Jennifer Richards

When Relaxation Causes Instability in Hypermobile Clients

By Jennifer Richards, LMT 2026

There’s a moment that can feel confusing—for both client and therapist.

The client gets off the table feeling loose, lighter, and deeply relaxed…

And then later that day—or even the next morning—something shifts.

A knee slides slightly out of place.

An ankle feels unstable.

Wrists start popping more than usual.

And the question arises:

“Did something go wrong?”

Understanding the Hypermobile Body

For clients with Ehlers-Danlos Syndrome or generalized joint hypermobility, the body operates a little differently.

Ligaments are more lax → joints have less passive stability

Muscles work harder → to create active stability

Tension is often protective → not just problematic

What feels like “tightness” or “knots” is often the body’s way of saying:

“I’m holding things together.”

The Massage Paradox

Massage therapy is designed to:

Reduce muscle tension

Improve circulation

Calm the nervous system

Increase range of motion

All wonderful goals.

But here’s the paradox:

When we reduce too much protective tension in a hypermobile client, we may also reduce joint stability—temporarily.

This doesn’t mean the massage was wrong.

It means the body has entered a new state it needs to adapt to.

What Instability Can Look Like

After a session, a hypermobile client may experience:

A brief joint “slip” or subluxation

Increased popping or cracking

A sense of looseness or lack of control

Mild fatigue in stabilizing muscles

In many cases, the body self-corrects quickly.

This is especially true when:

The therapist worked thoroughly (but respectfully)

Guarding patterns were reduced

The nervous system downshifted

Why It Happens

Think of the body like scaffolding.

Before massage:

Muscles are tight but supportive

Joints feel restricted but stable

After massage:

Muscles are relaxed and lengthened

Joints are more mobile—but temporarily less supported

For a hypermobile client, that shift can feel like:

“I have more space… but less structure.”

This Is Not a Failure—It’s Information

Experiences like this are incredibly valuable.

They tell us:

Where the body relies on compensatory tension

Which areas act as stability anchors

How much release the system can comfortably integrate

For therapists, this is where skill deepens.

Clinical Considerations for Massage Therapists

When working with hypermobile clients:

1. Not All Tension Needs to Be Eliminated

Some muscular tone is functional and protective.

Aim to reduce excess tension, not erase all of it.

2. Respect Stabilizing Structures

Areas around joints (like the knee, ankle, and shoulder) often contain:

Co-contraction patterns

Fascial tension for support

Avoid aggressively “chasing knots” in these regions.

3. Integrate Proprioception

Help the body feel safe in its new range:

Gentle compressions

Joint approximation

Slow, intentional holds

This gives the nervous system a sense of where the joint is in space.

4. Consider Closing Techniques

Instead of ending with full relaxation, try:

Light activation work

Rhythmic compressions

Grounding techniques

Think: “We opened the system—now let’s help it reorganize.”

For Clients: What to Expect

If you are hypermobile and receiving massage:

Some post-session looseness is normal

Occasional joint shifting can happen

Your body may need time to recalibrate

Helpful tips:

Move slowly after your session

Avoid extreme ranges of motion right away

Hydrate and allow integration time

Gentle strengthening (not stretching) can help later

The Balance: Mobility vs. Stability

Massage therapy is still incredibly beneficial for hypermobile bodies.

But the goal shifts from:

“Release everything”

“Create ease with support”

This is where massage becomes not just relaxing—but therapeutic, intentional, and truly individualized.

Final Thoughts

If a client experiences temporary instability after a session, it doesn’t mean something went wrong.

It may mean:

The body finally felt safe enough to let go

And now it’s learning how to function with less tension

That’s not a setback.

That’s part of the process.

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical advice. Every body is different—especially in the presence of hypermobility or connective tissue disorders. Always consult with a qualified healthcare provider for concerns about joint instability, pain, or underlying conditions.

Let’s Continue the Conversation

If you’re a therapist working with hypermobile clients—or someone living in a hypermobile body—I’d love to hear your experiences.

What have you noticed after massage?

What helps you feel both relaxed and supported?

Let’s learn from each other.

Hypermobility and Feet

By Jennifer Richards, LMT 2026

If you live with hypermobility—or work with clients who do—you’ve probably noticed that the feet tell a big part of the story.

Pain, fatigue, instability, weird pressure patterns… it often starts here.

And yet, feet are one of the most misunderstood areas in hypermobile bodies.

Let’s break it down in a way that actually makes sense—and helps you do something about it.

What’s Going On in Hypermobility?

In conditions like Ehlers-Danlos Syndrome, the connective tissue—especially ligaments—is more elastic than it should be.

