Hypermobility: When Flexibility Is Only Part of the Story
Hypermobility is often misunderstood.
For some people it is reduced to a party trick, being “double-jointed”, or something they are told they will “grow out of”. For others, it is framed only in terms of pain or fragility. Neither view captures the full picture.
In clinical reality, hypermobility is not just about joints that move more. It is about how the body senses, controls, and adapts to movement, load, and change.
Understanding this difference matters, because it changes how pain is interpreted, how rehabilitation should be approached, and why some people struggle with recovery even when scans look normal.
What is hypermobility?
Hypermobility describes joints that move beyond what is considered the typical range. This can be local, affecting a few joints, or generalised across the body.
Some people are hypermobile and completely symptom-free. Others experience pain, instability, fatigue, or recurring injuries. Many sit somewhere in between.
Hypermobility exists on a spectrum and may be described using terms such as:
Joint Hypermobility
Hypermobility Spectrum Disorder (HSD)
Hypermobile Ehlers-Danlos Syndrome (hEDS)
The label matters less than the functional impact. Two people can have similar joint ranges and very different experiences.
Why hypermobility is not just a joint issue
Connective tissue is not passive scaffolding. It plays an active role in:
Joint stability
Force transmission
Proprioception, your sense of joint position
Vascular tone
Support of organs and airways
In hypermobility, connective tissue tends to be more compliant. This means joints may rely less on passive restraint and more on muscular and neurological control.
That changes how the body manages load.
It also explains why hypermobility is often associated with patterns beyond the joints, including:
Poor tolerance of sudden or unpredictable load
Fatigue that feels disproportionate to effort
Slower recovery after injury or surgery
Sensitivity to certain medications
Symptoms that fluctuate rather than follow a neat mechanical pattern
None of this implies weakness. It implies a high-gain system that needs different inputs.
Hypermobility and pain
One of the most common frustrations for hypermobile people is being told that pain is “out of proportion” to findings.
Imaging may look reassuring. Strength tests may be adequate. And yet pain persists.
In many hypermobile bodies, pain is not a simple reflection of tissue damage. Instead, it is often influenced by:
Reduced proprioceptive clarity
Increased muscular co-contraction
Ongoing protective tone in the nervous system
Difficulty fully settling after stress or injury
Pain may:
Flare hours or days after activity
Move rather than stay in one exact spot
Appear with fatigue, stress, or novelty rather than load alone
This does not mean the pain is imagined. It means the system is still working hard to maintain control.
Treating this kind of pain purely as a structural problem often leads to frustration on both sides.
Why standard rehab often falls short
Many rehabilitation protocols are built around tissue timelines. Once a structure has healed, load is progressed and symptoms are expected to settle.
In hypermobility, tissues may heal on schedule, but the nervous system often needs longer to integrate the change.
This is why some people:
Feel worse when rehab is intensified despite “doing everything right”
Lose confidence in a joint even after successful surgery
Are discharged from rehab before they feel stable or safe
The missing piece is usually sensorimotor integration, not effort or compliance.
Rehabilitation that works well for hypermobile bodies prioritises:
Precision before intensity
Control before complexity
Predictable progression rather than sudden jumps
Strength used to simplify control, not just increase capacity
Progress may look slower on paper, but outcomes are often more robust and sustainable.
Hypermobility and the nervous system
There is growing recognition that hypermobility often overlaps with differences in autonomic and sensory processing.
This can include:
Strong physical reactions to certain drugs, particularly stimulants or adrenaline-like medications
Difficulty tolerating sudden exertion or abrupt demands
Feeling physically “wired” without feeling emotionally anxious
Clear awareness during medical procedures or rapid emergence from anaesthesia
These are physiological traits, not personality traits.
Understanding this helps prevent mislabelling people as anxious, difficult, or non-compliant when their body is simply responding in a high-gain way.
What good care looks like
Supportive care for hypermobility is not about being overly cautious or avoiding challenge.
It is about matching the input to the system.
Effective approaches tend to:
Respect variability rather than force uniformity
Build confidence through repeatable success
Allow adequate recovery between sessions
Address movement quality, not just movement quantity
Integrate breathing, posture, and load rather than isolating parts
Manual therapy, when used, should be specific and well-paced. Strength and conditioning should aim to create clarity and trust, not constant fatigue.
Above all, symptoms should be interpreted as information, not failure.
A final word
Hypermobility is not something to fix. It is a way a body is built.
When it is understood and worked with appropriately, many hypermobile people develop excellent body awareness, resilience, and movement skill. When it is misunderstood, people are often left doubting themselves despite doing everything asked of them.
If you are hypermobile and feel that your symptoms do not quite fit standard explanations, that does not mean you are broken. It means your system needs a different conversation.
That is where thoughtful, individualised care makes all the difference.
