Do you have many seemingly unrelated body wide pain, fatigue or health symptoms? These may indicate that you have hypermobility. Hypermobility refers to joints that move beyond the normal range of motion. It’s often described as being “double-jointed” and can be present in various joints such as elbows, wrists, fingers, shoulders and knees [1]. Symptoms of hypermobility can vary widely as can the associated health issues, which may include chronic pain, fatigue, frequent injuries and joint instability. It can also affect internal organs, leading to gastrointestinal problems like irritable bowel syndrome (IBS) and overactive bladder. While many people with hypermobility experience no symptoms, others may face challenges due to joint instability and pain.

When hypermobility leads to symptoms such as pain, joint instability, or other complications, it can be part of a larger diagnosis, such as Hypermobile Spectrum Disorders (HSD), Ehlers-Danlos Syndrome (EDS), Marfan’s Syndrome or Loeys Dietz Syndrome.

Causes of Hypermobility

Hypermobility can have various underlying causes, ranging from genetic factors to acquired conditions [2]. Some of the primary causes include:

• Genetic Factors: Many cases of hypermobility are inherited, meaning they run in families. Genetic disorders affecting connective tissue, such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome, and Loeys-Dietz Syndrome, are common causes of hypermobility. These conditions result from mutations in genes responsible for producing collagen and other components of connective tissue.
• Connective Tissue Disorders: Conditions like EDS and Marfan Syndrome directly affect the structure and function of connective tissue. In these disorders, the connective tissue is overly flexible and fragile, leading to joint hypermobility and other systemic symptoms.
• Developmental Factors: Some individuals are born with naturally more flexible joints due to variations in their connective tissue structure. This can have no symptoms at all and be a benign trait or it may potentially lead to symptoms and complications.
• Acquired Conditions: Certain conditions or injuries can lead to joint hypermobility. For example, prolonged stretching or certain types of physical activities, such as gymnastics or dance, can increase joint flexibility over time.
• Hormonal Factors: Hormones, especially during pregnancy, can affect the laxity of connective tissues, leading to temporary or permanent hypermobility. Some patients even note changes in their mobility and pain with their menstrual cycles.
• Neuromuscular Disorders: Conditions affecting the muscles and nerves, such as multiple sclerosis or myopathies, can result in joint instability and hypermobility.

Common Hypermobility Syndrome Disorder (HSD) symptoms and the reasons behind the issues with your tissues

Hypermobility Spectrum Disorder (HSD) can affect multiple systems in the body, leading to a wide range of symptoms beyond just flexible joints. Many of these symptoms arise due to weaknesses in connective tissue, particularly collagen, which plays a vital role in joint stability, skin elasticity, and organ function. When collagen is too lax or structurally deficient, the body compensates in ways that can cause pain, fatigue, instability, and even issues with balance, digestion, and circulation. Below are some of the most common symptoms associated with HSD, along with the underlying reasons why they occur.

• Pain/Stiffness in joints and muscles [3]: Persistent or recurring pain and tenderness in the muscles and joints, that is often exacerbated by physical activity. This is also one of the signs that overlaps with Fibromyalgia. Your pain can affect any joint but most commonly affects shoulders, knees, wrists, elbows, and fingers. Weakened collagen makes connective tissue too flexible, causing muscles to work harder to stabilise joints, muscles around lax joints are overcompensating as they are constantly guarding joints and this results in pain.
• Joint Instability [4]: Frequent joint dislocations, subluxations (partial dislocations), and a feeling of joints giving way. This can lead to injuries and impair daily activities. Sometimes joints can easily go out of alignment or dislocate, causing severe pain. This is especially common in conditions like Ehlers-Danlos Syndrome (EDS).
• Headaches: Recurrent and painful headaches, often due to pain in the joints and muscles of the upper body, including the neck and shoulders.
• Cracking/Popping joints: Clicking joints are common, and joint popping can be particularly loud and painful in those with hypermobility syndrome.
• Fatigue/Lack of energy [5]: Many of my patients with hypermobility experience chronic fatigue, which can be debilitating and impact their quality of life. Chronic fatigue is common due to over “guarding” (related to the body’s constant effort to stabilise the joints), resulting in pain and stiffness, leading to poor sleep and tiredness. Ongoing pain also drains energy and motivation.
• Slow to reach developmental milestones [4]: Children with hypermobility spectrum disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS) can experience delayed motor development and poor coordination
• Poor Balance/Coordination/Joint feedback [7]: Lax joints, weak connective tissue, and poor posture combine to make sensing the position and movement of the body difficult which leads to clumsiness, coordination problems and balance issues.
• Frequent recurring injuries [8]: Weakened or altered connective tissues, especially collagen makes individuals more susceptible to injuries like sprains, dislocations, and muscle tears.
• Poor sleep [9]: As the body’s message system related to feedback from the muscle and joints to the brain is altered because of the faulty connective tissues, during the day, muscles and joints may fail to signal the brain that the body has worked and so needs rest.  Additionally, since these muscles work harder, to protect joints and they become overfatigued. As a result, pain and discomfort often wake my patients or make it difficult for them to sleep.
• Stretchy/thin skin: Skin may be thin, stretchy, or saggy, making it more prone to bruises, cuts, and tearing. Some individuals may also have soft, velvety skin. Scars may not heal properly, and stitches may not stay in place needing repeated stitching.
• Dizziness, brain fog and increased or unusual heart rate patterns: Some people with hypermobility experience symptoms of autonomic dysfunction, such as dizziness, light-headedness, and an increased heart rate, especially upon standing up (a condition known as postural orthostatic tachycardia syndrome or POTS).
• Posture issues and scoliosis: Many patients say they feel “not held together well” and often have poor posture as they find it exhausting to keep themselves upright. This can also be a sign of hypermobility. Scoliosis is a condition where a person’s spine curves sideways in an “S” or “C” shape. This curve can happen at any part of the spine but is most commonly found in the upper back or lower back. The exact cause of scoliosis is often unknown, but it can be due to genetic factors, birth defects, or other medical conditions.
• Urinary Incontinence [10]: Difficulty controlling bladder functions, which many patients report is their worst symptom as it can be embarrassing and affect daily life.
• Digestive complaints and nutritional issues [11][12][13]: Issues like diarrhoea, constipation, irritable bowel syndrome (IBS), and acid reflux are common due to problems with the coordination of involuntary muscle movement within the gut.
• Problems with internal organs: Problems such as mitral valve prolapse (heart valves) or organ prolapse may occur due to the over flexibility or laxity of connective tissues.
• Anxiety and stress [14]: Chronic pain and other symptoms associated with hypermobility can lead to anxiety and stress, which can further disrupt sleep by making it difficult to fall asleep or stay asleep.
• Sleep Apnoea: Some individuals with hypermobility may also have sleep apnoea, a condition where breathing repeatedly stops and starts during sleep. This can lead to poor sleep quality and daytime fatigue.

