in women, children and people of Asian or African descent. Many people with hypermobile joints have no symptoms at all. Symptomatic hypermobility — where the hypermobility causes pain, instability, fatigue or other complaints — is what defines JHS and HSD.
What are the symptoms?
The symptom profile of joint hypermobility syndrome is broad and often underappreciated. Musculoskeletal symptoms are the most prominent — widespread joint and muscle pain, recurrent joint sprains and strains, joint instability and subluxations or dislocations, and chronic fatigue that is often disproportionate to activity level. Individuals with joint hypermobility syndrome frequently experience joint pain and discomfort, particularly after physical activity or periods of sustained posture.
Beyond musculoskeletal symptoms, autonomic dysfunction is increasingly recognised as a significant feature of symptomatic hypermobility — POTS (postural orthostatic tachycardia syndrome) and hypotension occur with greater frequency in people with HSD and hEDS than in the general population. Gastrointestinal symptoms, anxiety, proprioceptive impairment, skin findings and sleep disturbance are all associated features that can significantly affect quality of life. Proprioceptive impairment — a reduced sense of joint position — is a particularly significant finding as it contributes to joint instability and injury risk.
How is it diagnosed?
Diagnosis is typically based on clinical evaluation, medical history, and assessment of joint hypermobility using the Beighton score and other criteria. The Beighton score assesses hypermobility at nine sites — little finger passive extension, thumb passive opposition to the forearm, elbow hyperextension, knee hyperextension and forward trunk flexion with palms flat on the floor — producing a score out of nine. A score of five or more is the threshold for generalised hypermobility in adults, though the Beighton score alone is not sufficient for diagnosis and must be interpreted alongside the clinical history and symptom pattern.
Referral to a clinical geneticist or specialist with experience in connective tissue disorders is appropriate where a specific heritable condition is suspected. The Ehlers-Danlos Society and Hypermobility Connect Australia provide comprehensive patient resources and clinician directories for those navigating a diagnostic pathway.
How can physiotherapy help?
Physiotherapy is the cornerstone of management for joint hypermobility syndrome and hypermobility spectrum disorders — there is no medication that addresses the underlying connective tissue laxity, but there is strong evidence that targeted exercise programs significantly improve pain, stability and quality of life.
The physiotherapy approach for JHS and HSD is distinct from that for non-hypermobile musculoskeletal conditions in several important ways. Passive stretching — which would be appropriate for a stiff joint — is contraindicated or minimised in hypermobile patients who already have excessive range and need stability rather than more flexibility. End-range loading — exercises that take joints to their limits — is approached cautiously, with proprioceptive and neuromuscular control training prioritised over range of motion work.
The rehabilitation focus centres on building active muscular stability around hypermobile joints through progressive, low-load strengthening programs, proprioceptive training to improve the joint position sense that is consistently impaired in symptomatic hypermobility, pacing strategies to manage the fatigue and post-exertional symptom flares that are a consistent feature of HSD, and education on joint protection strategies for daily activities and sport.
Orthotics and assistive devices — custom orthotic insoles, braces or splints — may be prescribed to provide joint support and stability where passive stabilisation is needed to allow the active rehabilitation program to progress. Taping provides similar short-term joint support and proprioceptive benefit.
Clinical Pilates is particularly well suited to hypermobility rehabilitation — the emphasis on movement quality, body awareness and controlled loading at submaximal ranges is directly appropriate for the proprioceptive and stability deficits of JHS. Load can be precisely controlled and progression carefully managed. Real time ultrasound guides deep stabilising muscle retraining — particularly the deep cervical flexors, lumbar multifidus and transversus abdominis — 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, beginning with recumbent exercise and progressing very gradually toward upright activity.
Our physiotherapist Yulia Khasyanova holds certifications through the Ehlers-Danlos Society and has specialist experience in hypermobility spectrum disorders 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.
