Hypermobility Spectrum Disorders: Symptoms, Causes, and Related Conditions
What are Hypermobility Spectrum Disorders?
Hypermobility Spectrum Disorders (HSD) and hypermobile Ehlers–Danlos Syndrome (hEDS) are connective tissue conditions characterised by joint hypermobility, instability, and associated symptoms.
hEDS is a heritable connective tissue disorder, part of the broader Ehlers–Danlos syndromes, distinguished by generalised joint hypermobility, chronic musculoskeletal symptoms, and systemic features.
HSD is diagnosed when joint hypermobility causes symptoms but does not meet the strict criteria for hEDS or other connective tissue syndromes.
Both conditions can significantly affect quality of life, with chronic pain, fatigue, and frequent injuries. Diagnosis often takes years because symptoms overlap with many other conditions.
Physiological Processes and Current Theories
Connective tissue laxity: In hEDS, collagen and extracellular matrix abnormalities lead to joint instability and tissue fragility. The precise genetic mutation remains unidentified as of 2025, unlike other EDS subtypes.
Proprioceptive dysfunction: Impaired joint position sense contributes to instability and injury risk.
Muscle deconditioning: Repeated injuries and pain lead to reduced activity, which worsens weakness and instability.
Nervous system involvement: Autonomic dysfunction (such as postural orthostatic tachycardia syndrome, POTS) is common.
Central sensitisation: Many patients experience amplified pain responses, suggesting overlap with chronic pain syndromes.
Common Symptoms
Joint hypermobility (often measured using the Beighton score)
Joint pain and frequent subluxations or dislocations
Chronic musculoskeletal pain and stiffness
Fatigue and reduced endurance
Easy bruising and soft tissue injuries
Poor proprioception and coordination difficulties
Less Common Symptoms
Gastrointestinal complaints (IBS-like symptoms, reflux, delayed gastric emptying)
Autonomic dysfunction (dizziness, palpitations, fainting with standing)
Headaches, sometimes migraine-like
Pelvic floor dysfunction
Temporomandibular joint (TMJ) issues
Comorbidities and Associated Conditions
HSD and hEDS often overlap with other systemic and pain-related conditions, including:
POTS (postural orthostatic tachycardia syndrome)
MCAS (mast cell activation syndrome)
Irritable bowel syndrome and other GI dysmotility disorders
Chronic fatigue and fibromyalgia-like symptoms
Anxiety disorders, often linked to autonomic dysfunction and chronic pain
Pelvic organ prolapse and bladder dysfunction
Diagnosis in 2025
Diagnosis is clinical, based on 2017 International EDS criteria for hEDS, and HSD criteria when hEDS is not met but hypermobility causes symptoms. As of 2025, no genetic marker has been identified for hEDS, which makes diagnosis challenging.
Assessment includes:
Beighton scoring for joint hypermobility
Clinical history of pain, instability, and systemic features
Exclusion of other connective tissue disorders
Diagnosis is usually made by rheumatologists, geneticists, or specialist clinics.
Current State of Knowledge
Research into hEDS and HSD has expanded, with focus areas including:
Genetic underpinnings of hEDS, still under investigation
Overlap with autonomic dysfunction (POTS, MCAS) and the role of connective tissue in vascular and immune regulation
Role of exercise and physiotherapy in preventing deconditioning and joint damage
Psychological burden of chronic pain and misdiagnosis, which is common
HSD and hEDS are now recognised as systemic connective tissue disorders, not simply “being flexible.”
If you are living with hypermobility or hEDS in Cork and want to understand your options for management and rehabilitation, read more about treatment for HSD and hEDS here.
Hypermobility Spectrum Disorders Treatment and Rehabilitation in Cork
International Standards of Care
There is no cure for hypermobility spectrum disorders (HSD) or hypermobile Ehlers–Danlos Syndrome (hEDS). International recommendations focus on symptom management, injury prevention, and long-term functional support. The most effective approach is multidisciplinary and includes:
Physiotherapy and structured exercise to improve joint stability and reduce pain
Pain management strategies, both medical and lifestyle-based
Education on pacing, joint protection, and safe movement strategies
Somatic and mind–body practices to support nervous system regulation
Psychological support for coping with chronic pain and fatigue
Medical Management
Doctors may be involved in managing comorbidities such as gastrointestinal problems, autonomic dysfunction, or mast cell issues. Pain management may include:
Analgesics or neuropathic pain medication
Medication for POTS or MCAS if present
In some cases, supportive bracing or splints for unstable joints
But medication and bracing are not enough. The core of long-term management is rehabilitation and movement retraining.
Exercise and Physiotherapy in HSD and hEDS
Exercise in hypermobility is not about pushing flexibility. It is about stability, strength, and control. People with HSD or hEDS often live with fragile joints that slip or sublux easily, leaving them afraid to move or frustrated by repeated injuries.
Research shows that exercise, when carefully prescribed, is the most effective strategy to:
Build joint stability through muscular support
Improve proprioception and coordination, reducing injury risk
Lower baseline pain and improve energy levels
Protect long-term mobility and independence
The challenge is that progress must be slower and more precise than in other conditions. Overloading unstable joints worsens pain. Under-loading leads to further deconditioning.
A specialised physiotherapist can guide you by:
Teaching joint protection strategies for daily life
Using low-load strengthening that respects connective tissue fragility
Progressing gradually with careful pacing to avoid setbacks
Addressing hand, foot, and core stability as foundations for movement
Supporting you in finding the right balance between movement and rest
This process is not just about exercises on a sheet. It is about learning how to trust your body again, step by step.
Somatic and Mind–Body Approaches
Living with hypermobility is not only about unstable joints. It is about fatigue, nervous system over-arousal, and the stress of unpredictability. Somatic and mind–body practices help bridge this gap.
Yoga therapy builds strength and mobility in a controlled way, improving body awareness and balance without overstretching.
Breathwork improves autonomic regulation, which is particularly valuable in patients with POTS or anxiety.
Guided relaxation lowers the background tension that worsens pain.
Mindfulness and body awareness reduce fear of movement and help patients reconnect with safe, confident patterns of activity.
These practices complement physiotherapy by calming the system and creating a sense of stability from the inside out.
Psychological and Lifestyle Support
Cognitive behavioural therapy (CBT) and Acceptance and Commitment Therapy (ACT) help people cope with the ongoing nature of the condition and manage the psychological toll of repeated injuries.
Nutrition and hydration strategies can support POTS and gut symptoms.
Sleep optimisation is crucial, as poor sleep worsens pain and fatigue.
Pacing education allows patients to manage energy without constant boom-and-bust cycles.
Rehabilitation at Neurokinetica
At Neurokinetica, we understand that hypermobility is not about being “double-jointed.” It is about the daily frustration of joints that slip, the fear of exercising and making things worse, and the exhaustion that comes from constant pain and fatigue. Many patients feel they are walking a tightrope between doing too much and not doing enough.
Our role is to walk that path with you. We guide you in building stability and strength without overloading fragile joints. We help you improve proprioception, balance, and endurance so you can trust your body again.
Our programmes combine targeted physiotherapy with yoga-based movement, breathwork, guided relaxation, and nervous system regulation. This combination strengthens the body while calming the system that drives fatigue and pain. Patients often report feeling not only stronger but more grounded, confident, and in control of their health.
Our goal is not temporary symptom relief. It is to give you the skills, stability, and confidence to live more fully with hypermobility or hEDS.
If you are looking for hypermobility or hEDS treatment in Cork, and want a professional approach that combines joint stability training, nervous system regulation, and personalised physiotherapy, book a session to get an assessment and learn more about our programmes.