"I'm Not Just 'Double-Jointed'": A Guide to Hypermobility and Ehlers-Danlos Syndrome
Could you always do "party tricks" as a kid?
Bend your thumb to your forearm? Fold your hands behind your back with ease? Perhaps you were the "clumsy" one, always rolling an ankle, or the one who complained of "growing pains" long after everyone else stopped.
Or maybe now, as an adult, you live with a confusing collection of symptoms: joints that "pop out" and "go back in," chronic, widespread pain, debilitating fatigue, and a feeling that your body is just... unreliable.
If this sounds familiar, you may be living with joint hypermobility. For many, this is a benign trait. For others, it's the defining feature of a Hypermobility Spectrum Disorder (HSD) or the more complex, genetic Ehlers-Danlos Syndrome (EDS).
You're not "just flexible." You're not "making it up." And you're not alone.
Welcome to your guide. As a multidisciplinary clinic of physiotherapists and chiropractors, we "get" hypermobility. We understand the paradox of being incredibly flexible yet feeling painfully stiff.
In this article, we'll break down what hypermobility is, what separates it from EDS, and—most importantly—how our integrated physiotherapy and chiropractic approach can help you stop managing pain and start building a stronger, more stable life.
What is Joint Hypermobility? It's a Spectrum.
At its simplest, joint hypermobility means some or all of your joints move beyond the "normal" range of motion. This is due to laxity in your connective tissues, primarily your ligaments.
Think of ligaments as the body's duct tape. They are tough, fibrous bands that connect bones to each other and keep joints stable. In hypermobile individuals, this "tape" is more like a stretchy rubber band.
It's crucial to understand this exists on a spectrum:
Generalised Joint Hypermobility (GJH): You're "double-jointed." You might be a great gymnast or dancer. You have no pain or other symptoms. This is not a disorder; it's just your body type.
Hypermobility Spectrum Disorder (HSD): You have all the flexibility of GJH, but it now comes with symptoms. This is the key difference. These symptoms can include chronic pain, joint instability (subluxations), fatigue, and more.
Ehlers-Danlos Syndrome (EDS): This is a group of hereditary (genetic) disorders affecting the body's connective tissue. Connective tissue is the "glue" that holds everything together—not just joints, but skin, blood vessels, and internal organs.
Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common type, and its symptoms look almost identical to HSD. The diagnostic criteria are complex and strict, but the management strategy for both HSD and hEDS is very similar.
How Do I Know If I'm Hypermobile? The Beighton Score
One common clinical tool is the Beighton Score, a 9-point test.
Can you bend your pinky finger back to 90 degrees? (1 point for each hand)
Can you bend your thumb to touch your forearm? (1 point for each hand)
Can you hyperextend your elbow past 10 degrees? (1 point for each arm)
Can you hyperextend your knee past 10 degrees? (1 point for each leg)
Can you place your palms flat on the floor with your knees straight? (1 point)
A score of 5 or more (4 for adults over 50) often indicates hypermobility. However, this test is not a diagnosis. It doesn't check your shoulders, hips, or ankles, which are often the most problematic joints. It's just one piece of a much larger puzzle. At Velca we will asses your whole body so that we can better guide you.
Ehlers-Danlos Syndrome: More Than Just "Stretchy Joints"
If HSD is about the symptoms in the musculoskeletal system, Ehlers-Danlos Syndrome is about a systemic, body-wide issue with the collagen itself.
Because connective tissue is everywhere, people with EDS (especially hEDS) often experience a "cluster" of symptoms that go far beyond their joints. This is critical for you to hear, as it can validate years of confusing, seemingly unrelated health problems.
Common symptoms and co-morbidities of hEDS can include:
Musculoskeletal: Widespread joint pain, frequent subluxations (partial dislocations) and dislocations (full dislocations), chronic fatigue, and early-onset osteoarthritis.
Skin: Soft, "velvety" skin that may be hyperextensible (stretchy) and fragile, leading to easy bruising and slow wound healing.
Autonomic Dysfunction (Dysautonomia): This is a major one. Your autonomic nervous system controls your "automatic" functions (heart rate, blood pressure, digestion).
POTS (Postural Orthostatic Tachycardia Syndrome): Feeling dizzy, lightheaded, or having a racing heart when you stand up.
