Hypermobility: Separating Myths From the Evidence
Bendy joints, aching muscles, and a lifetime of being told "you're just double-jointed" — sound familiar? Hypermobility is often dismissed as a party trick, but for many people it comes with real pain, fatigue, and years of feeling unheard by healthcare providers.
This blog unpacks the evidence behind some of the most common hypermobility myths — from pain thresholds to splinting to exercise — and what the research actually says about managing it well.
This blog will cover the following topics on hypermobility:
- What Is Hypermobility, and How Is It Assessed?
- Myth: People With Hypermobility Have a High Pain Threshold
- Myth: If There's Nothing on Imaging, You're Just Hypervigilant
- Myth: You Can't Be Hypermobile If You've Lost Your Flexibility
- Myth: Splinting or Bracing Weakens the Joint
- Myth: Exercise Is Bad for Hypermobile People
- When Should You See a Physiotherapist?
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Our Brisbane Physiotherapy Clinic, services areas including: Salisbury, Brisbane, Tarragindi, Mount Gravatt, Holland Park, Rocklea, Yeronga, Annerley, Camp Hill, Carindale, Coorparoo, Salisbury, Sunnybank, Greenslopes, Seven Hills, Acacia Ridge, Indooroopilly, Woolloongabba, etc.
Because of our expertise in hip conditions, hypermobility, sports injuries, and dance injuries and performance, we also have people visiting us from all over Queensland, Australia and even international visitors. We also have a telehealth service for remote patients.
Quick Hypermobility Check
- Can you now (or could you ever) place your hands flat on the floor without bending your knees?
- Can you now (or could you ever) bend your thumb back to touch your forearm?
- As a child, did you amuse your friends by contorting your body into strange shapes, or could you do the splits?
- As a child or teenager, did your kneecap or shoulder dislocate (or partially dislocate) on more than one occasion?
- Do you consider yourself "double-jointed"?
This isn't a party trick, it's a validated screening tool, the five-part questionnaire, used clinically to pick up hypermobility that may no longer be obvious on examination today [1]. Answered yes to two or more? You may be hypermobile. Add symptoms like chronic pain, fatigue, dizziness or digestive issues, and you may fall somewhere on the hypermobility spectrum, from generalised joint hypermobility through to Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS).
If the above sounds like you, you've likely seen a long list of practitioners and scans with little clarity, and felt dismissed along the way, offered little beyond a psychology referral, with few practical strategies for day-to-day life.
That's slowly changing. Research into the biology of Hypermobile Disorders is growing, along with our understanding of conditions that often coexist with it, chronic fatigue syndrome, IBS, mast cell activation syndrome (MCAS), Postural Orthostatic Tachycardia Syndrome (POTS), and functional neurological disorder, among others. A 2025 study found joint hypermobility and MCAS overlap in young people with POTS far more than chance would predict — a reminder these conditions cluster and shouldn't be assessed in isolation [2].
My hope is that this blog gives you a clearer, evidence-informed understanding of hypermobility, some strategies worth exploring, and a sense of where to seek help.
Hypermobility-related pain can be aggravated by prolonged standing, repetitive movements, high-impact activity, or simply holding a joint at end-range for too long. Because pain in a hypermobile joint can stem from several sources — ligament laxity, muscle guarding, or nervous system sensitisation — an accurate assessment is important.
Not sure if your pain could be related to hypermobility?
Book in with one of our experienced hypermobility physiotherapists at PhysioTec today for a comprehensive assessment and personalised management plan.
A note from Rachel
"I've been a physiotherapist for more than 30 years, largely in private practice helping people with chronic musculoskeletal pain, initially in the UK before moving to Australia in 2014. Over the last decade I've seen more people with complex coexisting problems and this challenged my thinking on traditional Physiotherapy management and led me to focus my clinical practice in this area.
Let's explore some of the most common myths or misunderstandings and dive into the research to help explain further."
Myth: "People with hypermobility have a high pain threshold"
This is one of the most persistent myths in this space, I hear it from patients as much as I hear it used to dismiss them. In my own practice, I regularly meet people who describe dislocating a joint, or breaking a bone, and simply carrying on. That's a genuine pattern, not exaggeration.
