Hypermobility means your joints move beyond the normal range. This can lead to pain, instability, fatigue, and even issues with digestion, circulation, and mental health. Because it affects different parts of the body, you may need to see a variety of healthcare professionals to help manage your symptoms. If you have General Joint Hypermobility (GJH) and are living with Hypermobility, you’re not alone – it’s a common condition, affecting 2–57% of people [1]. People with GJH may also experience physical and/or psychological symptoms, which affect about 10% of people with this condition. However, not all people with Hypermobility have pain or other symptoms. This is called Asymptomatic Hypermobility.

Diagnosing Hypermobility and Hypermobility Spectrum Disorders (HSD) involves a combination of clinical evaluation, patient history, and specific diagnostic criteria.

Hypermobility can make everyday life a bit more challenging, but with the right health supports you can manage symptoms and enjoy a good quality of life. Whether you have Generalised Joint Hypermobility or a diagnosed condition like Ehlers-Danlos Syndrome (EDS), a multidisciplinary approach is often the best way to stay on top of your health.

Issues to consider when living with Hypermobility

Living with hypermobility goes beyond joint flexibility and musculoskeletal concerns – it can affect multiple body systems, leading to a variety of complex and sometimes unexpected symptoms. Many individuals with hypermobility experience issues beyond pain and instability, including difficulties with bladder and bowel function, dental health complications, pregnancy-related challenges, and autonomic dysfunctions like POTS. Additionally, research continues to explore the links between hypermobility and conditions such as neurodivergence and anxiety. Understanding these broader implications can help individuals and healthcare providers adopt a more comprehensive and proactive approach to management, ensuring a better quality of life. Below, we explore some of these interconnected issues in more detail.

Subluxations and dislocations in Hypermobility

People with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS) often experience joint subluxations and dislocations due to lax connective tissue in their ligaments. A subluxation occurs when a joint partially slips out of place but returns on its own, while a dislocation is a complete separation of the joint that often requires medical intervention – though many patients I work with can dislocate and relocate joints independently (I wouldn’t recommend this due to the risk of nerve, vascular, or other tissue damage and complications). These events can cause pain, inflammation, and long-term joint instability.

Management strategies include physiotherapy to strengthen surrounding muscles, bracing or taping to provide support, and joint protection techniques to reduce strain. For many patients, prolotherapy may be considered as an option to stabilise a particularly troublesome joint. In severe cases, individuals may require assistive devices such as splints or mobility aids, and potentially surgery. Avoiding high-impact activities and learning safe movement patterns can help minimise the frequency and severity of joint instability.[3].

Digestion, Bowel issues and Hypermobility

Many people with hypermobility experience gastrointestinal (GI) issues, including constipation, irritable bowel syndrome (IBS), nausea, and gastroparesis (delayed stomach emptying). These symptoms are often associated with autonomic dysfunction, impaired connective tissue integrity affecting the gut, and altered gastrointestinal motility [4].

Dietary changes such as identifying food triggers, increasing non-reactive fibre intake, staying well hydrated, and following a low-FODMAP diet may help manage symptoms. Physiotherapy and targeted exercises to strengthen core muscles can also support bowel function. In more severe cases, medications like Osmolax (which increases water content in the bowel) or other laxatives may be prescribed. Working with a dietitian and gastroenterologist familiar with hypermobility-related GI issues is highly recommended, as they can offer a tailored management approach. Every individual is unique – what works for one person may not work for another.

Dysautonomia and POTS and Hypermobility

Dysautonomia refers to a dysfunction of the autonomic nervous system—the part of the nervous system that controls automatic bodily functions such as breathing, heart rate, hormone regulation, and digestion. One of the most common forms of dysautonomia is Postural Orthostatic Tachycardia Syndrome (POTS), which is frequently associated with hypermobility disorders, including Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD) [6]. POTS is characterised by an excessive increase in heart rate upon standing, often leading to symptoms such as dizziness, fatigue, brain fog, and even fainting. These symptoms are believed to stem from connective tissue laxity, which can impair blood vessel tone and hinder effective circulation [7].