Gastrointestinal (GI) Issues: Problems like acid reflux, irritable bowel syndrome (IBS), and gastroparesis (slow stomach emptying) are very common.
Mast Cell Activation Syndrome (MCAS): A condition where your body's "allergy" cells are overactive, leading to seemingly random allergic reactions, hives, or flushing.
Anxiety and Fatigue: Living in a body that feels unreliable is, frankly, exhausting and stressful.
Key Takeaway: If you have chronic joint pain plus a collection of other "weird" symptoms like dizziness, stomach problems, or easy bruising, it's worth exploring the possibility of a hypermobility disorder like HSD or hEDS with a knowledgeable practitioner.
The Hypermobility Paradox: "I'm So Flexible, Why Am I So Stiff?"
This is the number one thing hypermobile patients tell us, and it’s the most important concept to grasp.
"My back is rock solid. My neck is in knots. How can I be 'too flexible'?"
Here's the answer: Your body is smart. It knows your ligaments (the "duct tape") aren't doing their job. So, it reverts to its backup plan: your muscles.
Your muscles are desperately over-working 24/7, tensing up and "guarding" to create the stability your joints lack. They are acting like a "muscular cast" to hold you together.
This constant, low-level tension leads to:
Deep, aching muscle pain.
Severe knots and trigger points.
Chronic fatigue (your muscles never get a day off).
A feeling of being "stiff" and "locked up," especially in your neck, back, and hips.
This is the Hypermobility Paradox. Your joints are too mobile, so your muscles become too tight.
This is why traditional "stretching" can be one of the worst things for a hypermobile person. Stretching your already-lax ligaments just makes the problem worse. You're stretching the part that's already too long, while the tight muscle just spasms harder in protest.
How We Help: An Integrated Approach to Management
Living with HSD or hEDS is not about finding a "cure." It's about finding a management plan. It's about taking back control.
At our clinic, we use an integrated team of physiotherapists and chiropractors who are trained in hypermobility. Our philosophy is simple:
Stability over stretch. Strength over strain.
Here’s how each practitioner plays a vital role.
1. The Role of Physiotherapy: Your "Stability Coach"
A hypermobility-aware physiotherapist is your number one ally. Their job is not to stretch you; it's to teach your muscles how to be smart stabilizers.
The Problem: Poor Proprioception - Proprioception is your body's awareness of where your body is in space. In hypermobile people, this system is faulty. Your brain doesn't get clear signals from your loose joints, which is why you might feel "clumsy", roll your ankle on a flat surface. or knock your elbow on a wall you were familiar with.
The Physio Solution:
Proprioceptive Retraining: We start with small, "brain-focused" exercises. Think balancing on one leg, exercises on unstable surfaces, or simply learning to find a "neutral" joint position. We are re-training your brain-body connection.
Strengthening (The Right Way): This is the core of your management. But we don't just throw you on the leg press. We focus on isometric (static holds) and closed-chain exercises that build strength without pushing your joints into hyper-extension.
We build your "muscle armour": Strong glutes to support your pelvis. A strong "core" to protect your back. Strong rotator cuffs to keep your shoulders in their sockets.
Pacing and Pain Education: We help you understand the "boom-and-bust" cycle. You finally have a good day, do all the things, and then crash for three days. We teach you pacing (the "spoon theory" of bending but not breaking) to help you find a sustainable level of activity.
Bracing and Taping: We can use Kinesiology tape or rigid strapping to provide your brain with extra "feedback" from a joint. We can also help fit you for braces (e.g., ring splints, SI belts) to use as tools (not a crutch) during a flare-up.
Key Takeaway: Physiotherapy is the long-term solution. It's the hard work that builds a body strong enough to support itself.
2. The Role of Chiropractic: Your "Joint and Nerve Mechanic"
I know what you're thinking: "Chiropractic? For someone with loose joints? Are you crazy?!"
This is a common and 100% valid concern. Traditional high-velocity "cracking" manipulations are often NOT appropriate for hypermobile patients.
A hypermobility-aware chiropractor, however, does not practice that way. Our approach is completely different. We are not focused on increasing mobility; we are focused on decreasing pain and improving function using gentle, specific techniques.