When it’s more than just being bendy – Understanding Symptomatic Hypermobility

While many people with hypermobility do not experience any problems, others may face significant challenges. When hypermobility is accompanied by symptoms such as pain, frequent injuries, fatigue, joint instability, and other symptoms, it is referred to as symptomatic hypermobility. When these symptoms significantly impact daily life, hypermobility is then referred to as “syndromic” or “symptomatic” [15]. The two primary conditions associated with symptomatic hypermobility are Hypermobile Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) [16].

If you suspect hypermobility is causing your health issues…

Hypermobility is a complex condition with a wide range of symptoms and causes. While some people may experience it as a harmless trait, others may face significant challenges that impact their quality of life. Understanding the symptoms and causes of hypermobility is crucial for proper diagnosis and multidisciplinary management. If you suspect you have hypermobility or related conditions/syndromes it is essential to consult with a healthcare professional for a comprehensive evaluation and personalised care plan.

References

[1] Hypermobility Syndromes Association. (n.d.). What is hypermobility? Retrieved February 18, 2025, from https://www.hypermobility.org/what-is-hypermobility, Hypermobility Syndromes Association (HMSA – UK)

[2] Nicholson, L. L., Chan, C., Tofts, L., & Pacey, V. (2022). Hypermobility syndromes in children and adolescents: Assessment, diagnosis and multidisciplinary management. Australian Journal of General Practice, 51(6)

[3] Alsiri, N., Alhadhoud, M., Alkatefi, T., & Palmer, S. (2023). The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review. Seminars in arthritis and rheumatism, 58, 152127-152127. https://doi.org/10.1016/j.semarthrit.2022.152127

[4] Russek, L. N., Stott, P., & Simmonds, J. (2019). Recognizing and Effectively Managing Hypermobility-Related Conditions. Physical therapy, 99(9), 1189-1200. https://doi.org/10.1093/ptj/pzz078

[5] Hakim, A. J., De Wandele, I., O’Callaghan, C., Pocinki, A., & Rowe, P. (2017). Chronic fatigue in Ehlers-Danlos syndrome—Hypermobile type. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175C(1), 175-180.

[7] Wang, Y., Strutton, P.H. & Alexander, C.M. Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review. BMC Musculoskelet Disord 26, 88 (2025). https://doi.org/10.1186/s12891-025-08318-3

[8] Nathan JA, Davies K, Swaine I. Hypermobility and sports injury. BMJ open sport & exercise medicine. 2018 Oct 1;4(1):e000366.

[9] Celletti, C., Camerota, F., Castori, M., & Grammatico, P. (2012). Evaluation of sleep disturbance in joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type. American Journal of Medical Genetics Part A, 158A(9), 2176-2180.

[10] The Ehlers-Danlos Society. (n.d.). Bladder problems. Retrieved from https://www.ehlers-danlos.org/what-is-eds/information-on-eds/bladder-problems/

[11] N Chang, D Borovsky, Y Yuan, D Armstrong, a81 Gastrointestinal (Gi) features of hypermobile Ehlers Danlos Syndrome (heds) and hypermobility spectrum disorder (hsd): a scoping review, Journal of the Canadian Association of Gastroenterology, Volume 7, Issue Supplement_1, March 2024, Pages 56–57, https://doi.org/10.1093/jcag/gwad061.081

[12] The Ehlers-Danlos Society. (n.d.). Digestive disorders. Retrieved from https://www.ehlers-danlos.org/what-is-eds/information-on-eds/digestive-disorders/

[13] Lam C, Amarasinghe G, Zarate-Lopez N, et al, Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management, Frontline Gastroenterology 2023;14:68-77.

[14] Kampoureli CN, Rae CL, Gould Van Praag C, et al. Neural processes linking joint hypermobility and anxiety: key roles for the amygdala and insular cortex. The British Journal of Psychiatry. Published online 2025:1-7. doi:10.1192/bjp.2024.259

[15] Tinkle, B., Castori, M., Berglund, B., Cohen, H., Grahame, R., Kazkaz, H., & Levy, H. (2017). Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD): Clinical description and natural history. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 48-69.

[16] Hypermobility Syndromes Association. (n.d.). What is hypermobility? Retrieved February 18, 2025, from https://www.hypermobility.org/what-is-hypermobility