What I Wish Everyone Knew About Hypermobility & Pain (EDS)
Key insights: 60-second read
- Hypermobility doesn't rule out stiffness or restriction - you can be very flexible overall and still have limited movement in specific areas.
- Restrictions elsewhere may affect how you move - limited movement in adjacent areas can change how load and movement are shared across hypermobile joints.
- Exercise technique matters - control and a suitable progression are important when training with hypermobility.
- Shoulder taps and squats are useful options - they can challenge coordination, control and strength when appropriately scaled.
- Hypermobility is not automatically a disadvantage - with suitable training and movement strategies, flexibility can be an asset.
If you have Ehlers-Danlos syndrome (EDS) or joint hypermobility and are in pain, you may have been told that it's due to poor joint stability. And while that can absolutely be the case for many, I'd also like you to consider another possibility as well.
You may be more flexible than the average human. But as you still live in the same modern environment as everyone else, you may still develop the same stiffness, tightness and movement restrictions as everyone else.
They just may not be as obvious.
These restrictions can be easy to miss because your overall range of movement may still be greater than average. In some cases, they may influence how movement and load are distributed through joints that are already vulnerable.
On this page
A Different Perspective on Joint Hypermobility
In my clinical experience, once someone receives a diagnosis or label, it can be easy to assume that it explains every symptom. These labels matter, but they shouldn't stop us from looking at a person's movement, function and individual circumstances.
Greater joint mobility can make strength, coordination and control important parts of managing load over time. However, in my clinical practice, I also look for mobility restrictions elsewhere that may be contributing to pain or dysfunction.
"I would almost call hyperflexibility a little bit of a superpower rather than a negative. Many people in the modern world are too stiff or restricted in certain areas."
If you are naturally bendy and can move comfortably through a wide range, that flexibility can be an advantage. The aim is to pair it with appropriate strength, control and movement habits, rather than treating flexibility itself as a problem.
Can You Be Hypermobile and Still Have Stiffness?
One thing I wish more people with hypermobility knew is that a dislocating kneecap, an unstable shoulder or another painful area may have just as much to do with a lack of range somewhere else - rather than just being locally hypermobile and unstable.
Living in this modern, sedentary world of ours can ask our tissue to become more restricted than it should be. And while being hypermobile gives the impression that everything is loose everywhere, that elite mobility can sometimes hide those hidden handbrakes underneath.
And clinically, it's these hidden restrictions that could be influencing how you move or distribute load through a more mobile, vulnerable joint close by.
Where Might Restrictions Be Worth Assessing?
- For shoulder symptoms: Consider neck, upper back and posterior shoulder mobility, as well as shoulder strength and control.
- For kneecap symptoms: Consider ankle and hip movement, and how the whole lower limb moves under load.
- For any joint: Assess the area itself and the relevant regions above, below and nearby. The source of a contributing movement issue may not be where you feel the pain.
Scapular strength and rotator cuff training can be important. In my clinical approach, I also assess for upper-back and shoulder restrictions, because focusing on strength alone may overlook other factors contributing to recurring symptoms or instability.
The goal is to improve how the whole movement system functions, not just to build strength around one joint.
Upper Body Stability Exercise: The Shoulder Tap
With hypermobility, I find it helpful to train individual parts of the body in a way that asks them all to work together. Strength in individual muscles is clearly useful, but it does not automatically translate into coordinated control during everyday movement.
Shoulder taps combine weight-bearing, trunk control and shoulder loading in one exercise. They're a simple and effective way to help build coordinated stability, provided the variation suits your current ability and symptoms.
How to Do the Shoulder Tap
- Setup: Use a bench or table at about a 45-degree angle. Get into the start of a push-up position.
- Set your shoulders: Keep your hands pointing forwards. Pull your shoulder blades back - it will feel like your chest is sinking through your shoulders.