That means:

Joints don’t have enough passive stability

Muscles have to work overtime

The body compensates… everywhere

👉 The foot, which should act as a stable foundation, becomes mobile but unstable.

Common Foot Patterns in Hypermobility

Flat Feet (Pes Planus)

This is one of the most common patterns.

What’s happening:

The arch collapses due to ligament laxity

The foot rolls inward (overpronation)

Ankles drift inward

What you may feel:

Foot fatigue

Heel or arch pain

Shin splints

Knee or hip discomfort

👉 Your muscles are trying to hold up what your ligaments can’t.

Morton’s Toe

This is when the second toe appears longer than the big toe.

Why it matters:

The big toe is supposed to stabilize push-off

With Morton’s toe, that stability shifts

Pressure moves into the second metatarsal

Common issues:

Ball-of-foot pain Calluses Less efficient walking mechanics

Bunions (Hallux Valgus)

What you see:

Big toe drifting inward

A prominent, sometimes painful joint

Why hypermobility contributes:

Joint instability allows bones to shift over time Muscles can’t fully counteract the pull

This is less about “bad shoes” and more about long-term instability + load patterns.

Piezogenic Papules (“Heel Bumps”)

These are small, soft bumps that appear on the heels when standing and disappear when pressure is removed.

What’s happening:

Fat from the heel pad herniates through connective tissue

This is more common in hypermobile individuals due to weaker structural support

What you may notice:

Visible bumps when standing

Sometimes tenderness or aching

Often mistaken for something more serious

They’re usually harmless, but they’re a visible sign of how pressure and tissue integrity are interacting.

The Bigger Picture: It’s Not Just Your Feet

When the feet are unstable, the body adapts:

Feet → knees collapse inward

Knees → hips rotate

Hips → pelvis destabilizes

Pelvis → spine compensates

This is why foot issues often show up as:

Knee pain

Hip tightness

Low back discomfort

The feet are the foundation—and everything builds from there.

Bodywork Considerations

If you’re receiving massage—or you’re a therapist—this matters.

Helpful focus areas:

Calves (often overworking)

Plantar fascia

Peroneals and tibialis posterior

Intrinsic foot muscles

Important caution:

Avoid aggressive stretching (there’s already too much mobility)

Focus on support and neuromuscular awareness, not just release

Practical Support Strategies

Footwear matters more than you think:

Supportive, stable shoes

Arch support (custom if needed)

Avoid overly flexible, unsupportive footwear

Movement matters too:

Foot strengthening (short foot exercises)

Balance training

Proprioception work

And sometimes…

Barefoot isn’t always better—especially on hard surfaces.

Hypermobility + Foot Structure

Footcare in hypermobile Ehlers-Danlos syndrome → Explains how flat feet and altered joint mechanics are common in hypermobile individuals

Hypermobility and plantar fasciitis (Jeannie Di Bon) → Discusses how foot mechanics affect the entire kinetic chain and notes higher prevalence of flat feet in hypermobility

Many people with hypermobile Ehlers-Danlos Syndrome have altered foot structure and mechanics, often including flat or low arches.

Piezogenic Papules (Heel Bumps)

Piezogenic papules overview (DermNet) → Clear explanation of what they are and why they occur Piezogenic pedal papules (NIH / PMC) → Notes how common they are with weight-bearing

Clinical explanation of piezogenic papules → Medical definition and mechanism

Piezogenic papules are caused by fat herniating through connective tissue under pressure and are associated with connective tissue disorders like EDS.

Connective Tissue + Structural Impact

National Academies: Connective tissue disorders overview → Mentions pes planus (flat feet) in hypermobility spectrum disorders

Key takeaway:

Flat feet (pes planus) are frequently associated with hypermobility disorders.

Final Thoughts

Hypermobility in the feet isn’t just about “flat feet” or “bad posture.”

It’s about:

Stability vs mobility

Load distribution

Compensation patterns throughout the body

And once you understand that—you can start making choices that actually support your body.

Disclaimer

This content is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, podiatrist, or licensed healthcare professional, regarding any medical concerns or conditions.

Massage therapy and bodywork should be adapted to individual needs, especially for those with hypermobility or connective tissue disorders like Ehlers-Danlos Syndrome. If you experience pain, instability, or worsening symptoms, seek professional evaluation.

If this resonates with you—or you’re noticing these patterns in your own body or your clients—I’d love to hear your experience.

When the Body Speaks in Many Languages: Understanding Multi-System Symptoms

By Jennifer Richards 2026

As a massage therapist, I often see clients who don’t fit neatly into one category. They come in with pain—but also fatigue. Or headaches—but also digestive issues. Or anxiety—but also joint instability.

These are not random symptoms.