At first glance that sits oddly next to the research. Studies using quantitative sensory testing consistently find people with HSD and hEDS have lower pain thresholds than the general population — not higher. A 2015 study found generalised increased sensitivity in adults with hEDS [3], and a 2025 study in adolescents found the same pattern, consistent with central sensitisation — a nervous system that's become more reactive to stimuli that wouldn't normally be painful [4].
So how can both be true? The answer is the difference between pain threshold and pain tolerance.
Pain Threshold: The point at which a stimulus starts to register as painful.
Pain Tolerance: How much pain someone can endure and keep functioning through.
For many with HSD/hEDS, pain tolerance is built out of necessity, years of unpredictable joints, increased muscle pain due to active splinting causing chronic pain. This means that "keeping going" is often the only option, not evidence of a numb system. We also know with research that impaired proprioception found in hEDS (reduced precision in sensing joint position [5]) is also a plausible reason a dislocation might not sound the alarm it "should."
None of this means your pain isn't real, a 2025 study found pain from HSD/hEDS meaningfully interferes with everyday activities for most patients [6]. What's really going on is a more reactive nervous system, paired with hard-won tolerance and a proprioceptive system that doesn't always sound the alarm when it should, not a "high pain threshold," and not a reason to dismiss chronic pain.
What this means for you: understanding what you're feeling, where, and what preceded it beats pushing through or dismissing it. For example, gently moving a stiff-but-improving joint within comfortable range, rather than ignoring it or aggressively stretching it.
Myth: "There's nothing structurally wrong — you're just hypervigilant, so ignore it"
This is the flip side of the pain threshold myth, the implication being that because nothing shows on imaging, the pain is purely psychological and should be overridden.
Pain in HSD/hEDS is genuinely multifactorial, not "all in your head," and not purely structural either. Joints moving beyond a typical range, place repetitive stress through soft tissues dense with nerve endings, and repeated stress into end-range sensitises these tissues over time. This end-rang tissue stress is layered on top of the central sensitisation described above [4]. Psychological factors like catastrophising and anxiety do correlate with pain sensitivity here, but correlation is not causation, and doesn't mean "ignoring it" is a good strategy [4].
In my experience, younger people in their early twenties with HSD often have a fairly positive, matter-of-fact relationship with their pain — it's often all they've known — and aren't particularly hypervigilant. Where hypervigilance exists, it's more often a consequence of unhelpful messaging from the internet or even health professionals, rather than a root cause.
Take-home: your pain is real, has both musculoskeletal (in the tissues) and central (in the nervous system) drivers, and deserves a genuine physical assessment, not a default referral to "manage your anxiety about it."
Myth: "If you can't put your hands flat on the floor or your thumb to your forearm, you can't be hypermobile"
This misunderstands how hypermobility is assessed. The Beighton score, the standard clinical measure, is age-adjusted, because joints naturally stiffen with age [1]. That's why clinicians also use the five-part questionnaire you tried above: current flexibility alone is unreliable, so it's a validated way of capturing a history of hypermobility in people whose joints have since stiffened with age, injury or years of compensatory guarding [1]. Losing the party trick doesn't mean you were never hypermobile — assessment should always weigh history alongside current findings.
Experiencing joints that ache, give way, or feel unstable during everyday movement or exercise? Finding certain positions, repetitive tasks, or prolonged activity uncomfortable?
Book today and let one of our experienced PhysioTec physiotherapists assess your joints, identify the source of your pain, and create a personalised management plan to build stability, strength, and confidence in movement.
Helping you move better and get back to the activities you love.
Myth: "Splinting or bracing is bad — it weakens the joint"
This genuinely needs pushing back on, though the evidence base is still developing. A 2020 study found meaningful improvements in hand function with custom-fitted finger orthoses [7]. Splinting and bracing are recognised as part of an evidence-informed approach to HSD/hEDS, particularly for frankly unstable joints — like fingers, wrists, knees and ankles — where support can be the difference between a joint that functions and one that keeps giving way [8].
