Hypermobility / Ehlers-Danlos Syndrome (EDS)

What is Hypermobility?

Joint hypermobility means your joints move further than the normal range. For some people this causes no problems. For others, it leads to pain, joint instability, fatigue, and symptoms that affect the whole body.

There are three terms you may hear:

• Joint Hypermobility: Joints that move beyond normal limits. Common and often harmless on its own.
• Hypermobility Spectrum Disorder (HSD): Hypermobility that causes symptoms like pain and instability, but does not meet the full criteria for hEDS.
• Hypermobile Ehlers-Danlos Syndrome (hEDS): An inherited connective tissue disorder that affects the joints, skin, and multiple body systems. Diagnosis is based on the 2017 international clinical criteria.

HSD and hEDS overlap a lot. People with either one often deal with the same joint instability, pain, and day-to-day challenges, and both respond well to the right physiotherapy plan.

Prevalence

• Hypermobility disorders affect an estimated 255 million people worldwide
• hEDS makes up more than 80% of all Ehlers-Danlos syndrome cases
• Much more common in women, with most clinical groups being 70% to 90% female
• Often diagnosed in teens and young adults, but affects children and older adults too

Common Symptoms

Primary Symptoms

• Joint pain that can be short-term or long-lasting
• Joint instability, including partial dislocations (subluxations) and full dislocations, most often in the knees, ankles, and shoulders
• Fatigue that does not match activity level
• Muscle weakness and reduced endurance
• Poor joint position sense (proprioception), making joints feel unstable or "loose"
• Soft, stretchy skin and easy bruising

Secondary Symptoms

• Clumsiness and changes in walking pattern
• Increased pain sensitivity (central sensitization)
• Burning, tingling, or numbness from small nerve fibre involvement
• Fear of movement because of past injuries or pain flares
• Anxiety and low mood linked to living with ongoing symptoms

Associated Conditions

• Dizziness and lightheadedness, especially when standing up
• POTS (Postural Orthostatic Tachycardia Syndrome)
• Headaches and migraines, including vestibular migraine
• Bladder leakage, urgency, and pelvic floor issues
• Pelvic organ prolapse and painful intercourse
• Digestive issues such as IBS, reflux, and constipation

Understanding the Causes

Connective Tissue and Collagen

Collagen is the protein that gives strength to ligaments, tendons, skin, blood vessels, and organs. In hypermobility disorders, this connective tissue is more lax and stretchy than usual. That is why joints slip out of place more easily, and why the bladder, pelvic floor, and blood vessels can also be affected.

Genetics

hEDS runs in families. Unlike other types of EDS, no single gene has been found for hEDS yet, so diagnosis is made through a clinical assessment rather than a genetic test.

Why Symptoms Vary

Two people with hypermobility can have very different experiences. Symptoms depend on:

• How much the nerves and pain system are involved
• Whether POTS or other autonomic issues are present
• Repeated strain on specific joints
• Age, sex, and activity level

This is why a personalized assessment matters so much.

Why Physiotherapy is Effective

Physiotherapy is the recommended first-line, non-drug treatment for hypermobility, HSD, and hEDS. It targets the main problem: joints that need more muscular support and better control.

Pain Reduction

• Therapeutic exercise and motor control training are shown in research to reduce pain
• Education combined with exercise reduces fear of movement, pain, and fatigue

Joint Stability and Strength

• Strengthening the muscles around loose joints gives them the support ligaments cannot
• Stabilization and closed chain exercises improve joint stability and balance

Better Joint Awareness

• Proprioceptive training improves your sense of where your joints are
• This helps protect joints from overextending and reduces subluxations

Improved Daily Function

• Builds endurance for work, school, and sport
• Supports better breathing strength and exercise capacity
• Improves quality of life

Advantages Over Medication or Surgery

• Fewer risks: Surgery in hypermobile patients carries higher complication rates because of tissue fragility
• Active approach: Builds long-term strength and control rather than masking symptoms
• Whole-person care: Addresses joints, pelvic floor, balance, and dizziness together

Prognosis and Timeline

Living Well With Hypermobility

• Hypermobility and hEDS are lifelong conditions that can be managed well with the right plan
• The focus is on stronger, more stable joints, fewer flares, and getting back to the activities you enjoy

Treatment Response Timeline

Short-Term (4 to 8 Weeks)

• Reduced pain
• Better joint awareness, muscle strength, and balance

Medium-Term (3 to 6 Months)

• Lasting improvements in pain and daily function
• More confidence with movement and activity

Long-Term

• Ongoing home exercise and smart activity choices help maintain your progress
• Regular check-ins help adjust your program as your needs change

