A Clinical Question Worth Asking

By Jennifer Richards, LMT, NCBTMB Approved Provider

Over the past several weeks, I’ve noticed an interesting pattern in online support communities for people with hypermobility and Ehlers-Danlos syndrome (EDS).

Several individuals shared that after significant weight loss—whether through GLP-1 medications, bariatric surgery, chemotherapy, or serious illness—they actually felt worse, not better.

Their stories weren’t identical, but common themes emerged:

Increased joint instability
More pain
Worsening fatigue
Increased symptoms of dysautonomia
Feeling as though their bodies had “fallen apart”

As a massage therapist and educator specializing in hypermobility, I found myself asking a question:

Are we missing an opportunity to support these patients during major physiological changes rather than waiting until afterward?

I want to be very clear: what follows is my clinical opinion and a hypothesis based on current understanding of hypermobility, biomechanics, and connective tissue disorders. It is not an evidence-based guideline, and research specifically addressing this question is currently lacking.

The Connective Tissue Doesn’t Change

Hypermobile joints rely less on ligament stability and more on dynamic stabilization from muscles, proprioception, and motor control.

When someone experiences significant weight loss, their body undergoes much more than a reduction in body fat.

Changes may include:

Loss of muscle mass (unless actively preserved)
Altered balance and movement patterns
Changes in body mechanics
Nutritional challenges
Reduced blood volume
Deconditioning during illness or recovery

For someone with typical connective tissue, these changes may simply require an adjustment period.

For someone with hypermobility, they may reveal weaknesses that had previously been compensated for by muscle strength or habitual movement patterns.

More Than Weight Loss

One thing that stood out to me was that the cause of the weight loss varied.

Some people used GLP-1 medications.

Some underwent bariatric surgery.

Others lost weight because of chemotherapy or serious illness.

The common denominator wasn’t necessarily how they lost weight.

It was that their bodies had experienced a significant physiological stress.

That made me wonder whether the body’s stabilization systems are challenged whenever major changes occur, regardless of the reason.

Why Wait Until Goal Weight?

Several commenters mentioned being told that physical therapy would begin after reaching their target weight.

That surprised me.

Again, this is my opinion—but I wonder if that timing may miss an important opportunity.

If muscle strength, proprioception, posture, gait, and joint stability are changing throughout the weight-loss journey, wouldn’t it make sense to monitor and support those changes as they occur?

Rather than waiting until the process is complete.

Perhaps physical therapy for hypermobile individuals could focus on:

Preserving muscle strength
Improving proprioception
Maintaining joint stability
Teaching pacing strategies
Monitoring changes in balance and movement
Helping patients adapt as their bodies change

The goal would not simply be rehabilitation after weight loss.

It would be guidance throughout the process.

This Isn’t About Avoiding Weight Loss

Please don’t misunderstand my point.

Many people experience tremendous health benefits from weight loss.

Lower blood pressure.

Improved diabetes management.

Less sleep apnea.

Reduced stress on weight-bearing joints.

Sometimes these treatments are medically necessary or even life-saving.

I’m certainly not suggesting that people avoid them.

Instead, I’m asking whether hypermobile patients may benefit from a different rehabilitation model than the general population.

A Gap in the Research

At present, I’m not aware of studies specifically examining whether:

Physical therapy during GLP-1 treatment improves outcomes in hypermobile patients.
Early rehabilitation during bariatric weight loss reduces joint instability.
Ongoing strengthening during chemotherapy or other significant illnesses improves recovery in patients with connective tissue disorders.

That doesn’t mean the answer is “no.”

It means we don’t yet know.

And when patients consistently describe similar experiences, I believe those experiences deserve careful study.

Patient stories should not replace scientific evidence—but they can help generate important research questions.

Questions Worth Studying

As researchers continue to learn more about hypermobility, I hope we begin asking questions like:

Does preserving muscle mass improve long-term stability during weight loss?
Would early physical therapy reduce pain or subluxations?
Does maintaining proprioception improve function?
Are there predictors for which hypermobile patients are most likely to struggle?

These are questions that matter—not because we want to discourage weight loss, but because we want patients to thrive during it.

Final Thoughts

One of the most important lessons I’ve learned from working with hypermobile clients is that our connective tissue changes the rules.

What works well for the general population isn’t always the best approach for someone living with joint hypermobility.

Perhaps rehabilitation shouldn’t begin only after a major body transformation.

Perhaps it should be part of the journey itself.

I don’t know the answer.

But I think it’s a question worth asking.

Medical Disclaimer

This article reflects the author’s clinical observations and opinions and is intended for educational purposes only. It should not be interpreted as medical advice or as an evidence-based treatment recommendation. Individuals considering weight-loss medications, bariatric surgery, cancer treatment, or physical therapy should consult their physician and other qualified healthcare professionals. Further research is needed to determine the optimal rehabilitation strategies for people with hypermobility during significant physiological change.

References

Castori M, Hakim A. Contemporary approach to joint hypermobility and related disorders.

The International Consortium on the Ehlers-Danlos Syndromes. 2017 International Classification.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription.

The Ehlers-Danlos Society. Educational resources on hypermobile EDS, HSD, physical therapy, and exercise.

Stubbs B, et al. Skeletal muscle changes associated with weight loss and implications for physical function. Clinical Nutrition.

American Society for Metabolic and Bariatric Surgery (ASMBS). Nutritional and rehabilitation guidance following bariatric surgery.