One important thing before we start: being hypermobile is a characteristic, not a diagnosis. Having hypermobile joints does not automatically mean you have a connective tissue condition. That said, there’s plenty worth understanding about what it does mean, and I’ll explain all of this in more detail below.
Below I’ve written a summary of everything I think is useful to know if hypermobility might be relevant to you. It’s what I’d cover if we only had 10 minutes together to go through the basics.
Consider it your Hypermobility Starter Guide 🚀
Your Hypermobility Starter Guide
Here’s how I explain what hypermobility really means in simple terms👇
At a Glance 👀
- Hypermobility is an innate quality that someone either has or does not have due to their connective tissue makeup.
- Being hypermobile is not the same as having a diagnosis of a connective tissue disorder.
- Hypermobility can be local or regional (limited to a single joint or a few joints), or general (throughout the body). And it can be historical (you were previously hypermobile, and now you are not due to age-related stiffening)!
- The Beighton Scale is one tool used to assess for Generalised Joint Hypermobility, but current research suggests it works best as part of a comprehensive assessment by a hypermobility-informed healthcare provider rather than in isolation.
Hypermobility Is Not Flexibility!
These two terms get used interchangeably a lot, but they actually refer to very different things.
- HYPERMOBILITY refers to joint-based excessive movement beyond normal limits due to hypermobile connective tissue. Hypermobility is something you are born with (think of it as any other characteristic like having brown eyes, or being tall), as it is an innate quality of your connective tissue. For example, if your knees hyperextend you didn’t have to work to achieve that range of motion. It’s just how your knees are.
- FLEXIBILITY refers to muscle-based ability for joints to move through an unrestricted range of motion that does not result in pain or injury. Flexibility is acquired through stretching and developing the ability to move a joint in a greater range of motion due to neuromuscular adaptation of the soft tissue structures within and around the joint. For example, if you are someone who could never touch your toes and you worked consistently over time on hamstring stretches and then developed the ability to touch your toes, that would be an example of increasing your flexibility
There Are Different Types of Hypermobility
Hypermobile connective tissue can be local, regional, general or historical depending on how the person is affected.
TYPES OF HYPERMOBILITY
Local hypermobility: a singular joint/group of joints is hypermobile. For example, someone might just have hypermobile knees (and not be hypermobile anywhere else in their body). I don’t see this very often in my patients, but it does occasionally happen.
Regional hypermobility: sometimes joints are grouped in different ways in the body, and these are referred to as “bodily regions.” Some examples of regions include the upper extremities (your hands, arms and shoulder blades), your lower extremities (your feet, legs, and hips), and your axial skeleton (your sacroilliac joints, your pelvis, your spine, your jaw, and your skull). Some patients will present with hypermobile joints in one region of their body, without having hypermobile joints in another region of their body. Commonly patients who are only hypermobile in their lower extremities (hips, feet, knees, ankles etc.) are not identified as being hypermobile by healthcare providers, as the most common hypermobility assessment (the Beighton Scale) neglects to adequately asses the lower extremities.
Generalised joint hypermobility (GJH): sometimes people will have hypermobile connective tissue in joints throughout their body. This is referred to as Generalised Joint Hypermobility (GJH). GJH is typically assessed using the Beighton Scale, with people who score 5 or more on the 9 point scale given the label of GJH. Although the Beighton Scale is commonly used, it is far from perfect. You can listen to my Help! I’m Hypermobile podcast episode by clicking here where I do an in-depth discussion and analysis of the Beighton Scale, and please also be sure to check out The Beighton Score as a measure of generalised joint hypermobility by Sabeeha Malek et al. (2021) which reaches the conclusion that:
“The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH.” (Malek, Reinhold and Pearce, 2021)
Historical hypermobility: some people were hypermobile earlier in life, but as they’ve aged, or as cumulative injuries have caused tissue scarring and stiffening, their joints no longer present as visibly hypermobile. This is why taking age into account when assessing patients for Generalised Joint Hypermobility (GJH) is critical, as the way in which hypermobility presents in a person’s joints will change over their lifetime. Patients with historical hypermobility are in no way less affected than younger patients where joint hypermobility is more obvious, and it is critical that patients with historical hypermobility are not overlooked when assessed by healthcare providers.
HYPERMOBILITY SUMMARY
Hypermobility and Health Consequences
There is ongoing discussion in the research community about the health implications of hypermobility, and clinical understanding in this area continues to develop. What the current evidence does suggest is that joints which move beyond their typical range of motion, even slightly, may over time place additional strain on the surrounding supportive structures, particularly where muscular support is insufficient or movement patterns are not well managed.
This is one reason why many clinicians who specialise in hypermobility recommend proactive management strategies, even in the absence of significant current symptoms. Early intervention and appropriate support may reduce the risk of chronic joint issues. If you have concerns about your joints or symptoms, speaking with a hypermobility-informed healthcare provider is always the best first step.
