Joint Hypermobility Syndrome: When Flexibility Becomes a Problem

Key Takeaways

Joint hypermobility means joints move beyond the normal range of motion
Hypermobility becomes a “syndrome” when it causes symptoms like pain and instability
It’s a spectrum—from benign flexibility to connective tissue disorders like EDS
Treatment focuses on strengthening muscles to stabilize joints
Many hypermobile people can live active, healthy lives with proper management
Diagnosis is clinical—there’s no blood test or imaging that confirms it

Being flexible is usually considered a good thing. Dancers, gymnasts, and yoga practitioners often prize their range of motion. But for some people, joints that bend too far cause more problems than benefits—chronic pain, frequent injuries, and joints that feel unstable.

If your joints have always been “too flexible” and you experience pain or injuries others don’t, you may have joint hypermobility syndrome.

What Is Joint Hypermobility?

Defining Hypermobility

Joint hypermobility means your joints move beyond what’s considered the normal range of motion. Your ligaments (the tissues connecting bones) are more lax than usual, allowing greater flexibility.

Examples:

Bending your thumb to touch your forearm
Hyperextending your elbows or knees beyond straight
Bending forward to place palms flat on the floor with straight knees
Fingers that bend backward significantly

Hypermobility vs. Hypermobility Syndrome

Simple hypermobility:

Joints are flexible but don’t cause problems
Very common, especially in children and young women
Often an advantage in certain activities
No treatment needed

Hypermobility Spectrum Disorder (HSD):

Hypermobility plus symptoms
Joint pain, instability, or recurrent injuries
Symptoms affect daily life
Treatment focuses on management

Hypermobile Ehlers-Danlos Syndrome (hEDS):

More severe end of the spectrum
Specific diagnostic criteria (2017 criteria)
Often involves multiple body systems
Family history common

The Spectrum

Think of hypermobility as existing on a spectrum:

Asymptomatic flexibility → Hypermobility spectrum disorder → hEDS → Rarer EDS types

Most hypermobile people fall somewhere in the middle—experiencing some symptoms but managing well with appropriate care.

Who Is Affected?

Prevalence

About 10-20% of the general population has some degree of hypermobility
Much more common in children (flexibility naturally decreases with age)
2-3 times more common in women than men
More common in certain ethnic groups (Asian, African descent)
Hypermobility syndrome (with symptoms) affects about 3% of the population

Risk Factors

Female sex: Hormones affect connective tissue laxity
Family history: Strong genetic component
Ethnicity: Some populations have higher rates
Age: Hypermobility decreases with age but symptoms may persist

Signs and Symptoms

The Beighton Score

The Beighton score is a simple clinical tool to assess hypermobility. One point for each of the following (max 9 points):

Pinky fingers: Can bend back beyond 90 degrees (1 point each hand)
Thumbs: Can bend to touch the forearm (1 point each hand)
Elbows: Hyperextend beyond straight (1 point each arm)
Knees: Hyperextend beyond straight (1 point each leg)
Forward bend: Palms can rest flat on floor with knees straight (1 point)

Score interpretation:

≥4/9 in adults (≥5/9 in children): Suggests generalized hypermobility
Score alone doesn’t diagnose a syndrome—symptoms must also be present

Common Symptoms

Joint-related:

Joint pain (often widespread)
Recurrent joint dislocations or subluxations
Early-onset osteoarthritis
Frequent sprains and strains
Joints that “pop” or “click”
Feeling that joints are unstable or “give out”

Muscle-related:

Muscle fatigue and pain
Muscle cramps
Reduced muscle strength
Feeling of heaviness in limbs

Other common features:

Chronic fatigue
Headaches
Digestive issues (IBS-like symptoms)
Dizziness when standing (dysautonomia)
Anxiety
Poor proprioception (sense of body position)
Soft, stretchy, or fragile skin
Easy bruising
Slow wound healing

The Triad

Many people with hypermobility syndrome experience a common triad:

Joint hypermobility with pain and instability
Autonomic dysfunction (POTS, dizziness)
Mast cell activation (allergies, reactions, skin issues)

This overlap is increasingly recognized by specialists.

Diagnosis

Why Diagnosis Can Be Challenging

No definitive lab test
Symptoms overlap with many other conditions
Many doctors aren’t familiar with hypermobility spectrum disorders
Symptoms may be dismissed as “just being flexible”
Criteria have changed over time

How Diagnosis Is Made

Clinical evaluation:

Beighton score assessment
Joint examination
Medical and family history
Symptom evaluation

For hypermobile EDS specifically (2017 criteria):

Generalized joint hypermobility (Beighton score)
Two or more of:
- Systemic features (soft skin, hernias, etc.)
- Family history
- Musculoskeletal complications
Exclusion of other causes

Ruling out other conditions:

Autoimmune diseases
Other connective tissue disorders
Marfan syndrome
Other EDS types (some have genetic tests)

Who Can Diagnose

Rheumatologists
Geneticists (especially for EDS)
Physiatrists (physical medicine doctors)
Some knowledgeable primary care doctors

Treatment and Management

The Foundation: Strengthening and Stability

The most important treatment for hypermobility is building muscle strength to compensate for ligament laxity.

