Physical Therapy & Hypermobility: Why where you go matters

Hypermobility affects many people worldwide, yet the physical therapy they receive often varies widely in quality and effectiveness. Not all physical therapy is equal when treating hypermobility, and this difference can significantly impact patient outcomes. Understanding why this inequality exists and how it affects treatment can help patients and therapists work together for better care.

What Is Hypermobility and Why Does It Matter?

Hypermobility means joints have excessive motion due to laxity in the tendons and ligaments. While some people with hypermobility experience no problems, others suffer from pain, instability, and frequent injuries. Hypermobility tends to be a sliding scale- some people have mild or moderate hypermobility while others have a more severe case, which can be diagnosed as hypermobility spectrum disorder (HSD) or Ehlers-Danlos syndrome (EDS). Any level of hypermobility can cause issues and can be helped with physical therapy.

As our bodies age, our joints become stiffer and less flexible. Even if you were very bendy when younger but have lost that flexibility, issues related to hypermobility can still affect your movements and rehab as you age.

Why Physical Therapy for Hypermobility Is Not One-Size-Fits-All

Many physical therapists are trained in general musculoskeletal care but may lack specialized knowledge about hypermobility. This gap leads to several issues:

• Misdiagnosis or underdiagnosis: Without recognizing hypermobility, therapists might treat symptoms without addressing the root cause.

• Inappropriate exercise selection: Exercises that work for typical patients can worsen symptoms in hypermobile individuals by overstretching joints or strengthening the wrong muscle.

• Lack of focus on proprioception and joint stability: These are critical areas for hypermobile patients but often overlooked.

• Inconsistent patient education: Patients may not receive guidance on the cause of their issues, how to fix them on their own, and what lifestyle changes to make.

  
  

For example, a therapist who prescribes aggressive stretching to a hypermobile patient may inadvertently increase joint laxity and pain. Conversely, a therapist who understands hypermobility will emphasize controlled strengthening and stability exercises.

Key Differences in Effective Physical Therapy for Hypermobility

Effective therapy starts with a thorough assessment that identifies hypermobility and related symptoms. This includes:

• Full body alignment

• Movement patterns

• Posture

• Joint stability

• Muscle tone and tightness

While all therapy should be individualized, therapy while treating hypermobility should focus on the following principles for maximum benefit:

• Restoring proper alignment to help with pain and proper muscle activation

• Decrease muscle tightness with soft tissue work or muscle inhibition (not stretching)

• Stabilize the joints by working on strengthening the smaller muscles around the joints before adding in larger muscle strengthening

• Correcting movement patterns and posture with external cues to help retrain the brain

• Educating the patient on how to manage pain, tightness, and live their lives easier

Empowering Patients

Even if you are not near a physical therapist who has experience with hypermobility, always remember that you know your body best and to speak up if something does not feel right. Physical therapy should not be painful; it should be a happy place! The goal of therapy is to return each patient to their lives feeling better and independent.