Joint Hypermobility

Overview

Joint hypermobility means that some or all of your joints move further than most people's. It is common — particularly in young women and in people of Asian descent — and for many it causes no problems at all; dancers, gymnasts and swimmers often benefit from it. It becomes a condition worth treating when the extra range comes with pain, joints that feel unstable, frequent sprains or dislocations, or fatigue from muscles working hard to control loose joints. This is referred to as hypermobility spectrum disorder (HSD), and at the more significant end, hypermobile Ehlers-Danlos syndrome (hEDS), which is diagnosed by a doctor.

The underlying issue is that the ligaments and connective tissue are more elastic than usual, so the joints rely more heavily on the muscles for stability. When those muscles are not strong or well coordinated enough, joints are pushed to the end of their range repeatedly, tissues become irritated, and pain follows — often in several places at once, and often in the knees, ankles, shoulders, hips and lower back.

Symptoms frequently appear or worsen in the teens and twenties, during growth spurts, after a period of inactivity, or when starting a new job or sport. The good news is that hypermobility-related pain generally responds well to the right kind of exercise.

Causes and risk factors

• Inherited differences in collagen, the protein that gives ligaments their strength
• Being female — hormones influence ligament laxity
• Younger age; joints tend to stiffen slightly with age
• Family history of hypermobility or "double-jointedness"
• Low muscle strength or periods of reduced activity
• Activities that repeatedly push joints to their end range, such as yoga or dance, without strength work
• Associated conditions such as flat feet, frequent sprains or digestive and dizziness symptoms (seen in some people with hEDS)

How we may be able to help

Assessment first. We measure your joint range using a standard scoring system, identify which joints are symptomatic, test muscle strength and how well you control movement, and ask about related symptoms. If the picture suggests a connective tissue disorder that needs medical confirmation, we can arrange an online private GP consultation.

Physiotherapy is the main treatment. Rather than stretching — which people with hypermobility often do instinctively but which tends to make things worse — the focus is on building strength and control in the mid-range of each joint. This includes progressive resistance training, balance and proprioception work (improving your sense of where your joints are), and learning to move without "hanging" on the ligaments at the end of range. Programmes start gently, because hypermobile tissues can be easily irritated, and build steadily. Manual therapy is used sparingly and gently where a joint has become stiff from guarding.

A 3D posture scan can show habitual positions, such as locked-back knees or a sway-back, that load joints at end range. Kinesiology taping can give unstable joints extra sensory feedback during the early phase of training. Where flat feet are adding to lower-limb strain, a 3D foot scan and custom orthotics may be considered. Rehabilitation exercise continues through your follow-up sessions and becomes a long-term habit.

What you can do at home

• Swap stretching for strengthening; if something feels tight, it usually needs stability, not more range
• Avoid locking your knees and elbows when standing or supporting weight — keep a soft bend
• Start resistance exercise two to three times a week, beginning with bodyweight or light bands
• Practise single-leg balance daily, ideally with eyes closed once it is easy
• Choose supportive footwear and avoid long periods in high heels or flat, flimsy shoes
• Pace new activities — hypermobile tissues take longer to adapt to increased load