Management strategies for POTS typically include increasing salt and fluid intake, wearing compression garments to improve blood flow, and following a structured exercise program that emphasises recumbent or low-impact activities [8]. In some cases, medications such as beta-blockers or midodrine may be prescribed [7]. Autonomic rehabilitation—including gradual physical reconditioning and techniques to calm the nervous system—can significantly improve quality of life for individuals living with POTS and hypermobility.

The connection with Anxiety and Hypermobility

Many people with hypermobility find themselves dealing with anxiety more often than others—and it’s not just in their head. Anxiety disorders are more prevalent in individuals with hypermobility [9]. Research suggests that the body’s nervous system reacts differently when you have hypermobility, which can lead to feeling extra stressed or “on edge.” [10] It’s like the body’s fight-or-flight response gets turned up too high, causing things like a racing heart, dizziness, and trouble calming down or thinking clearly during stressful moments [11].

From my experience and from working with many patients over the years ​managing anxiety associated with hypermobility can be approached through various therapeutic techniques and lifestyle adjustments. Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) have demonstrated efficacy in treating anxiety disorders by helping individuals reframe negative thought patterns and develop acceptance strategies [12]. Relaxation techniques, mindfulness, and physical grounding exercises (like focusing on your feet or touching something textured) can really help [13]. Sensory destimulation methods, including the use of sunglasses or noise-canceling headphones, may help calm the nervous system by minimizing overwhelming sensory input [14]. Additionally, addressing physical health factors like managing Postural Orthostatic Tachycardia Syndrome (POTS) symptoms and maintaining stable blood sugar levels can contribute to alleviating anxiety symptoms. Recognizing the connection between hypermobility and anxiety allows for a comprehensive treatment approach that integrates both physical and mental health strategies.

The connection with Neurodivergence and Hypermobility

There is a growing body of research suggesting a strong link between neurodivergence (including Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD)) and hypermobility. Individuals with hypermobility are more likely to exhibit traits of neurodivergence, and vice versa, suggesting a shared underlying mechanism, potentially involving connective tissue abnormalities and nervous system differences [15].

Many neurodivergent individuals with hypermobility experience sensory processing issues, proprioceptive challenges, and heightened pain perception [16]. Understanding this connection can improve diagnostic accuracy and ensure that individuals receive appropriate care tailored to both their musculoskeletal and neurological needs. Strategies such as occupational therapy, sensory integration techniques, and structured routines can help manage daily challenges [17].

Dental health and Hypermobility

Individuals with hypermobility often experience dental and oral health issues due to connective tissue fragility [18]. These may include frequent cavities, gum disease, high-arched palate, temporomandibular joint dysfunction (TMJ), and increased risk of dental trauma. Gum recession and delayed wound healing after dental procedures are also common [19].

Good oral hygiene, including regular dental checkups, gentle brushing, and flossing, is essential. Dentists familiar with hypermobility can recommend specialised mouthguards for TMJ support and pain management strategies. Additionally, avoiding excessively chewy or hard foods can help prevent jaw strain and dental injuries. Some individuals may benefit from orthodontic treatments tailored to their unique connective tissue needs.

Bladder issues and Hypermobility

Bladder dysfunction is common in individuals with hypermobility, with symptoms ranging from urinary urgency and frequency to incontinence or difficulty emptying the bladder completely. This is often due to weak pelvic floor muscles, autonomic nervous system dysfunction (as seen in conditions like POTS and dysautonomia), or connective tissue abnormalities affecting the bladders’ support structures [20].

Pelvic floor physiotherapy can help increase awareness of over guarding, weakness, and assist to strengthen muscles and improve control, while dietary modifications (such as reducing bladder irritants like caffeine, histamines and alcohol) may provide symptom relief [21]. In some cases, medications or medical interventions, such as intermittent catheterisation, may be necessary. Proper hydration and bladder training techniques can also help improve symptoms and enhance quality of life [21].

Pregnancy, and childbirth and Hypermobility

Pregnancy can present unique challenges for individuals with hypermobility, as hormonal changes (such as increased relaxin levels) can further loosen ligaments, leading to increased joint instability, pain, and fatigue. Common issues include pelvic girdle pain, increased risk of joint subluxations, and complications during labour due to excessive tissue elasticity [22].

