Supporting the Hypermobile Client While They Wait for Answers
By Jennifer Richards, LMT
Disclaimer
This article is intended for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Massage therapists do not diagnose hypermobile Ehlers-Danlos syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), or other medical conditions. If you suspect a connective tissue disorder, seek evaluation from an appropriately qualified healthcare professional. Always work within your professional scope of practice and consult your healthcare provider before beginning any new exercise or rehabilitation program.
The Reality Many Clients Face
Imagine knowing something isn’t right with your body but spending years searching for answers.
Unfortunately, this is the reality for many people with symptomatic hypermobility. Some communities have no specialists familiar with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). Others face wait times measured in months—or even years. Many patients are told that they are “just flexible,” “just anxious,” or that their symptoms are unrelated.
As massage therapists, we are often among the first healthcare professionals to notice recurring patterns:
- Multiple joint injuries
- Chronic muscle tension despite regular massage
- Frequent sprains or subluxations
- Unexplained widespread pain
- Fatigue
- Poor proprioception (“I never know where my body is in space.”)
- Dysautonomia symptoms such as dizziness or rapid heart rate
- Gastrointestinal complaints
- Headaches and neck instability
- Skin that bruises or scars easily
Recognizing these patterns is not diagnosing. It is recognizing when a client may benefit from further evaluation while providing safe, supportive care.
Hypermobility Is Often a Clue—Not the Entire Story
One of the biggest misconceptions is that hypermobility itself is the problem.
In reality, excessive joint motion is often one feature of a larger condition.
For some people, hypermobility causes no symptoms and requires no treatment. For others, it may occur alongside connective tissue disorders such as hEDS or HSD, where differences in connective tissue may contribute to joint instability, chronic pain, fatigue, autonomic dysfunction, gastrointestinal symptoms, and many other systemic concerns.
Rather than trying to “take away” flexibility, the goal becomes helping the individual develop better stability, movement quality, and confidence.
Why Traditional Exercise Advice Doesn’t Always Work
Many rehabilitation programs are designed for bodies with typical connective tissue integrity.
Hypermobile bodies often behave differently.
Some clients faithfully perform strengthening exercises only to experience:
- increased pain
- prolonged fatigue
- muscle guarding
- autonomic flares
- headaches
- delayed recovery
This doesn’t necessarily mean exercise is harmful.
It often means the body requires a different approach.
Rehabilitation for hypermobility is frequently most successful when it emphasizes gradual progression, motor control, proprioception, and nervous system regulation rather than simply increasing strength or flexibility.
Start With the Nervous System
A body living in chronic pain or instability often exists in a heightened state of alertness.
When the nervous system remains activated, muscles frequently compensate by tightening in an attempt to stabilize loose joints. Unfortunately, this protective strategy may also increase pain and fatigue.
Helping the nervous system feel safe can be just as important as strengthening muscles.
Helpful practices may include:
- diaphragmatic breathing
- mindfulness meditation
- paced breathing
- restorative yoga (appropriately modified)
- Tai Chi
- Qi Gong
- gentle walking
- adequate sleep
- pacing daily activities
The goal is not simply relaxation—it is improving the body’s ability to shift between states of activation and recovery.
Stability Before Strength
Rather than asking, “How strong can I become?”
A better question is:
“How well can I control my movement?”
Many rehabilitation specialists begin with:
- posture awareness
- foot positioning
- breathing mechanics
- scapular stability
- deep core activation
- hip stabilization
- balance training
- closed-chain exercises
- proprioceptive retraining
Small improvements practiced consistently often produce greater long-term results than aggressive strengthening programs that repeatedly trigger symptom flares.
Baby Steps Are Not Weakness
One of the hardest lessons for many hypermobile individuals is learning that “more” is not always “better.”
Progress often looks like:
- stopping before exhaustion
- taking recovery seriously
- increasing activity gradually
- respecting symptom flares
- celebrating consistency instead of intensity
Some researchers describe this as staying within an individual’s “energy envelope”—reducing the likelihood of symptom exacerbation while gradually improving function.
Educational Resources Worth Exploring
When local expertise is unavailable, reputable educators can provide valuable information. These resources should complement—not replace—individualized medical care.
Jeannie Di Bon
Jeannie Di Bon is a movement therapist and founder of The Zebra Club. Her work emphasizes gentle movement, proprioception, breathing, nervous system regulation, and gradually improving joint stability. Her educational approach is particularly accessible for beginners and those recovering from repeated setbacks.
The Fibro Guy (Will Harlow)
Physiotherapist Will Harlow focuses on chronic pain, fibromyalgia, hypermobility, pacing, nervous system education, and progressive strengthening. While not exclusively focused on EDS, many individuals with hypermobility appreciate his practical explanations of pain science and rehabilitation.
Michelle Koehler, PT, DPT
Physical therapist Michelle Koehler specializes in hypermobility rehabilitation. Her educational content focuses on movement quality, stabilization, exercise progression, and helping individuals understand why conventional rehabilitation sometimes fails in hypermobile populations.
Jess Janneman — The Hypermobile Therapist
Jess Janneman provides education on connective tissue disorders, rehabilitation principles, exercise modification, pain science, and functional movement. Her work helps bridge the gap between current research and practical application.
Helpful Apps for Self-Regulation
Many clients find it helpful to build a daily nervous system practice.
Popular options include:
Meditation
- Calm
- Headspace
- Insight Timer
- Balance
Breathing
- Breathwrk
- Paced breathing apps
Sleep
- Calm
- Headspace
- BetterSleep
The best app is often the one a person will actually use consistently.
Other Strategies That May Help
Depending on the individual’s medical history and healthcare team’s recommendations:
- Learning about their condition through reliable educational resources
- Activity pacing
- Appropriate hydration
- Electrolyte support (when medically appropriate)
- Supportive footwear
- Occupational therapy for joint protection and energy conservation
- Compression garments for some individuals with orthostatic intolerance
- Mental health support to address the emotional burden of chronic illness
- Appropriate assistive devices when recommended by qualified professionals
What Massage Therapists Can Do
Massage therapists cannot diagnose connective tissue disorders.
We can, however:
- recognize patterns that warrant referral
- modify pressure and techniques
- avoid aggressive stretching and forceful joint mobilizations when instability is suspected
- educate within our scope of practice
- support relaxation and nervous system regulation
- validate our clients’ experiences without making unsupported medical claims
Sometimes the greatest gift we offer is helping someone feel heard after years of being dismissed.
Final Thoughts
Many clients spend years waiting for answers. During that time, they deserve compassionate care, thoughtful movement education, and practitioners willing to recognize that flexibility is only one piece of a much larger puzzle.
As massage therapists, we cannot replace physicians, physical therapists, or other specialists. But we can become knowledgeable members of an interdisciplinary team—supporting our clients safely while encouraging evidence-informed care.
Helping someone feel safer in their own body may not sound dramatic, but for many people living with symptomatic hypermobility, it can be life-changing.