Why this works:

Ligaments can’t be “tightened”
Strong muscles actively stabilize joints
Better muscle control improves proprioception
Prevents injuries by supporting vulnerable joints

Exercise approach:

Low-impact activities initially
Focus on stability and control
Progress gradually (hypermobile joints are injury-prone)
Water-based exercise often well-tolerated
Pilates and specific physiotherapy protocols helpful
Avoid end-range stretching (you don’t need more flexibility!)

Physical Therapy

Work with a therapist who understands hypermobility:

Key focus areas:

Core stability
Proprioceptive training (balance, body awareness)
Joint-specific strengthening
Posture correction
Pacing strategies for fatigue

What to avoid:

Pushing joints to their full range
High-impact activities initially
Exercises that stress already-unstable joints
Generic stretching programs

Pain Management

Non-medication approaches:

TENS units
Heat/ice as appropriate
Massage (gentle)
Acupuncture (may help some people)
Pacing activities to avoid boom-bust cycles

Medications:

NSAIDs for acute pain (long-term use problematic)
Acetaminophen for chronic pain
Low-dose antidepressants (help with chronic pain and sleep)
Avoid opioids if possible (don’t address the underlying issue)

Joint Protection

Splinting and bracing:

Can provide stability for specific joints
Especially helpful during activities
Should not replace strengthening
Avoid overuse (muscles can weaken)

Activity modification:

Avoid positions that hyperextend joints
Use good body mechanics
Take breaks during repetitive activities
Listen to your body’s signals

Managing Other Symptoms

Fatigue:

Pacing (most important strategy)
Sleep hygiene
Treating underlying dysautonomia if present

Dysautonomia (POTS):

Increased salt and fluid intake
Compression stockings
Gradual exercise progression
Medications if needed (under specialist care)

Anxiety:

Cognitive-behavioral therapy
Understanding that anxiety is common with chronic pain
Treatment of underlying physical symptoms helps

Living Well with Hypermobility

Mindset Shifts

Helpful perspectives:

“My joints are different, not defective”
Focus on what you can do, not limitations
Strength training is treatment, not optional
Pacing isn’t giving in—it’s strategic
Progress may be slow but is possible

Building Your Support Team

Physical therapist experienced with hypermobility
Doctor who understands the condition
Mental health support if needed
Online communities for shared experiences

Activities to Consider

Often well-tolerated:

Swimming and water exercise
Cycling (low impact)
Pilates (with knowledgeable instructor)
Walking (with appropriate footwear)
Strength training (controlled, progressive)

Approach with caution:

Yoga (avoid end-range stretching)
Running (depends on individual)
Contact sports (injury risk)
Activities with high joint stress

Frequently Asked Questions

Is joint hypermobility the same as Ehlers-Danlos syndrome?

Not exactly. Joint hypermobility is a feature that exists on a spectrum. Hypermobile EDS (hEDS) is at the more severe end of that spectrum and has specific diagnostic criteria beyond just being flexible. Most hypermobile people don’t have EDS, but hEDS is the most common type of EDS.

Will my hypermobility get worse with age?

The flexibility itself typically decreases with age (joints stiffen). However, accumulated joint damage can cause increasing symptoms over time. Proper management helps minimize long-term complications.

Can hypermobility be cured?

No, the underlying connective tissue laxity is genetic and can’t be changed. However, symptoms can be managed very effectively with strengthening, pacing, and other strategies. Many people with hypermobility live full, active lives.

Should I avoid stretching?

You should avoid aggressive stretching or pushing to your full range of motion. You already have plenty of flexibility—what you need is stability. Gentle movement is fine, but you don’t need to “improve” your flexibility.

Hypermobility itself is not autoimmune. However, some people with hypermobility spectrum disorders have conditions like POTS or mast cell activation that involve immune system dysfunction. True autoimmune diseases are separate conditions.

Can children be diagnosed with hypermobility syndrome?

Children are naturally more flexible, making diagnosis more complex. A Beighton score of 6/9 or higher is typically needed to consider a child hypermobile. Diagnosis usually focuses on whether symptoms are present and affecting function, not just flexibility.

Looking for more information on joint conditions? Explore our guides on fibromyalgia and joint pain or visit our conditions hub.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you suspect you have joint hypermobility syndrome, please consult a healthcare provider experienced in this condition.