Understanding Hypermobility

Hypermobility is a term people often use to describe ‘double-jointed’ or ‘very flexible’. For many people it’s harmless, however, for others, it can be a contribution to pain, instability, or recurrent injuries. As physiotherapists, our role is to help people understand what hypermobility means, how it can be assessed, and what the best form of management is.

What is Hypermobility?

Joint hypermobility means that certain joints in your body move beyond the normal or expected range. This increased movement can happen due to variations in connective tissue, joint shape, or muscle control. Hypermobility can exist on its own or can be associated with a systemic condition such as Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (EDS). 

It is important to understand that hypermobility is not always an issue in everyone. Many dancers, gymnasts and athletes can thrive with flexible joints. It only becomes more of a clinical issue when it is associated with pain or instability that can lead to recurring injuries.

How is Hypermobility Assessed?

Physiotherapists can use a combination of clinical history and a physical assessment to examine hypermobility:

• Beighton Score
  • This is a simple 9-point scale that looks at specific joint movements:
    • Elbows and knees that straighten past neutral position (1 point for each joint)
    • Pinky finger extensions beyond 90° (1 point for each finger)
    • Thumb touching the forearm (1 point per thumb)
    • Forward bending to place hands flat on the floor with straight knees (1 point)
  • A higher score suggests greater hypermobility.
• Clinical History
  • We ask about symptoms such as:
    • Recurrent ankle sprains
    • Joints that sub lux or feel unstable
    • Unexplained joint pain
    • Fatigue or muscle aching after activity
• Functional Assessment
  • Observation of posture, gait, balance and control in everyday movements. Hypermobility often reveals itself during dynamic movements such as squatting, running, or jumping.
• How can Hypermobility be Managed?
  • While we can’t change connective tissue or joint structure, physiotherapy focuses on optimising control, strength, and confidence in movement. Management can be individualised, but common strategies include:
    • Muscle Strengthening: building muscle will help support around the joints.
    • Proprioception and Balance Training: Improving awareness of joint position to reduce the risk of sprains.
    • Activity Modification: Guiding patients on safe ways to train or exercise without overloading joints.
    • Pain Management: Education, pacing, gentle exercise, sometimes with the support of tape or a brace.
  • For athletes and performers, the aim is not to reduce range but to increase control to balance it out.

Common Myths About Hypermobility:

1. If you are hypermobile, you shouldn’t exercise: False. Movement and strengthening are essential for managing hypermobility.
2. Hypermobility is always bad: Not true. Some people may not even experience any pain or injury. Flexibility can also be a huge advantage in certain sports.
3. Stretching is the best treatment: Stretching is not a priority, strengthening is. 

Practical Tips for Living with Hypermobility

• Focus on strength before flexibility: Prioritise resistance training, especially core, hips & shoulders.
• Control end ranges: Try and avoid ‘locking out’ your joints (e.g.: elbows or knees).
• Pace activity: Break tasks into smaller chunks to reduce overload and fatigue.
• Footwear: Supportive footwear or orthotics can help reduce the strain on ankles and knees.

Hypermobility should not be feared but does require awareness and understanding. With the right assessment and a tailored physiotherapy approach, people with hypermobility can build strength and prevent further injury while staying active long term.

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