The Problem: The Hypermobility Paradox. Your joints are loose, but your muscles are "locked." This also means that while some joints are too loose, others can become rigid and stiff to compensate.
The Chiro Solution:
Gentle, Low-Force Mobilisation: We use gentle, hands-on mobilisation (not a "crack") or instrument-assisted techniques (like an Activator) to help restore normal motion to the joints that are stiff, not the ones that are loose.
Soft Tissue Therapy: This is our primary tool. We work on the muscles that are in spasm. By using techniques like trigger point therapy, we "melt" that rock-solid muscle tension, which provides immense, immediate relief. If needed, then we have massage therapists on site as well.
Pain Relief for Subluxations: Did you "pop a rib out" (a common and painful complaint)? We can use gentle techniques to help guide it back, calming the associated muscle spasms and nerve pain.
Nervous System "Down-Regulation": Gentle manual therapy can have a powerful effect on your nervous system, helping to shift you out of that "fight-or-flight" state (sympathetic) and into a "rest-and-digest" (parasympathetic) state. This calms the pain signals and reduces overall sensitivity.
Key Takeaway: A hypermobility-aware chiro provides the relief so you can do the rehab. We calm the spasmed muscles and stiff compensation joints, paving the way for your physio exercises to be more effective.
The Integrated Approach: Why You Need Both
This is where the magic happens. Using a physiotherapist and a chiropractor in isolation is like trying to build a house with only a hammer. You'll get some of the way, but it won't be stable.
Here is what our integrated approach looks like:
Scenario: You come in with sharp lower back pain and pain between your shoulders.
The Assessment: Our team works together. The Physio identifies that your shoulder and hip joints are unstable and your glutes/core are weak. The Chiro finds that your thoracic spine (mid-back) is rigid and your QL and paraspinal muscles (in your low back) are in severe spasm.
The Treatment (Day 1):
The Chiropractor performs gentle soft tissue release on your spasmed back muscles. They use low-force mobilisation to "unlock" your stiff thoracic spine.
Result: You walk out with significantly less pain and stiffness.
The Treatment (Day 2):
The Physiotherapist now has a "calm" system to work with. Since your muscles aren't in spasm, you can now feel and activate the correct muscles.
They teach you a basic core breathing exercise and a gentle glute-strengthening exercise (like a bridge).
Result: You start building the foundation for long-term stability.
The chiropractor gets you out of pain. The physiotherapist keeps you out of pain. This one-two punch is the most effective and sustainable way to manage the musculoskeletal component of HSD and hEDS.
Your Life Is Not Over—It's Just Beginning
If you've made it this far, you are probably feeling one of two things:
Overwhelmed. (This is a lot of information.)
Seen. (This is the first time someone has accurately described your life.)
Let us leave you with this: Your diagnosis is not your destiny.
Living with hypermobility or Ehlers-Danlos Syndrome is not a life sentence of pain and fatigue. It's a management challenge. It's a new set of rules for your body. You may be more of a "high-maintenance" vehicle, but you can still run beautifully with the right fuel and the right mechanics.
You are not "broken." You are a zebra in a world of horses, and you just need a team that knows how to care for a zebra.
Key Takeaways for Your Journey:
Hypermobility is a spectrum, from benign flexibility to the complex, systemic Ehlers-Danlos Syndrome.
If you have joint pain plus "weird" symptoms (dizziness, GI issues, fatigue), get assessed by a knowledgeable practitioner.
You are not "stiff and flexible" at the same time. Your muscles are stiff because your joints are flexible.
Stop stretching! (At least, not without guidance). Start strengthening.
The best approach is integrated. Physiotherapy builds your stability. Chiropractic (gentle) provides the relief.
You don't have to figure this out alone. You don't have to bounce from specialist to specialist, collecting "unhelpful" labels. If you're ready to stop guessing and start building a stronger, more resilient body, we are here to help.
Our Chiropractor Matt and Senior Physiotherapists, Abduallah and Simone are here to help you.
We frequently work with GP’s and rheumatology or MSK specialists and welcome any referrals.
Ready to Take Back Control?
Your "party trick" doesn't have to be your liability. Let's make stability your new superpower.
Call us today at 09 950 6801 or Click Here to Book Your Initial Appointment. We're ready to build your team.