Many people who are hypermobile spent their childhood being told they were "double-jointed", a party trick, a quirk, something to show off. For some, it stays that way. For others, it becomes a source of recurring pain, fatigue, and injuries that no one seems to be able to fully explain. If that sounds familiar, understanding what hypermobility actually means, and what matters most about managing it, is a good place to start.
What Hypermobility Is (and Isn't)
At its core, hypermobility refers to joints that move beyond the typical range of motion, driven by increased laxity in the connective tissue, primarily ligaments. It is more common in women than men, and frequently runs in families. It tends to be most noticeable in the hands, knees, elbows, and spine, though it can affect any joint. Importantly, hypermobility exists on a spectrum. At one end, you have asymptomatic generalised joint hypermobility, flexible joints, no particular problems. Further along, you encounter hypermobility spectrum disorders (HSD) and, at the more complex end, hypermobile Ehlers-Danlos syndrome (hEDS). The 2017 International Classification of EDS formalised this spectrum and introduced clearer diagnostic criteria. Many people with significant symptoms have spent years without a clear label, this is one of the most common presentations we see.
Hypermobility vs Instability: A Critical Distinction
These two terms are often used interchangeably, but they describe very different things:
- Hypermobility = increased range of motion
- Instability = insufficient control within that range
Not everyone with hypermobility develops problems. The people who do are typically those in whom the neuromuscular system cannot adequately compensate for the reduced passive stability that lax ligaments provide. When the muscles responsible for joint control fatigue or fail to activate precisely, joints are left in vulnerable positions, and that is when pain and injury occur.
Why Some People With Hypermobility Develop Pain
The mechanism is worth understanding. Ligaments in hypermobile individuals provide less passive support, meaning the muscles must work harder, and more continuously, to maintain joint stability. This increased demand leads to faster fatigue. And when muscles fatigue, joint positioning deteriorates. Research consistently shows that people with hypermobility have measurably reduced proprioception, the body's ability to sense joint position, which compounds the problem further. The joint moves into a range the nervous system doesn't fully register, and minor repetitive trauma accumulates over time. This is why hypermobile individuals often describe feeling "worn out" by activities others find easy. It is not deconditioning, it is a genuinely higher neuromuscular cost of movement.
Who Commonly Presents With This?
Hypermobility is significantly more common in women than men. It is often seen in dancers, gymnasts, musicians, and swimmers, populations drawn to activities that select for, or are facilitated by, increased flexibility. Many have been told for years that their flexibility is an asset, which makes the eventual shift to managing it as a vulnerability harder to accept.
Common Presentations
- Recurrent joint pain, often in multiple areas simultaneously
- Frequent minor injuries or "niggles" that don't have an obvious cause
- A persistent feeling of being "loose" or unstable, particularly after exertion
- Fatigue that seems disproportionate to activity levels
- Joints that click, pop, or partially give way
Management: What Actually Helps
The most evidence-supported approach centres on building genuine neuromuscular control, not increasing flexibility, which most hypermobile people have in abundance and do not need more of. Strengthening forms the foundation, with a particular emphasis on isometric and slow, heavy resistance work. Isometric exercise builds the capacity to hold joints in controlled positions under load, exactly what lax connective tissue cannot do passively. Heavy slow resistance training is well-tolerated and produces meaningful strength gains without placing excessive stress on already-challenged joints. Proprioceptive and control training runs alongside this. The goal is not just to build strength but to train the nervous system to use that strength accurately, quickly, and under fatigue, the conditions that matter in real life. Avoiding excessive stretching is equally important, and it is often the piece of advice that surprises people most. Stretching further into already hypermobile range provides no benefit and can reinforce the very instability that is causing problems.
How IP Physio Can Help
We begin by assessing whether your symptoms are truly driven by hypermobility, or whether something else is contributing, because not all joint pain in flexible people is hypermobility-related. From there, we build a structured programme focused on control and robustness. Our strength testing gives you objective, measurable data on where your capacity actually sits, so progress is tracked rather than assumed. The goal is not restriction, it is giving your joints the active support they need to work well and stay well. If you've been told you're "just flexible" and left to get on with it, we'd like to offer something more useful. Get in touch with us today.
References
- Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8–26.
- Castori M, Tinkle B, Levy H, et al. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175(1):148–157.
- Scheper MC, de Vries JE, de Vos R, et al. The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception. Disabil Rehabil. 2017;39(14):1391–1397.
- Smith TO, Jerman E, Easton V, et al. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Musculoskelet Sci Pract. 2013;18(5):762–772.
- Engelbert RHH, Juul-Kristensen B, Pacey V, et al. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers-Danlos syndrome. Am J Med Genet C Semin Med Genet. 2017;175(1):158–167.
- Tinkle B, Castori M, Berglund B, et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. EDS III – joint hypermobility syndrome): Clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017;175(1):48–69.
- Gündüz R, et al. The effects of joint hypermobility on strength, proprioception, and functional performance. Sci Rep. 2025. doi:10.1038/s41598-025-24199-x.