Close monitoring by a multidisciplinary team, including an obstetrician, physiotherapist, and pain specialist, is recommended. Prenatal physiotherapy focusing on core and pelvic stability can help manage discomfort. During labour, positioning techniques and careful epidural administration (due to potential spinal instability) should be considered. Postpartum rehabilitation is crucial to restore strength and prevent long-term complications such as pelvic organ prolapse [23].

Who can help?

Depending on your symptoms you may need help from a variety of health professionals.

General Practitioner (GP)

Your GP is usually the first port of call. They can assess your symptoms, provide referrals to specialists, and help manage ongoing care. If you suspect you have a Hypermobility syndrome, your GP can guide you towards the right diagnosis and treatment plan. If you Take the test! you will receive a PDF report to give to your GP to help start the conversation.

Physiotherapist

Physiotherapists play a key role in improving joint stability, improving strength, balance, your walking patterns, and overall function. They can design a tailored exercise program to strengthen muscles around hypermobile joints, helping to reduce pain and prevent dislocations. Low-impact activities like Pilates, swimming, or strength training under guidance can be beneficial.

Counsellor, Psychologist or Psychiatrist

Living with a chronic condition can take a toll on mental health. Anxiety, depression, and health-related stress are common. A psychologist or psychiatrist can provide emotional support and coping strategies to improve overall well-being.

Occupational Therapist

Daily tasks can sometimes be a challenge with Hypermobility. Handwriting and typing, doing up buttons, household tasks and cooking, lifting, and carrying objects, dressing, and grooming and sleeping can all be affected by Hypermobility. An occupational therapist can suggest adaptive techniques and tools – such as ergonomic pens, braces, or modified kitchen tools – to reduce strain on your joints and make daily life easier.

Pain Specialist

Chronic pain is common in Hypermobility, and a pain specialist can help with pain management strategies, including medications, nerve treatments, or holistic approaches like mindfulness and cognitive behavioural therapy (CBT).

Cardiologist

Some Hypermobility syndromes affect the heart and blood vessels, leading to symptoms like dizziness, fainting, or heart palpitations. A cardiologist can assess and manage these issues.

Rheumatologist

A rheumatologist specialises in joint and connective tissue disorders and can help diagnose Hypermobility syndromes, such as Ehlers-Danlos Syndrome. They can also recommend treatment strategies, including medication and lifestyle changes.

Gastroenterologist

Many people with Hypermobility experience digestive issues, such as irritable bowel syndrome (IBS) or acid reflux. A gastroenterologist can help manage these symptoms through diet, medication, and lifestyle adjustments.

Geneticist

If other family members are also hypermobile and you have other more severe body-wide signs and symptoms, this might lead to a suspicion that you have a hereditary connective tissue disorder, like Ehlers-Danlos Syndrome; a geneticist can confirm the diagnosis and offer genetic counselling.

Living with Hypermobility (everyday tips for managing Hypermobility)

Stay active (but smart)

While overdoing it will usually cause pain, gentle and controlled and specifically Hypermobility aware exercise will help support joint stability. Under the guidance of a hypermobile trained physiotherapist, strength training, swimming, and Pilates are great options.

Pace yourself

Fatigue is a common issue. Break up tasks, take regular breaks, and listen to your body to avoid overexertion.

Use supportive aids

Braces, compression garments, and ergonomic tools can make daily activities more manageable and reduce strain on your joints.

Manage pain holistically

Pain relief isn’t just about medication. Try heat packs, gentle stretching, massage, or mindfulness techniques to ease discomfort.

Look after your mental health

Chronic pain and fatigue can be frustrating. Seeking emotional support from a mental health professional, support groups, or even online communities can be beneficial.

Be kind to yourself

Hypermobility can be unpredictable, and some days will be harder than others. Accepting your limits and adapting as needed can help maintain a positive outlook.

Finally…

Living with Hypermobility can be complex, but with the right support, you can manage symptoms effectively and live a fulfilling life. A team of healthcare professionals can guide you through various aspects of care, ensuring that you get the best possible treatment for your unique needs.

If you suspect you have Hypermobility or are struggling with symptoms, talk to a Hypermobility or Ehlers-Danlos Syndrome-aware GP or allied health professional about the next steps. With the right approach, you can build a lifestyle that supports your body and well-being.

