Ehlers-Danlos Syndrome and Mast Cell Activation: What Massage Therapists Need to Know

By Jennifer Richards, LMT 2026

What is Ehlers-Danlos Syndrome?

Ehlers-Danlos Syndrome (EDS) is a group of heritable connective tissue disorders that affect collagen—the structural support of the body.

Collagen is everywhere, so EDS can impact:

Joints (hypermobility, instability, subluxations)

Skin (fragility, bruising, delayed healing)

Blood vessels

Internal organs

The most commonly encountered type in clinical practice is hypermobile EDS (hEDS).

What clients may report:

Chronic pain and fatigue

Frequent injuries or “mystery” pain

Feeling unstable or “loose” in their joints

Poor recovery after bodywork or exercise

What is Mast Cell Activation Syndrome (MCAS)?

MCAS is a condition where mast cells release chemical mediators (like histamine) inappropriately or excessively.

Mast cells are part of the immune system and are found in:

Skin

Gut

Respiratory tract

Nervous system interfaces

When dysregulated, they can cause multi-system symptoms.

Common symptoms:

Hives, itching, flushing

Food and chemical sensitivities

GI distress (nausea, diarrhea, bloating)

Headaches, brain fog

Fatigue

Episodes resembling allergic reactions or anaphylaxis

The Connection Between EDS and MCAS

There is a recognized clinical overlap between EDS—especially hEDS—and mast cell disorders.

What does the research suggest?

Studies estimate ~30–60% of people with hypermobile EDS report symptoms consistent with mast cell activation The exact mechanism is still being studied, but may involve:

Connective tissue differences affecting immune signaling

Nervous system dysregulation

Increased tissue sensitivity

While not everyone with EDS has MCAS, the overlap is significant enough that therapists should be aware of it

Why This Matters in Massage Therapy

Clients with EDS + MCAS often have:

Unpredictable responses to touch

Increased sensitivity to pressure, temperature, and products

Delayed or exaggerated reactions after treatment

👉 What feels therapeutic one day may feel overwhelming the next

Massage Therapy Considerations

1. Pressure: Less is often more

Avoid aggressive deep tissue work Focus on nervous system regulation rather than force Use slow, intentional, supportive touch

2. Joint protection is critical

Avoid end-range stretching Stabilize joints during positioning Be mindful of subluxation risk

3. Watch for skin and histamine responses

Clients may:

Flush easily

Develop hives or itching during/after session

React to oils, lotions, or temperature

Use:

Minimal, hypoallergenic products

Neutral temperature (avoid extremes)

4. Pace the session

Shorter sessions may be better tolerated

Allow time for integration

Avoid overwhelming the system

5. Communication is everything

Ask:

“How did you feel after your last session?” “What does your body need today?”

These clients are the experts on their own variability

6. Post-session expectations

Clients may experience:

Fatigue

Flare-ups

Increased symptoms before improvement

Educate and normalize this without dismissing it

Red Flags for Massage Therapists

Be cautious if a client reports:

History of anaphylaxis

Severe chemical sensitivities

Extreme post-treatment reactions

Always stay within scope and refer out when appropriate

Supporting Resources

The The Ehlers-Danlos Society https://www.ehlers-danlos.com

Mast cell information via American Academy of Allergy, Asthma & Immunology https://www.aaaai.org

Overview of mast cell disorders: https://www.niaid.nih.gov/diseases-conditions/mast-cell-disorders

Final Thoughts

As massage therapists, we are uniquely positioned to:

Recognize patterns others may miss Support regulation instead of forcing change Help clients feel safe in their bodies again

Working with EDS and MCAS clients isn’t about doing more—

It’s about doing less, better, and more intentionally

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Massage therapists should work within their scope of practice and refer clients to appropriate healthcare providers when necessary. Clients with Ehlers-Danlos Syndrome or Mast Cell Activation Syndrome should consult their physician regarding diagnosis and treatment.