Ehlers-Danlos Syndrome, Generalized Hypermobility, and How Physiotherapy Can Help

Ehlers-Danlos Syndrome (EDS) and generalized hypermobility are conditions that affect connective tissue and joint stability. Many people living with these conditions experience chronic pain, frequent injuries, fatigue, and difficulty maintaining activity levels. While symptoms can be frustrating and unpredictable, physiotherapy can play an important role in improving strength, stability, function, and quality of life.

With the right approach, treatment can help people move with more confidence and reduce the impact symptoms have on everyday life.

What Is Ehlers-Danlos Syndrome?

Ehlers-Danlos Syndrome is a group of inherited connective tissue disorders that affect collagen, a protein that provides strength and support to tissues throughout the body.

Depending on the type of EDS, symptoms may include:

• Joint hypermobility
• Frequent sprains or dislocations
• Chronic pain
• Soft or stretchy skin
• Easy bruising
• Fatigue
• Poor balance or coordination
• Digestive symptoms
• Autonomic dysfunction such as POTS (learn more POTS here)

One of the most common forms is Hypermobile Ehlers-Danlos Syndrome (hEDS), which is closely linked with joint hypermobility and chronic musculoskeletal symptoms.

What Is Generalized Hypermobility?

Generalized hypermobility means multiple joints move beyond the typical range of motion. Some people are naturally flexible and have no symptoms. Others experience instability, pain, repeated injuries, or fatigue.

Generalized hypermobility may exist on its own or as part of a condition such as:

• Hypermobile EDS
• Hypermobility Spectrum Disorder (HSD)
• Other connective tissue disorders

Common Challenges with EDS and Hypermobility

Because connective tissue supports joints, muscles, ligaments, blood vessels, and organs, symptoms can affect many body systems.

Common challenges include:

• Joint pain and instability
• Recurrent sprains or subluxations
• Muscle tension from compensating for loose joints
• Poor posture
• Fatigue after daily tasks
• Reduced exercise tolerance
• Dizziness or orthostatic symptoms
• Anxiety related to unpredictable symptoms

Many people are told to simply “strengthen more” or “stretch less,” but successful management is usually more nuanced than that.

How Physiotherapy Can Help

Physiotherapy is often one of the most valuable tools for managing EDS and generalized hypermobility. Treatment should be individualized, gradual, and focused on control rather than aggressive stretching or high-impact exercise.

1. Strengthening for Joint Stability

When ligaments are more lax, muscles often need to provide more support for joints.

A physiotherapist may guide exercises to improve:

• Core stability
• Hip strength
• Shoulder control
• Lower limb strength
• Endurance of stabilizing muscles

The goal is controlled strength, not maximal loading.

2. Proprioception and Balance Training

Many people with hypermobility have reduced proprioception—the body’s sense of joint position.

Treatment may include:

• Balance exercises
• Coordination drills
• Controlled movement patterns
• Single-leg stability work
• Functional movement retraining

Improved proprioception can reduce injury risk and increase confidence.

3. Pain Management and Movement Strategies

Pain often develops from repeated strain, guarding, and inefficient movement patterns.

Physiotherapy may help through:

• Activity modification
• Manual therapy where appropriate
• Mobility work for stiff compensating areas
• Load management
• Pacing strategies
• Education around flare management

4. Fatigue and Energy Conservation

Fatigue is common in EDS and hypermobility, especially when movement requires extra muscular effort.

A physiotherapist can help by:

• Building exercise tolerance gradually
• Structuring rest and recovery
• Avoiding boom-and-bust cycles
• Improving movement efficiency

5. Breathing Retraining

Many people with EDS or hypermobility develop dysfunctional breathing patterns due to pain, rib cage mobility issues, poor posture, anxiety, or nervous system dysregulation.

This may present as:

• Chest-dominant breathing
• Frequent sighing
• Breath holding during movement
• Shortness of breath
• Neck and shoulder tension

Breathing retraining can help improve:

• Diaphragmatic breathing mechanics
• Rib cage mobility
• Coordination of breathing with exercise
• Nervous system regulation
• Tension in the neck and upper chest
• Exercise tolerance

For people who also experience POTS, dizziness, or autonomic symptoms, breathing retraining may be especially helpful. Here’s all you need to know about Breathing Pattern Disorder.

6. Return to Exercise and Daily Activities

Many people with hypermobility stop exercising after repeated pain or injury. Physiotherapy can rebuild confidence with a safe progression back to:

• Walking
• Strength training
• Gym exercise
• Sports participation
• Work demands
• Household tasks

What Makes a Good Physiotherapy Plan?

Successful treatment is usually:

• Individualized
• Gradual
• Symptom-responsive
• Focused on control and endurance
• Built around meaningful goals
• Sustainable long term

Aggressive stretching or pushing through pain often worsens symptoms.

Final Thoughts

Living with Ehlers-Danlos Syndrome or generalized hypermobility can be challenging, but the right rehabilitation approach can make a significant difference. Physiotherapy helps build strength, improve joint stability, reduce pain, manage fatigue, and address breathing dysfunction that may be contributing to symptoms.

Progress is often steady rather than fast, but with the right plan, many people become stronger, more capable, and more confident in their bodies. If you’re in Kingston, ON, and want help to assess and treat EDS or generalized hypermobility, book with us now!