Why are Hypermobile People Tired?

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2 Surprising Reasons Why Hypermobile People Are Tired

Fatigue is one of the most common symptoms hypermobile patients experience. 


Although it’s difficult to find statistics on it (as with many things hypermobility-related), my conservative estimate is that at least half of my patients mention fatigue as a symptom in their initial appointment. 

Although there are MANY causes of fatigue (and this is why it’s always important to see an appropriately qualified healthcare provider regarding this!!) 2 of reasons why hypermobile people (including people with Hypermobility Spectrum Disorder and Hypermobile Ehlers-Danlos Syndrome and other related conditions)  are SO tired include:

  1. ADHD (Diagnosed/Self-Diagnosed/Undiagnosed)
  2. Their Hypermobile Connective Tissue Makes Movement Literally Take More Effort


Over 50 percent of people who have hEDS also have ADHD. The link between ADHD and fatigue is well-known in research, but rarely talked about. Although dopamine is the most famous neurotransmitter involved with ADHD, issues with histamine (a chemical in your body that acts as a neurotransmitter AND a hormone) also contribute to fatigue. This is because histamine stimulates and modulates dopamine release in the brain

And guess who often has issues with histamine?

Hypermobile people.

I’ll get into detail on this in another blog post, but histamine issues present in hypermobile people typically as either Histamine Intolerance (think of this like being intolerant to dairy. . . your body reacts poorly to histamine in your digestive tract) and Mast Cell Activation Syndrome (in addition to reacting poorly to histamine that you consume, your body also reacts poorly to histamine that your own body produces). Unfortunately as with many things hypermobility/hEDS/HSD related there is little research done on the prevalence of HI and MCAS in the hypermobile patient population. However, even the small amount of research that has been done suffers from poor sample sizes and a lack of clarity regarding diagnostic criteria for these conditions. 

But based on what I see in my clinical practice as an osteopath, histamine issues are common in hypermobile people and may explain the link between ADHD and hypermobility.

For some patients, the first step to addressing their fatigue issues will be speaking with a medical doctor who specialises in this field. Some patients also benefit from taking supplements such as Diamine Oxidase (DAO) to improve their reaction to histamine. You can find DAO supplements HERE.


A diagram visualising the link between ADHD and Hypermobility due to the interaction of problems with histamine and problems with dopamine.

Visual representation of interaction of dopamine and histamine and how they affect both ADHD and hypermobility/hEDS/HSD


2. Their Hypermobile Connective Tissue Makes Movement Literally Take More Effort

There are two main ways in which hypermobile connective tissue makes you tired from a mechanical perspective. 

Firstly, you are much less effective at maintaining Passive Tension


Passive Tension

Passive Tension refers to the ability of your muscle to maintain tension in the absence of a contraction. It is produced by elastic resistance to a stretch stimulus by noncontractile proteins in the muscle. 

In simple terms: passive tension is the ability of your muscle to support a load while not being actively contracted by you. 

We use passive tension constantly without thinking about it, and it is one of the key ways in which your body moves efficiently (because moving efficiently takes work!). People with a collagen defect (such as those with HSD, hEDS, or other connective tissue disorders) have abnormal collagen which sustains passive tension less effectively than normal connective tissue. 

This means that to do nothing, you’re working. This means less rest, more work, and more fatigue. And this might be one reason why you get tired from seemingly doing nothing at all.


Active Tension

Active Tension refers to an active contraction of the muscle. The contraction can be concentric (think of a biceps curl with the weight being held up by your shoulder) or eccentric (think of the lowering phase of a biceps curl). Regardless, your connective tissue is still having to do a LOT to make these movements happen. 

And wonky connective tissue means that a movement that might be easy and almost effortless for someone else is challenging for you. 

My favourite example to illustrate this is a bow and arrow. A bow with normal tension in the string will, when the arrow is pulled back, launch the arrow with the expected amount of force. 

Whereas if the string of the bow is too loose and floppy, the arrow will be pulled back but the same amount of tension as in the normal bow will not be generated.

When the arrow is released, it will go less far. 

This means that to reach the same target as your normal-bow peer, you will release the arrow from the bow more times.

Diagram of a bow and arrow showing how a bow with greater tension (a collagen-typical bow) will shoot an arrow a greater distance than a bow with reduced tension (a hypermobile bow).

Diagram visualising the bow and arrow analogy for hypermobility



It’s always important to think of anything involving hypermobility from both a mechanical (think: muscles/joints/tendons) and systemic/inflammatory/neurological (think: hormones/neurotransmitters/systems other than your musculoskeletal system) perspective. 

If you are struggling with fatigue and have what feels like an overwhelming amount of muscle and joint pain then get in touch and let’s see if I’m the right person for you to work with.

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Kennedy, M., Loomba, K., Ghani, H., & Riley, B. (2022). The psychological burden associated with Ehlers-Danlos syndromes: a systematic review. Journal of osteopathic medicine, 122(8), 381–392. https://doi.org/10.1515/jom-2021-0267

Flik, G., Folgering, J. H., Cremers, T. I., Westerink, B. H., & Dremencov, E. (2015). Interaction Between Brain Histamine and Serotonin, Norepinephrine, and Dopamine Systems: In Vivo Microdialysis and Electrophysiology Study. Journal of molecular neuroscience : MN, 56(2), 320–328. https://doi.org/10.1007/s12031-015-0536-3

Monaco, A., Choi, D., Uzun, S., Maitland, A., & Riley, B. (2022). Association of mast-cell-related conditions with hypermobile syndromes: a review of the literature. Immunologic research, 70(4), 419–431. https://doi.org/10.1007/s12026-022-09280-1

Buttgereit, T., Gu, S., Carneiro-Leão, L., Gutsche, A., Maurer, M., & Siebenhaar, F. (2022). Idiopathic mast cell activation syndrome is more often suspected than diagnosed-A prospective real-life study. Allergy, 77(9), 2794–2802. https://doi.org/10.1111/all.15304

Hettige, P., Mishra, D., Granzier, H., Nishikawa, K., & Gage, M. J. (2022). Contributions of Titin and Collagen to Passive Stress in Muscles from mdm Mice with a Small Deletion in Titin’s Molecular Spring. International journal of molecular sciences, 23(16), 8858. https://doi.org/10.3390/ijms23168858

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I’m Alex, your Hypermobility Specialist Osteopath

more about me

hey there!

I’m a UK registered osteopath who specialises in working with hypermobile patients who have complex, chronic, and seemingly ‘treatment-resistant’ injuries. My years of professional experience (as well as my lifetime of personal experience of being hypermobile!) have given me a wealth of knowledge that I use to craft bespoke, scientifically-informed, truly patient-centred treatment plans for hypermobile patients whether they’re dealing with 1 injury or 10! I take pride in offering hypermobile patients healthcare support that addresses and works with their uniquely hypermobile bodies.