For further information, visit:

• Australian Physiotherapy Association
• The Royal Australian College of General Practitioners
• The Ehlers-Danlos Society

References

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[2] Chopra, P., & Tinkle, B. (2021). Joint hypermobility and hypermobile Ehlers-Danlos syndrome: Recognizing and managing an underdiagnosed spectrum disorder. Cleveland Clinic Journal of Medicine, 88(3), 157–164.

[3] Castori, M., Celletti, C., Camerota, F., & Grammatico, P. (2021). Chronic pain in the spectrum of Ehlers–Danlos syndromes and hypermobility spectrum disorders. Clinics and Practice, 11(4), 781–795.

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[7] Seeley, M. C., Lau, D. H., & Gallagher, C. (2023). Postural orthostatic tachycardia syndrome: Diagnosis and management guide for nurses. Nurse Researcher, 30(4), 14–21.

[8] Wells, R., Tonkin, E., & Neumann, D. L. (2021). Managing postural orthostatic tachycardia syndrome associated with joint hypermobility and Ehlers-Danlos syndrome. Clinical Autonomic Research, 31, 365–378. https://doi.org/10.1007/s10286-021-00791-6

[9] Kampouraki, E., Horder, J., & Eccles, J. A. (2024). Neural processes linking joint hypermobility and anxiety. medRxiv. https://doi.org/10.1101/2024.10.10.24315234

[10] Bulbena, A., Gago, J., Pailhez, G., Sperry, L., & Fullana, M. A. (2011). Joint hypermobility syndrome is a risk factor trait for anxiety disorders: A 15-year follow-up cohort study. General Hospital Psychiatry, 33(4), 363–370. https://doi.org/10.1016/j.genhosppsych.2011.03.004

[11] Eccles, J. A., Beacher, F. D. C., Gray, M. A., Jones, C. L., Minati, L., Harrison, N. A., & Critchley, H. D. (2012). Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms. BMJ Open, 2(6), e000995. https://doi.org/10.1136/bmjopen-2012-000995

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[14] Wada, M., Hayashi, K., Seino, K., Ishii, N., Nawa, T., & Nishimaki, K. (2023). Qualitative and quantitative analysis of self-care regarding sensory issues among people with neurodevelopmental disorders. Frontiers in Child and Adolescent Psychiatry, 2, 1177075. https://doi.org/10.3389/frcha.2023.1177075

[15] Bulbena, A., Pailhez, G., & Baeza-Velasco, C. (2017). Anxiety and joint hypermobility: An unexpected association. Frontiers in Psychology, 8, 1–4.

[16] Eccles, J., Smith, P., & Jones, L. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry, 13, 1234.

[17] Miller, L. J., Reisman, J. E., McIntosh, D. N., & Simon, J. (2001). An ecological model of sensory modulation: Performance of children with fragile X syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction. In Understanding the nature of sensory integration with diverse populations (pp. 143-154). Therapy Skill Builders.

[18] Malfait, F., De Paepe, A., & Castori, M. (2017). The Ehlers-Danlos syndromes: Historical background, clinical features, and diagnostic guidelines. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 8–26. https://doi.org/10.1002/ajmg.c.31552

[19] Ehlers-Danlos Support UK. (n.d.). Oral and dental implications of the Ehlers-Danlos syndromes. Ehlers-Danlos Support UK. Retrieved April 9, 2025, from https://www.ehlers-danlos.org/information/aaoral-and-dental-implications-of-the-ehlers-danlos-syndromes/

[20] Hypermobility Syndromes Association. (n.d.). Bladder issues. http://Hypermobility.org . Retrieved April 1, 2025, from https://www.hypermobility.org/bladder-issues

[21] Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil. 2021 Dec 27;17(6):379-387. doi: 10.12965/jer.2142666.333. PMID: 35036386; PMCID: PMC8743604.

[22] Blagowidow, N. (2021, December). Obstetrics and gynecology in Ehlers‐Danlos syndrome: A brief review and update. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 187, No. 4, pp. 593-598). Hoboken, USA: John Wiley & Sons, Inc.

[23] Pezaro, S., Pearce, G., & Reinhold, E. (2021). A clinical update on hypermobile Ehlers-Danlos syndrome during pregnancy, birth, and beyond. British Journal of Midwifery, 29(9), 492-500.