26) The Hidden Struggle of Hypermobility: How Physiotherapy Can Help

Introduction Hypermobility might sound like a superpower, but for many people, it’s a hidden struggle. Loose joints can lead to pain, fatigue, and even injuries. But here’s the good news—physiotherapy can make a massive difference. In this blog, we’ll break down what hypermobility is, why it happens, and how targeted physio treatment can help you stay strong and pain-free.

What is Hypermobility?

Hypermobility refers to excessive movement in the joints due to looser connective tissues. Some people are naturally more flexible, but when the increased flexibility causes pain, instability, or repeated injuries, it becomes a medical concern. This is often referred to as Joint Hypermobility Syndrome (JHS) or, in more severe cases, Ehlers-Danlos Syndrome (EDS).

Common complaints:

Frequent joint pain, especially after activity
Increased risk of sprains, dislocations, and joint injuries
Fatigue due to muscles working harder to stabilise joints
Poor proprioception (awareness of body position)
Digestive issues, dizziness, and other systemic symptoms in cases of EDS

Why Does Hypermobility Happen?

Hypermobility is largely genetic. The main culprit? Collagen. This vital protein gives connective tissues their structure and strength. When collagen is more elastic than normal, joints become extra flexible but also unstable. Other contributing factors include:

Hormones – Oestrogen can influence tissue laxity, which is why hypermobility symptoms often worsen during pregnancy or hormonal changes.
Muscle Weakness – Weak stabilising muscles allow joints to move excessively.
Poor Motor Control – The brain struggles to sense and control joint positions, increasing the risk of injury.

How Physiotherapists Assess for Hypermobility

Physiotherapists use a range of tests to assess joint hypermobility and determine its impact on function. One of the most widely used tools is the Beighton Score, which helps quantify joint laxity.

Beighton Score Assessment

The Beighton Score is a 9-point scale assessing hypermobility at five different joint areas:

Ability to bend the pinky finger back beyond 90 degrees (1 point per hand)
Ability to touch the thumb to the forearm (1 point per hand)
Hyperextension of the elbows beyond 10 degrees (1 point per elbow)
Hyperextension of the knees beyond 10 degrees (1 point per knee)
Ability to place palms flat on the floor with straight legs (1 point)

A score of 5 or more (out of 9) suggests generalised joint hypermobility, though clinical judgement is needed to assess its significance.

Additional Assessment Techniques

Functional Movement Analysis – Observing movement patterns during tasks like squatting, walking, and reaching.
Strength and Stability Tests – Checking for muscle control around hypermobile joints.
Proprioception Tests – Assessing balance and joint position awareness.
Pain and Fatigue Questionnaires – Understanding the broader impact of hypermobility on daily life.

This thorough assessment helps physiotherapists create individualised treatment plans tailored to each patient’s needs.

How Physiotherapy Helps Hypermobility

Physiotherapy plays a crucial role in managing hypermobility by strengthening muscles, improving proprioception, and reducing pain. Here’s what physios focus on:

1. Strengthening & Stability Training

Strength training is essential to help stabilise loose joints. The goal isn’t just to build muscle but to train the right muscles to activate at the right time.

Core stability work – Stronger core muscles help protect the spine and prevent excessive movement.
Glute activation exercises – Essential for hip and knee stability.
Shoulder stability drills – Helps reduce dislocations in hypermobile shoulders.

2. Proprioception & Motor Control Training

Since hypermobile individuals often struggle with joint position awareness, physios use:

Balance exercises – Like single-leg stands or wobble board training.
Closed-chain exercises – Movements with feet or hands in contact with the ground to improve stability.
Neuromuscular training – Teaching the brain to better control movement and prevent injuries.

3. Pain Management Strategies

Pain in hypermobility isn’t always from injury—it’s often from muscle overuse and poor joint alignment. Physios use:

Soft tissue techniques – To relieve muscle tightness.
Taping and bracing – Provides extra joint support during activity.
Activity modification – Finding the right balance between movement and rest.

4. Education & Lifestyle Advice

Education is a huge part of treatment. Physios teach:

How to move efficiently without overloading joints.
When to rest vs. push through discomfort.
The importance of proper footwear and ergonomic setups for daily life.

A Recent Success Story: Meet Sophie

Sophie, a 26-year-old yoga instructor, came to the clinic with chronic knee pain and frequent shoulder subluxations (partial dislocations). Despite being incredibly flexible, she struggled with strength and stability, making everyday activities exhausting.

During her physio sessions, we focused on glute and core strengthening, shoulder stability drills, and proprioceptive training to improve her joint control. We also adjusted her yoga practice to avoid overstretching vulnerable joints. After 12 weeks, Sophie reported significantly less pain, fewer dislocations, and more confidence in her body’s ability to move safely. She’s now back to teaching yoga but with a much smarter approach to her own movement.

Can You Prevent Hypermobility Issues?

While you can’t change your genetics, you can absolutely reduce the impact of hypermobility on your life. Here’s how:

Strength train regularly – Focus on controlled movements, not just flexibility.
Warm up properly – Avoid static stretching before exercise; opt for dynamic warm-ups instead.
Listen to your body – If an activity causes pain or excessive fatigue, modify it.
Seek professional advice – A physio can help tailor an exercise program specific to your needs.

Final Thoughts

Hypermobility doesn’t have to mean constant pain or injury. With the right physiotherapy approach, you can build strength, stability, and confidence in your movement. If you struggle with joint pain or instability, book a physiotherapy session and take control of your health today! Give us a call on 9806 3077 today to ask more about your injury.

References & Further Reading

National Health Service (NHS). (2024). Hypermobility and Joint Hypermobility Syndrome. Retrieved from: https://www.nhs.uk/conditions/hypermobility/
Ehlers-Danlos Society. (2024). Understanding Hypermobility. Retrieved from: https://www.ehlers-danlos.com/
Australian Physiotherapy Association (APA). (2024). Physiotherapy and Joint Hypermobility. Retrieved from: https://australian.physio/

Looking for more physio insights? Check out our other blogs on joint health, strength training, and injury prevention!