They are often part of a multi-system pattern, commonly seen in conditions like:

Hypermobility spectrum disorders / Ehlers-Danlos Syndrome (EDS)

Mast Cell Activation Syndrome (MCAS)

Dysautonomia (including POTS)

These conditions frequently overlap—and when they do, the body can feel unpredictable, overwhelming, and misunderstood.

Why So Many Symptoms?

The body is not a collection of separate systems—it’s an integrated network.

When one system becomes dysregulated, others often follow:

Connective tissue (EDS) affects joints, blood vessels, and organs

Nervous system (dysautonomia) affects heart rate, blood pressure, digestion

Immune system (mast cells) affects inflammation, allergies, skin, and more

This is why someone may experience:

Joint instability and GI issues

Anxiety and heart palpitations

Skin reactions and brain fog

The Overlap Matters

Research increasingly supports this triad:

Ehlers-Danlos Syndrome

Postural Orthostatic Tachycardia Syndrome

Mast Cell Activation Syndrome

These conditions often coexist and amplify each other.

Massage Therapy Considerations

This is where your work becomes incredibly powerful—but also requires nuance.

What Helps

Gentle, slow techniques

Lymphatic support

Nervous system regulation (parasympathetic activation)

Myofascial work (with caution)

Client-led pressure and positioning

What to Be Careful With

Deep pressure on unstable joints

Overstretching (especially in hypermobile clients)

Rapid positional changes (can trigger dizziness)

Strong scents (may trigger mast cell reactions)

Long sessions without breaks

Clinical Insight

Many hypermobile clients present with:

Tight muscles + loose joints

The tightness is protective, not pathological

Your job is not to “loosen everything”

It’s to support stability and calm the system

The Bigger Picture

Clients with these patterns are often told:

“It’s just anxiety” “Your tests are normal” “You’re fine”

But their experience is real.

Understanding multi-system involvement allows us to:

Validate their experience

Adapt our treatment approach

Avoid harm

Become part of their support system

References & Further Reading

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

Dysautonomia International https://www.dysautonomiainternational.org

The Mast Cell Disease Society https://tmsforacure.org Afrin LB. Never Bet Against Occam: Mast Cell Activation Disease Hakim A, Grahame R. Hypermobility research publications

Disclaimer

This content is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Always refer clients to qualified healthcare providers for diagnosis and management of medical conditions. Massage therapists should work within their scope of practice and modify techniques based on individual client needs and responses.

Invitation

If you recognize yourself or your clients in this pattern, you’re not alone—and you’re not imagining it.

I’d love to hear your experience or answer questions. These conversations are how we move the profession forward.

CE Class: Hypermobility

Flexible…or Hypermobile? There’s a Difference.

Do you have a client who’s “really flexible”?

Before you encourage more stretching, ask yourself this:

Are they actually flexible…or are they hypermobile?

These two terms are often used interchangeably, but they are not the same.

Flexibility is the normal ability of muscles and connective tissues to lengthen through a healthy range of motion. Hypermobility, on the other hand, is often related to differences in connective tissue that can affect the joints, nervous system, cardiovascular system, gastrointestinal system, immune system, and much more.

A hypermobile client may present with:

Frequent sprains or joint instability
Chronic pain
Fatigue
POTS or dysautonomia
Mast Cell Activation Syndrome (MCAS)
Digestive issues
Anxiety or sensory sensitivity
A lifetime of being told they’re “just flexible”

Understanding the difference can change the way you assess, treat, and educate your clients—and may help you avoid techniques that could worsen their symptoms.

Join me for my NCBTMB-approved continuing education course:

Hypermobility & Connective Tissue Disorders
🕒 3 CE Hours (NCBTMB Approved)
💲 $100

Whether you’re a massage therapist, bodyworker, or healthcare professional, this course will help you recognize hypermobility, understand the science behind it, and provide safer, more effective care.

I’d love to have you in class.

Check out when here!

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.

Ehlers-Danlos Syndrome, MCAS, Brain Fog, and Brain Inflammation

Understanding the Brain–Body Connection in Hypermobility

By Jennifer Richards, LMT 2026

Many people with Ehlers-Danlos Syndrome (EDS) or hypermobility spectrum disorders report symptoms that go far beyond joint instability. One of the most common — and frustrating — experiences is brain fog: difficulty concentrating, memory lapses, mental fatigue, or feeling “spaced out.”

Emerging research suggests that this may be connected to neuroinflammation, mast cell activation, and changes in the blood–brain barrier. While research is still evolving, understanding these connections can help both clients and massage therapists adapt treatment approaches.

What Is Brain Fog?