- Add external rotation: Keeping your hands pointing forwards, rotate your elbows outwards so the crease of your elbow points forwards. This engages your rotator cuff.
- Hold: Keep the movement controlled and use a hold duration that you can manage without pain or losing your position. You might begin with shorter holds and build gradually.
- Progress to tapping: Once comfortable, start tapping one shoulder, then the other, making sure to re-engage the muscles each time your arm comes down.
- Progress to single-arm: If appropriate, progress towards brief single-arm holds while maintaining control.
As your control improves, you can gradually lower the incline towards the floor. More demanding variations, such as elevating your feet, should only be attempted if they suit your strength, symptoms and goals. A wall-supported handstand is an advanced option, and an amazing end-goal for most people to aim towards.
Key Point: The aim is control and stability. If you progress to a push-up, use a comfortable range and keep your elbows in a position that feels controlled. Just know that an elbow flare is technically a less inherently stable shoulder position.
Lower Body Stability Exercise: The Squat
With hypermobility or EDS, the way you perform an exercise matters just as much as the exercise you choose. A suitable range, load and level of control can help you train in a way that matches your current capacity.
A squat is a practical way to practise lower-body strength and control, provided the variation and depth suit you.
How to Do the Squat with Stability
- Setup: Stand with your feet pointing forwards, using a stance that feels comfortable.
- Create external rotation: Keeping your big toes on the ground, gently rotate your legs outwards so your knees track in line with your feet. You may feel your glutes engage and your arches lift slightly.
- Squat: Lower your body down as far as you can while maintaining this sense of activation.
- Return: Come back up to standing, maintaining the same control throughout the movement.
Some hypermobile people can squat deeply but find it harder to maintain control throughout the movement. Choose a depth at which you can consistently control, then build range or load as appropriate.
"We want to build strength and improve how the area is loaded. In some cases, looking at movement and the direction of force may be a useful part of the bigger picture."
Returning to hidden restrictions, limited ankle or hip movement may influence how someone performs a squat or other tasks. Whether a restriction matters, and whether it contributes to symptoms, depends on the individual; it's a possibility worth assessing rather than a universal explanation.
A diagnosis of hypermobility does not guarantee that every part of your body moves freely. You can have a large overall range of movement and still have specific areas of stiffness or restriction.
Building strength, stability, and control is still valuable, but we also need to consider nearby areas and how they move so we don't overlook a potentially relevant restriction simply because the symptoms are elsewhere.
Even a relatively small restriction may be worth considering if it affects a movement that matters to you.
- Grant
Frequently Asked Questions
Can you be hypermobile and still have stiffness or restriction?
Yes. You can be hypermobile overall and still have stiffness or limited movement in specific areas. In my clinical experience, these restrictions are sometimes relevant to pain or movement difficulties.
Where should I look for hidden restrictions?
Assess the problem area as well as relevant areas nearby. For shoulder symptoms, this may include the neck, upper back and shoulder itself. For kneecap symptoms, it may include ankle and hip movement and lower-back joint stiffness. What matters will vary from person to person.
What exercise can help shoulder stability with hypermobility?
Shoulder taps are one option for practising shoulder and trunk control. Start with your hands on a stable raised surface, use a variation you can control, and progress gradually to alternating taps if comfortable.
How can I practise squats if I'm hypermobile?
Choose a comfortable squat depth and focus on controlled movement through your feet, knees and hips. A forward-facing foot position can be a useful starting point, but adapt your stance to your body and symptoms rather than forcing one position initially.
One key insight from this video
"Being hypermobile and hyperflexible doesn't exclude you from having other parts of your tissue that are also restricted. You must develop strength, stability, and control by doing things the way your body is designed to do them. But if we don't also take a step back and go looking for restrictions close by, we may never realise they are there, and the impact they might be having."
Need personalised guidance for your hypermobility or pain?
If you would like help making sense of your hypermobility, joint instability, or any musculoskeletal issue, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