Factors That Support Improvement

• A tailored, gradual exercise plan matched to your joint control and pain levels
• Patient education so you understand your body and your triggers
• Supportive tools like compression garments, taping, and bracing when needed
• Family support and consistent home practice, especially for children and teens

Physiotherapy Treatment Approaches

Strength and Stability Training

• Starts with isometric (holding) exercises and joint control work
• Progresses to closed chain, core, and functional strengthening
• Low-to-moderate progressive loading, typically 2 to 3 sessions per week
• Builds muscle support around unstable joints

Proprioception and Balance Training

• Exercises to improve joint position sense and coordination
• Balance training to improve stability and reduce falls
• Use of supportive insoles and compression garments where helpful

Activity Pacing and Load Management

• Gradual increases in activity to avoid flare-ups
• Joint protection strategies for work, sport, and daily tasks
• Guidance on choosing activities that suit your joints

Gentle Manual Therapy

• Used carefully alongside exercise for short-term pain relief
• Avoids aggressive stretching or forceful techniques on hypermobile joints

Pelvic Health Physiotherapy

Pelvic floor issues are very common in people with hypermobility because the same connective tissue supports the bladder and pelvic organs.

• Bladder leakage affects 50% to 69% of people with EDS/HSD
• Painful intercourse was reported by 43% of women in a study of 386 women with hEDS
• Pelvic organ prolapse is more common and tends to start earlier

Our Pelvic Health physiotherapists help with:

• Pelvic floor strengthening and coordination
• Bladder leakage, urgency, and frequency
• Prolapse symptoms
• Pelvic pain and painful intercourse
• Pregnancy and postpartum care for hypermobile patients

Vestibular Rehabilitation

Dizziness and balance problems are very common with hypermobility, especially when POTS is also present.

• About 3 in 4 people with hEDS experience lightheadedness or dizziness when standing
• In one study of POTS patients, 59% also had EDS or hypermobility
• 63% of patients with follow-up data showed meaningful improvement after vestibular physiotherapy

Our Vestibular Rehabilitation program helps with:

• Dizziness and lightheadedness
• Unsteadiness and balance problems
• Positional vertigo
• Visual and motion sensitivity
• Vestibular migraine symptoms

Custom Orthotics and Bracing

• Custom Orthotics for flat feet and ankle instability
• Custom Orthopaedic Braces for extra support on unstable knees, wrists, and thumbs

Key Takeaways

1. Hypermobility is more than being flexible: It can affect joints, the pelvic floor, balance, and more
2. Physiotherapy is the first-line treatment: Strength, control, and education are the foundation of care
3. Stability beats stretching: The goal is stronger support around joints, not more range
4. Whole-body care works best: Pelvic health and vestibular rehab address common related symptoms
5. Gradual progress matters: A paced, tailored plan helps you improve without flare-ups

Why Choose Our Clinic for Hypermobility and EDS?

1. Evidence-Based, Whole-Body Care
   • Physiotherapy, pelvic health, and vestibular rehabilitation under one roof
   • Treatment built on current research for HSD and hEDS
   • Therapists experienced working with athletes, including gymnasts, dancers, and cheer athletes
2. Personalized Care Plans
   • Detailed assessments of joint stability, strength, balance, and pelvic floor function
   • Gradual, tailored programs that build stability without triggering flares
   • Support with pacing, joint protection, and activity planning
3. Support for Long-Term Management
   • Clear home exercise programs you can keep up on your own
   • Custom orthotics and bracing when extra support is needed
   • Virtual and in-home physiotherapy options for flare-up days

Take the First Step Toward Stronger, More Stable Joints

Hypermobility doesn't have to hold you back. At Vaughan Physiotherapy Clinic, we help you build the strength and control you need to move with confidence.

Book Your Hypermobility Assessment Today:

• Phone: 905-669-1221
• Location: 398 Steeles Ave W #201, Thornhill, ON L4J 6X3
• Online Booking: www.vaughanphysiotherapy.com

Proudly serving Thornhill, Langstaff, Newtonbrook, Willowdale, North York, Markham, Richmond Hill, Concord, and North Toronto. Evening/weekend appointments available.

Your Path to Stronger, More Stable Joints Starts Here

Whether you're dealing with joint instability, ongoing pain, dizziness, or pelvic floor symptoms, our team can help you:

✅ Build strength and stability around loose joints

✅ Reduce pain, dizziness, and pelvic floor symptoms

✅ Develop long-term strategies to stay active and confident

Let us help you take control of your symptoms and get back to the activities you love.

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