Brain fog is not a formal diagnosis but a cluster of cognitive symptoms, including:

Difficulty concentrating Forgetfulness or poor short-term memory Slow thinking Difficulty finding words Mental fatigue Feeling disconnected or “not present”

Clients often describe it as:

“My brain feels thick.” “I can’t find words.” “I’m exhausted mentally.”

For people with hypermobility, these symptoms may fluctuate daily and often worsen with stress, illness, lack of sleep, or mast cell flares.

Mast Cell Activation and the Brain

A common comorbidity with hypermobility disorders is Mast Cell Activation Syndrome (MCAS).

Mast cells are immune cells that release chemicals such as:

Histamine Cytokines Prostaglandins Leukotrienes

These chemicals help protect the body from threats, but in MCAS they may be released too easily or excessively.

When Mast Cells Affect the Brain

Mast cells exist not only in the skin and gut but also near nerves and blood vessels in the brain. When activated, they can trigger:

Neuroinflammation

Headaches or migraines

Cognitive dysfunction

Fatigue

Sensory sensitivity

Histamine and inflammatory chemicals may influence brain signaling, contributing to the “brain fog” feeling many EDS clients report.

The Blood–Brain Barrier

The blood–brain barrier (BBB) is a protective filter that regulates what enters the brain from the bloodstream.

It normally prevents:

toxins pathogens inflammatory molecules

from reaching brain tissue.

However, inflammation, stress hormones, infection, and mast cell activity may temporarily increase BBB permeability. When this occurs, inflammatory molecules can influence brain function and lead to:

cognitive slowing

headaches

dizziness

fatigue

This process is often referred to as neuroinflammation.

Why Hypermobility May Contribute

Researchers believe several mechanisms may overlap in hypermobility disorders:

1. Mast Cell Dysregulation

Many individuals with EDS report symptoms consistent with mast cell activation, including allergic-type reactions and systemic inflammation.

2. Autonomic Nervous System Dysfunction

Conditions such as Postural Orthostatic Tachycardia Syndrome (POTS) are common in hypermobile populations and may reduce blood flow to the brain during upright posture.

Reduced cerebral blood flow can worsen:

dizziness

fatigue

cognitive impairment

3. Chronic Inflammation

Connective tissue differences may influence immune signaling and inflammatory responses.

4. Gut–Brain Interaction

Many people with EDS also experience gastrointestinal dysfunction. The gut and brain communicate through the gut–brain axis, and inflammation in the gut may influence brain function.

What Clients May Experience

Clients with EDS, MCAS, or autonomic dysfunction may report:

Difficulty following conversations

Forgetting appointments

Sensitivity to light or noise

Migraines or pressure headaches

Dizziness or lightheadedness

Extreme fatigue after mental effort

These symptoms can fluctuate throughout the day and may worsen with:

heat

dehydration

allergic reactions

illness

stress

Does This Affect Massage Therapy?

Brain fog and neuroinflammation do not usually prevent massage therapy, but they may influence how a session should be approached.

Communication Considerations

Clients experiencing brain fog may:

need clear, simple explanations require extra time for intake forget instructions or aftercare recommendations

Written aftercare instructions can be helpful.

Sensory Sensitivity

Neuroinflammation and mast cell activation may increase sensory sensitivity, including reactions to:

strong essential oils

scented lotions

bright lights

loud sounds

A low-stimulus environment may improve comfort.

Autonomic Considerations

Because many hypermobile clients also experience autonomic dysfunction:

slow position changes may be necessary allow time before sitting up after the massage hydration may help reduce dizziness

Pressure Adjustments

Deep pressure is not always appropriate for hypermobile clients and may worsen inflammation or joint instability.

A slow, moderate pressure approach often works better.

Additional Considerations for Massage Therapists

Massage therapists working with hypermobile clients may consider:

• minimizing strong scents due to MCAS sensitivity

• avoiding excessive heat during flares

• checking in frequently regarding comfort levels

• allowing additional grounding time before standing

Many clients report that gentle, nervous-system-focused massage can help reduce overall stress and improve symptoms indirectly.

However, during severe mast cell or inflammatory flares, clients may prefer shorter or lighter sessions.

Current Research

Research on the relationship between EDS, MCAS, and neuroinflammation is still developing. However, clinicians have observed overlapping symptoms involving:

immune system dysregulation autonomic dysfunction inflammatory signaling neurological symptoms

Organizations such as the The Ehlers-Danlos Society continue to explore these connections as awareness grows.

When Clients Should Seek Medical Support

Massage therapists should encourage clients to consult a healthcare professional if they experience:

severe or worsening cognitive symptoms

persistent headaches or migraines

fainting or severe dizziness

neurological changes

These symptoms require medical evaluation.

Massage therapy should always be used in collaboration with medical care, not as a replacement.