Splinting isn't a permanent substitute for strength, it's most valuable during an acute flare, with a planned transition toward active strengthening as symptoms settle. Used alongside, not instead of, strengthening, it supports recovery rather than undermining it.
Myth: "Exercise is bad for hypermobile people"
Exercise is not the enemy, but it needs tailoring. A 2024 scoping review found individualised programmes combining strength, proprioception and graded activity are generally beneficial and well tolerated [9]. A 2026 meta-analysis found therapeutic exercise significantly improved pain, quality of life and proprioception, although it found no significant gain in strength, and rated overall evidence certainty as low given the small number of trials [10]. "Exercise helps" is well supported; exactly which, how much, and for how long is still being worked out, which is why individualised, physio-guided programmes outperform generic ones.
Yoga is often genuinely enjoyed by hypermobile people, and can build mobility and strength. The temptation to sink into end-range, because it's available and satisfying, means relying on ligaments rather than muscles, contributing to instability over time. Instead, focus on control through the movement and learn the optimum positions to achieve. Review recurring strains with your physio, small modifications often let you keep enjoying it while minimising strain.
If running is what genuinely works for you, it's worth protecting rather than abandoning at the first flare: consider supportive taping or orthotics, footwear, running surface, distance and frequency, and a strengthening programme for the hips, glutes and lower leg.
If you experience dizziness or fatigue on standing, common in POTS, which frequently coexists with HSD/hEDS [2], cardiovascular exercise usually still has a place, but may need modifying, such as starting reclined or seated and pacing around fatigue rather than pushing through it.
Take-home message
Monitor, modify, and don't assume a single rule applies to every joint, activity or person. Understanding what you're feeling, where, and what preceded it is the foundation for deciding whether to rest, mobilise, strengthen, brace or seek review. HSD and hEDS are complex and individual — exactly where an experienced physiotherapist can help.
If any of this sounds familiar, book an assessment with one of our physiotherapists at PhysioTec. We offer screening to support diagnosis, thorough assessment, and a treatment plan built around what we find in you — not a generic protocol.
Ready to take control of your hypermobility-related pain?
Book an assessment at PhysioTec and we'll build a plan that fits your body, your lifestyle, and your goals.
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Author
This blog was written by Rachel Crosbee, one of our musculoskeletal physiotherapists, and our lead hypermobility physiotherapist. Rachel has broad interests in treating a wide variety of musculoskeletal problems from acute to chronic, spine, lower and upper limb conditions. She also has a particular interest and expertise in treating neck pain and headaches.
You can read more about Rachel here.
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References:
- Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26; Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract. 2003;57(3):163-166.
- Yao L, Subramaniam K, Raja KM, et al. Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition. Front Neurol. 2025.
- Rombaut L, Scheper M, De Wandele I, De Vries J, Meeus M, Malfait F, Engelbert R, Calders P. Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia. Clin Rheumatol. 2015;34(6):1121-1129.
- Schubert-Hjalmarsson E, et al. Exploring signs of central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Eur J Pain. 2025.
- Clayton HA, Jones SAH, Henriques DYP. Proprioceptive precision is impaired in Ehlers-Danlos syndrome. SpringerPlus. 2015;4:323.
- Lindholm A, et al. The impact of pain on everyday activities of people with hypermobility spectrum disorders or hypermobility Ehlers Danlos syndrome. Eur J Pain. 2025.
- Jensen AM, Quist Andersen J, Quisth L, Ramstrand N. Finger orthoses for management of joint hypermobility disorders: relative effects on hand function and cognitive load. Prosthetics Orthot Int. 2020.
- Engelbert RHH, Juul-Kristensen B, Pacey V, et al. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. Am J Med Genet C Semin Med Genet. 2017;175(1):158-167.
- Brittain MG, Flanagan S, Foreman L, Teran-Wodzinski P. Physical therapy interventions in generalized hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome: a scoping review. Disabil Rehabil. 2024;46(10):1936-1953.
- Ebrahimi, et al. The effect of therapeutic exercises in individuals with joint hypermobility syndrome: a systematic review and meta-analysis. Egypt Rheumatol Rehabil. 2026;53(1):38.