Generalised Joint Hypermobility and Health Conditions
GJH is a feature of numerous connective tissue disorders, including Hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), and Marfan’s Syndrome to name a few. Each diagnosable connective tissue disorder has its own set of diagnostic criteria (for example, at the time of writing this hEDS is currently diagnosed using the 2017 hEDS Diagnostic Criteria). However, it’s important to note that due to a general lack of understanding and awareness in both the healthcare providers and the general population regarding connective tissue disorders that although they are relatively common (for example, hEDS/HSD occur in at least 1 in 500 people, which makes it more common than other relatively well known conditions such as Sickle Cell Anaemia and Inherited Familial Hypercholesterolaemia) they are frequently not diagnosed.
In her commentary on hEDS and HSD in midwifery patients, Dr. Sally Pezaro powerfully summarises the current diagnostic reality of hEDS and HSD by stating that: “[hEDS/HSD] should no longer be considered rare, only rarely diagnosed.”
This is why I’m so passionate about my work with people who are hypermobile: because it’s common(!), and it affects the lives of countless people across the globe. And although hopefully one day there will be greater awareness in healthcare as a whole regarding hypermobile connective tissue, for now unfortunately most patients have to learn about hypermobility and related conditions independently in order to be able to access care. The healthcare needs of people who are hypermobile are further complicated by the fact that hypermobile connective tissue (especially in people who are hypermobile throughout their body) is often not just limited to muscles and joints.
Connective Tissue is Everywhere (Literally)
Did you know that your gut is essentially a long tube of connective tissue?
And your eyes are connective tissue. And your teeth. And your skin. And your bones. Even your blood is technically connective tissue!
Connective tissue is everywhere.
Although some people who are hypermobile do not experience symptoms outside of those relating to their muscles and joints, anecdotally I can say with certainty that most of the patients who I see experience symptoms in at least a few other bodily systems. Common ones include:
- an unexplained IBS diagnosis (you can listen to my podcast episode where I discuss hypermobility and gut health here, and you can check out the research paper Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know by Phoebe Thwaites, Peter Gibson, and Rebecca Burgell)
- unexplained period issues (for example: serious muscle and joint pain before/during menstruation, excessive bleeding, cycle-related headaches)
- unexplained skin rashes that seem to come and go, and which often get labelled simply as “sensitive skin”
- unexplained dental issues (the classic example is the patient who tries their best to brush and floss their teeth and eat healthily and who still gets cavities)
- unexplained lightheadedness when transitioning from sitting to standing, or an unexplained chronically low or otherwise abnormal blood-pressure (for many patients this ultimately relates to conditions such as Postural Orthostatic Tachycardia Syndrome aka POTS or other forms of Orthostatic Intolerance, including Orthostatic Hypotension)
Important: this list is not diagnostic, and these symptoms have many possible causes. If you experience any of them, please seek appropriate medical investigation rather than assuming a connection to hypermobility. A good healthcare provider will always consider the full picture.
Incurable Does Not Mean Untreatable!
There is currently no way to change the fundamental nature of hypermobile connective tissue. However, many of the challenges associated with hypermobility, including joint instability, pain, and fatigue, can be meaningfully managed with the right support and strategies.
The more informed you are about hypermobility, the better placed you’ll be to have productive conversations with healthcare providers and make decisions that work for your body. And if you want to go deeper, I’ve spent a long time putting everything I know into one place.
Want to Learn More?
My book Help! I’m Hypermobile: Your How-to Guide for hEDS, HSD, and Life in a Hypermobile Body is coming out on May 12th. It’s the resource I wish had existed when I first started working with hypermobile patients — a comprehensive, practical guide written for anyone who is hypermobile, suspects they might be, or simply wants to understand their body better.
If this guide has resonated with you, the book goes much further. You can find out everything you need to know by clicking the link here: hypermobilityhq.com/book
And if you’d like to work with me directly in the meantime, you’re welcome to get in touch to enquire about a consultation. I’d love to hear from you.
All the best in health (and everything else),
Alex
About Alex
Alex is a highly sought-after Hypermobility Specialist Osteopath based in London, known for her extensive experience in treating chronic pain and injuries related to hypermobile connective tissue in both athletes and everyday individuals. She holds two four-year university degrees, including a Master’s in Osteopathy, and has completed numerous postgraduate certifications, such as Active Release Techniques®.
Alex began her career working with elite athletes, including two-time CrossFit Games Champion Annie Thorisdottir, before focusing on hypermobility-related injuries. She provides holistic, scientifically informed care for patients with Hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), and other connective tissue disorders. While hypermobility is her specialty, she also treats patients with complex, chronic, and treatment-resistant injuries who are not hypermobile.
Learn more at hypermobilityhq.com/about.