Key Takeaway

Brain fog and cognitive symptoms in hypermobility may be influenced by a combination of:

mast cell activation

inflammation

autonomic dysfunction

blood-brain barrier changes

While massage therapy does not treat these conditions directly, thoughtful adaptations can support comfort, reduce stress, and improve overall well-being.

https://www.ehlers-danlos.com/2017-eds-classification-non-experts/mast-cell-disorders-ehlers-danlos-syndrome-2/

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any medical condition. Individuals with Ehlers-Danlos Syndrome, Mast Cell Activation Syndrome, or related conditions should consult a qualified healthcare provider for medical advice. Massage therapists must practice within their scope of practice and should not attempt to treat medical conditions outside their training or licensure. Any massage therapy adaptations should be based on client comfort, professional judgment, and collaboration with appropriate healthcare providers.

Hypermobility and Hot Stone Massage

By Jennifer Richards, LMT 2026

Hot stone massage is a popular massage enhancement designed to relax muscles, increase circulation, and deepen relaxation. Many clients enjoy the soothing sensation of warmth during a session.

However, when working with people who have hypermobility, Hypermobility Spectrum Disorders (HSD), or Ehlers-Danlos Syndrome (EDS), heat therapies may need to be approached with extra caution.

Understanding how heat affects the body can help massage therapists make safer treatment choices.

What Are Hot Stones?

Hot stone massage uses heated stones placed on the body or used during massage techniques.

The stones are usually heated in water to a controlled temperature and used either statically (placed on the body) or dynamically (gliding across muscles).

The heat helps warm muscles and soft tissue, allowing the therapist to work more easily and often with less pressure.

Types of Heated Stone Modalities

Basalt Hot Stones

The most common stones used in massage are basalt stones, which are smooth volcanic stones that retain heat well.

They are typically placed on areas such as:

• the back

• shoulders

• hands

• feet

• along the spine

The heat helps increase circulation and muscle relaxation.

Himalayan Salt Stones

Himalayan stones are carved from pink Himalayan salt crystals and warmed before use.

Therapists use them similarly to basalt stones for massage techniques. Some practitioners believe these stones may provide additional benefits such as:

• gentle exfoliation

• mineral exposure

• calming sensory stimulation

Scientific evidence for these additional benefits is limited, but many clients enjoy the experience.

Other Heated Massage Modalities

Several other warming techniques are used in bodywork.

Examples include:

Herbal compresses

Heated bundles of herbs wrapped in cloth that are pressed onto the body.

Warm bamboo tools

Heated bamboo sticks used to apply massage pressure.

Hot towels or moist heat packs

Warm compresses applied to relax tissue before treatment.

All of these techniques rely on heat to relax tissue and increase circulation.

Why Heat Therapies Can Feel Helpful

Heat therapies can be beneficial for many people because warmth helps:

• increase circulation

• relax muscles

• reduce perceived stiffness

• stimulate the parasympathetic nervous system

• improve comfort during massage

For many clients, hot stone massage creates a deeply relaxing experience.

Why Heat Can Be Problematic for Hypermobile Clients

For individuals with hypermobility, heat may sometimes worsen certain symptoms.

1. Heat may increase joint laxity

Heat causes tissues to become more extensible, meaning they stretch more easily.

While this can feel helpful for tight muscles, in hypermobile bodies it may increase joint instability, because ligaments are already more elastic.

2. Heat may worsen dysautonomia symptoms

Many people with hypermobility also experience dysautonomia, including conditions such as Postural Orthostatic Tachycardia Syndrome (POTS).

Heat can cause blood vessels to dilate, which may lead to:

• dizziness

• fatigue

• rapid heart rate

• lightheadedness

The Ehlers-Danlos Society notes that dysautonomia and orthostatic intolerance are common in hypermobile individuals.

Learn more here:

Dysautonomia

3. Heat sensitivity is common in EDS

Many individuals with EDS report difficulty regulating body temperature and increased sensitivity to heat.

The Ehlers-Danlos Society explains that autonomic dysfunction can affect the body’s ability to regulate circulation and temperature.

What is EDS?

Because of this, prolonged heat exposure during massage may lead to discomfort or symptom flare-ups.

Massage Considerations for Hypermobile Clients

Hot stone massage is not automatically unsafe for hypermobile clients, but therapists should proceed carefully.

Helpful considerations include:

• always ask about heat tolerance

• avoid prolonged heat exposure

• monitor the client’s comfort closely

• consider using warm towels instead of hot stones

• prioritize nervous system relaxation rather than deep tissue effects

Some hypermobile clients tolerate warmth well, while others feel significantly worse with heat. Individual response is important.

Key Takeaway

Hot stone massage can be relaxing and beneficial for many people, but hypermobile bodies may respond differently to heat.

Because heat can increase tissue extensibility and affect circulation, massage therapists should carefully evaluate whether heated modalities are appropriate for clients with hypermobility or Ehlers-Danlos Syndrome.

Thoughtful communication and individualized care are essential.

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Individuals with hypermobility, hypermobility spectrum disorders, or Ehlers-Danlos Syndrome should consult a qualified healthcare professional for diagnosis and treatment. Massage therapists should work within their professional scope of practice and collaborate with appropriate healthcare providers when supporting clients with connective tissue disorders.

Hypermobility and Neurodivergence

(Autism, ADHD, OCD, and the Nervous System Connection)

By Jennifer Richards, LMT 2026

Hypermobility is often thought of as “just flexible joints,” but for many people, it is far more complex. It affects the nervous system, proprioception, pain processing, and overall body regulation.

In recent years, research has begun to show something many people have already noticed in real life:

👉 There is a meaningful overlap between hypermobility and neurodivergent conditions, especially autism and ADHD.

This doesn’t mean one causes the other—but it does suggest that the body and brain may be more connected than we once realized.

What does the research say?

Studies consistently show that:

Autistic individuals are more likely to have joint hypermobility People with hypermobility disorders (like HSD or hEDS) are more likely to have autism or autistic traits ADHD is also associated with hypermobility in both children and adults Anxiety is very common in hypermobile populations

Some studies suggest that:

Around 20–30% of autistic individuals may also have joint hypermobility The likelihood of hypermobility may be 3–5 times higher in autistic individuals

When it comes to OCD, the evidence is less clear. There may be overlap in some individuals, but current research does not show the same consistent connection seen with autism and ADHD.

Why might this happen?

We don’t have one clear answer yet—but several strong theories exist.

1. The connective tissue–brain connection

Connective tissue is everywhere—not just in joints:

Around nerves

In blood vessels

In the gut

Throughout the fascia system

If connective tissue behaves differently, it may influence how the body:

Processes sensory input

Regulates blood flow

Communicates between body and brain

2. Proprioception and body awareness

Many hypermobile individuals have reduced proprioception (awareness of where the body is in space).

This can lead to:

Clumsiness

Frequent injury

Constant muscle tension (the body trying to stabilize itself)

Now layer that with neurodivergence, where sensory processing may already be different—and you can see how the experience becomes amplified.

3. The nervous system and dysautonomia

Hypermobility is often associated with:

Dysautonomia (like POTS)

Fatigue

Dizziness

Temperature regulation issues

These symptoms can feel like:

Anxiety

Overwhelm

Burnout

“Crashing” after activity

For someone with autism or ADHD, this adds another layer of challenge:

👉 The body itself can feel unpredictable.

4. Chronic pain and sensory load

Pain changes everything.

When the body is constantly dealing with:

Micro-instability

Muscle guarding

Inflammation

Fatigue

…it increases the overall sensory load on the nervous system.

This can contribute to:

Difficulty focusing

Irritability

Shutdown or overwhelm

Increased need for control or routine

What might this look like?

Someone with both hypermobility and neurodivergence may experience:

Muscles that feel tight—but joints that are unstable

Sensitivity to touch, pressure, light, or sound

Difficulty with coordination or body awareness

Fatigue that doesn’t match activity level

Anxiety-like symptoms driven by the body

A feeling of “my body doesn’t cooperate with me”

Massage Therapy Considerations

This is where things really matter.

A hypermobile, neurodivergent client is not just a musculoskeletal case—they are a nervous system case.

1. Pressure is not the goal—regulation is

Tight does not always mean “needs deep pressure.”

In hypermobile bodies:

Muscles are often tight because they are stabilizing unstable joints Deep or aggressive work can make the body feel less safe, not better

👉 Slow, intentional, and moderate pressure is often more effective.

2. Predictability matters

For many autistic or ADHD clients:

Unexpected touch can be stressful

Transitions can be dysregulating

Helpful strategies:

Explain what you’re doing before you do it

Keep a predictable flow

Avoid sudden changes in pressure or pace

3. Sensory environment is part of the treatment

Consider:

Lighting Music (or silence)

Temperature

Scents

What is relaxing for one person may be overwhelming for another.

4. Joint safety is essential

Hypermobile clients may:

Sit or lie in positions that look comfortable—but aren’t safe

Not feel instability until later

Always:

Support joints with bolsters

Avoid end-range positioning

Watch for subtle signs of guarding

5. Communication must be individualized

Some clients may:

Under-report pain

Overwhelm quickly

Struggle to describe sensations

Check in clearly and specifically:

“How does this pressure feel?” “Do you feel supported here?” “Would you like more or less input?”

The Big Picture

This connection between hypermobility and neurodivergence is still being explored—but one thing is already clear:

👉 The body and nervous system are deeply connected.

When we understand that:

Pain Sensory processing

Fatigue

Emotional regulation

…are all part of the same system, we become better practitioners—and better advocates for our clients.

Reputable Sources

PubMed: Autism and Joint Hypermobility Systematic Review

Frontiers in Psychiatry: Autism and Generalized Joint Hypermobility

Frontiers: Neurodivergence, Hypermobility, Dysautonomia, and Pain

PubMed: ADHD and Joint Hypermobility Review

PMC: HSD/hEDS and Neurodevelopmental Conditions in Children

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical or mental health care. The relationship between hypermobility and neurodivergent conditions such as autism and ADHD is an emerging area of research and is not yet fully understood. Not all individuals with hypermobility are neurodivergent, and not all neurodivergent individuals are hypermobile. Massage therapists should remain within their scope of practice and adapt care based on each client’s individual presentation, comfort, and medical history.

Hypermobility and Mental Health

Jennifer Richards, LMT 2026

Hypermobility is commonly thought of as a musculoskeletal condition affecting joints and connective tissues. However, research increasingly shows that hypermobility—particularly in conditions such as hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders—can also influence mental health and nervous system regulation. Many individuals with hypermobility experience higher rates of anxiety, fatigue, and depression, often related to how the body’s connective tissue interacts with the autonomic nervous system.

Why Hypermobility Can Affect Mental Health

1. The Nervous System Connection

Connective tissue is present throughout the body, including structures that support the nervous system and blood vessels. In hypermobility disorders, collagen differences can affect how these systems function.

Many hypermobile individuals experience dysregulation of the autonomic nervous system, sometimes diagnosed as Postural Orthostatic Tachycardia Syndrome (POTS) or other forms of dysautonomia.

Symptoms can include:

Rapid heart rate

Lightheadedness

Fatigue Brain fog

Temperature dysregulation

Feeling shaky or faint

These symptoms can feel very similar to hypoglycemia or panic attacks, which can trigger anxiety or cause someone to believe something is seriously wrong.

When the nervous system is constantly in a heightened stress response, the brain may interpret this as anxiety even when the trigger is physiological.

2. Chronic Fatigue and Exercise Intolerance

Many people with hypermobility report severe fatigue. Several factors may contribute:

Poor joint stability requiring constant muscular effort

Dysautonomia affecting blood circulation

Sleep disruption due to pain

Deconditioning from repeated injuries

Exercise intolerance is also common.

When activity repeatedly leads to pain, injury, or extreme fatigue, individuals may begin to avoid movement, which can worsen physical symptoms and affect mental well-being.

3. Constant Injuries and Pain

Frequent sprains, subluxations, or chronic pain can significantly affect quality of life. When injuries occur repeatedly, individuals may feel:

Frustration Isolation Loss of independence

Fear of movement

These experiences can contribute to depression and anxiety, especially when the condition has not yet been properly diagnosed.

4. The Stress of Not Knowing What Is Happening

Many people with hypermobility spend years seeking answers before receiving a diagnosis. During that time they may be told that their symptoms are psychological or exaggerated.

This uncertainty can create significant emotional stress.

Common experiences include:

Feeling dismissed by healthcare providers

Struggling to keep up with work or daily responsibilities

Gaining weight due to reduced activity or metabolic changes

Feeling misunderstood by friends or family

Once individuals understand the underlying cause of their symptoms, many report that simply having an explanation reduces anxiety.

Massage Therapy Considerations

Massage therapy can be beneficial for both the physical and nervous system aspects of hypermobility.

Support Nervous System Regulation

Hypermobile individuals often have an overactive sympathetic nervous system (fight-or-flight). Massage can help shift the body toward a parasympathetic “rest and digest” state.

Helpful approaches include:

Slow, rhythmic strokes

Gentle myofascial work

Diaphragmatic breathing during treatment

A calm, predictable treatment environment

Be Mindful of Joint Stability

Avoid techniques that may increase joint instability, such as aggressive stretching or excessive joint mobilization.

Instead:

Support joints with proper positioning

Focus on surrounding muscle balance

Work within the client’s comfort range

Address Chronic Muscle Guarding

Hypermobile clients often develop tight muscles that compensate for unstable joints. Moderate pressure and neuromuscular techniques can help relieve protective tension without destabilizing the joint.

Encourage Body Awareness

Massage therapists can help clients reconnect with their bodies in a safe way by encouraging:

proprioception awareness

pacing strategies

gentle movement between sessions

This can improve both physical and emotional resilience.

Reputable Resources

The Ehlers-Danlos Society

Cleveland Clinic – Ehlers-Danlos Syndrome overview

National Institutes of Health – GeneReviews on hypermobile EDS

NHS – Joint Hypermobility Syndrome

Research on the association between hypermobility and anxiety disorders:

Key Takeaway

Hypermobility affects far more than joints. Because connective tissue supports many body systems—including the nervous system—individuals may experience fatigue, anxiety, and depression related to underlying physiological mechanisms.

Understanding these connections allows healthcare providers and massage therapists to approach hypermobile clients with greater empathy, safety, and effectiveness.

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Individuals experiencing symptoms of hypermobility, anxiety, dysautonomia, or other health concerns should consult a qualified healthcare professional. Massage therapy should be adapted to the individual needs and medical conditions of each client and performed by a licensed professional.

Hypermobility and Stiffness

Jennifer Richards, LMT 2026

Many people assume that individuals with hypermobility are always loose and flexible. In reality, many hypermobile people experience the opposite sensation: stiffness, tight muscles, and restricted movement.

This can be confusing for both clients and massage therapists. Understanding why stiffness occurs in a hypermobile body helps guide safe and effective treatment.

Why Stiffness Happens in Hypermobility

Hypermobility often occurs in connective tissue disorders such as hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). These conditions affect collagen, the protein that provides structure and support to ligaments, tendons, and other connective tissues.

When collagen is weaker or more elastic than normal:

Ligaments become looser Joints become less stable Muscles must work harder to stabilize the body

Because the joints are unstable, the muscles surrounding them tighten in an attempt to protect the joint.

This protective response is called muscle guarding. Over time, these muscles become overworked and fatigued, which can lead to chronic stiffness and tension.

In other words:

Loose joints often create tight muscles.

How It Happens (The Biomechanics)

Several mechanisms contribute to stiffness in hypermobile bodies:

1. Joint Instability

Ligaments normally help stabilize joints. In hypermobility, ligaments may be too lax, meaning muscles must constantly compensate.

2. Muscle Overcompensation

Muscles tighten to protect unstable joints. This constant contraction can cause chronic tension and fatigue.

3. Altered Proprioception

Many hypermobile individuals have reduced joint position awareness. The nervous system may increase muscle activity to maintain stability.

4. Protective Nervous System Responses

The brain may increase muscle tension to protect the body from perceived injury, creating persistent stiffness and pain.

How the Client May Feel

Clients with hypermobility-related stiffness often describe sensations such as:

Tight muscles that never seem to relax

Stiffness in the neck, back, or hips

Feeling like their body is working overtime just to stay upright

Limited range of motion in certain areas

Chronic muscle fatigue

Trigger points or tender areas

Morning stiffness or stiffness after activity

Some individuals even feel less flexible than others, despite having hypermobile joints.

Massage Therapy Considerations

Massage therapy can be very beneficial for hypermobile clients, but it must be approached thoughtfully.

Focus on Muscle Support, Not Just Relaxation

Because muscles are working to stabilize joints, the goal is not always to fully “release” tension.

Instead, focus on:

Reducing excessive muscle guarding Supporting healthy movement patterns Improving circulation Decreasing pain

Avoid Excessive Stretching

Hypermobile tissues are already lax. Aggressive stretching may increase joint instability.

Instead:

Use gentle mobilization Encourage controlled strengthening exercises

Moderate Pressure

Deep pressure may feel good temporarily but can sometimes destabilize already vulnerable joints.

Use:

slow myofascial work moderate pressure neuromuscular techniques

Work With the Nervous System

Hypermobile bodies often have heightened nervous system sensitivity.

Helpful approaches include:

slow pace rhythmic techniques diaphragmatic breathing calming the autonomic nervous system

Encourage Stability Between Sessions

Massage therapists may also suggest:

gentle strength training proprioception exercises core stabilization

These strategies help reduce the muscular overcompensation that leads to stiffness.

Reputable Resources

The following organizations provide reliable information about hypermobility and connective tissue disorders:

The Ehlers-Danlos Society

GeneReviews (NCBI) – Hypermobile Ehlers-Danlos Syndrome

NHS – Joint Hypermobility Syndrome

Cleveland Clinic – Ehlers-Danlos Syndrome

Key Takeaway

Hypermobility does not mean the body is loose everywhere.

In many cases, stiffness is the body’s attempt to create stability.

Understanding this paradox helps massage therapists provide safer, more effective care for hypermobile clients.

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Individuals with hypermobility disorders such as Ehlers-Danlos syndrome or Hypermobility Spectrum Disorder should consult a qualified healthcare provider for medical advice. Massage therapy should always be adapted to the client’s individual health needs and performed by a licensed professional.