499 pages dedicated to understanding hypermobility through the lens of massage therapy.
This comprehensive guide begins with the anatomy, physiology, pathology, and kinesiology of hypermobility, building the foundation massage therapists need to understand what may be happening beneath their hands.
From there, we explore common comorbidities, contraindications, cautions, and clinical considerations before moving body system by body system to examine how hypermobility and connective tissue disorders can affect far more than the musculoskeletal system.
Then we bring that knowledge into the treatment room.
Learn how to adapt massage therapy for the hypermobile body—including positioning, pressure, stretching, joint protection, communication, pacing, and session planning—while recognizing when treatment should be modified, postponed, or referred to another healthcare professional.
And because many massage therapists are hypermobile themselves, this book also addresses therapist body mechanics, joint protection, and strategies for building a sustainable career without sacrificing your own body.
Practical resources include sample intake forms, SOAP notes, client handouts, safety guidance, and clinical tools that can be incorporated into practice and education.
A comprehensive reference list is included throughout so readers can explore the research, evaluate the evidence, and continue learning for themselves.
499 pages. One goal: helping massage therapists understand the hypermobile body so they can work more safely, thoughtfully, and effectively.
One of the most common things I hear from people with hypermobility is:
“I’m tired all the time.”
Not just “I need a nap” tired.
We’re talking about the kind of fatigue that can make getting out of bed feel overwhelming. The kind where a trip to the grocery store requires hours—or even days—of recovery. The kind that friends and family often misunderstand because the person “looks fine.”
Many people assume this level of fatigue is simply part of living with Ehlers-Danlos syndrome (EDS) or Hypermobility Spectrum Disorder (HSD). While fatigue is certainly common in these conditions, there may be another explanation for some individuals: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
Although these are separate conditions, researchers are finding that they frequently overlap.
What Is ME/CFS?
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, chronic illness that affects multiple body systems. It is far more than “being tired.”
People with ME/CFS may experience:
Profound fatigue that is not relieved by rest
Brain fog and difficulty concentrating
Muscle and joint pain
Sleep that is not refreshing
Dizziness when standing
Sensitivity to light, sound, or temperature
Digestive problems
Difficulty tolerating physical or mental activity
One hallmark symptom sets ME/CFS apart from many other illnesses: post-exertional malaise (PEM).
What Is Post-Exertional Malaise?
Post-exertional malaise is a worsening of symptoms after physical, mental, or emotional activity that would not have caused problems before becoming ill.
The symptoms often do not appear immediately. Instead, they may develop 12 to 48 hours later and can last for days or even weeks.
For example, someone may feel well enough to attend a family gathering on Saturday but wake up Monday feeling as though they have the flu, with overwhelming fatigue, body aches, and brain fog.
This delayed “crash” is considered one of the defining characteristics of ME/CFS.
Why Do EDS and ME/CFS Overlap?
Researchers are still working to understand the connection, but several theories are emerging.
Dysautonomia
Many people with hypermobility also experience dysfunction of the autonomic nervous system, including conditions such as Postural Orthostatic Tachycardia Syndrome (POTS).
Symptoms can include:
Rapid heart rate when standing
Lightheadedness
Brain fog
Heat intolerance
Fatigue
Exercise intolerance
These same symptoms are also common in ME/CFS.
Connective Tissue Changes
Connective tissue is found throughout the body—not only in joints but also in blood vessels, nerves, the digestive tract, and many other organs.
Researchers believe that abnormalities in connective tissue may contribute to problems with blood vessel function and circulation, leading to reduced blood flow to the brain and muscles during activity.
Mast Cell Activation
Some individuals with hypermobility also experience Mast Cell Activation Syndrome (MCAS), which can cause:
Flushing
Hives
Food sensitivities
Medication sensitivities
Gastrointestinal symptoms
Although research is ongoing, mast cell activation may contribute to inflammation, fatigue, and autonomic dysfunction in some people.
Pain and Sleep
Chronic pain and poor sleep often occur together.
People with EDS frequently report:
Difficulty falling asleep
Frequent waking
Restless legs
Waking feeling as tired as when they went to bed
When restorative sleep is disrupted night after night, fatigue can become overwhelming.
Is It Just Deconditioning?
For years, people with chronic fatigue were often told they simply needed to exercise more.
We now know the answer is much more complicated.
People with hypermobility generally benefit from carefully designed strengthening programs that improve joint stability.
However, for individuals with ME/CFS, pushing through fatigue can worsen symptoms because of post-exertional malaise.
Understanding the difference is essential.
What Does This Mean for Massage Therapists?
Massage therapists are often among the first healthcare professionals to hear clients describe symptoms that extend beyond muscles and joints.
When working with hypermobile clients, it is helpful to ask questions such as:
How long does it take you to recover after activity?
Do you become more fatigued a day or two after doing too much?
Do you experience dizziness when standing?
Is your sleep restorative?
Are there days when your body simply “shuts down”?
These conversations can help guide treatment planning and may encourage clients to discuss their symptoms with their healthcare provider.
Massage therapists do not diagnose ME/CFS, but we can recognize patterns, provide appropriate modifications, and support clients with compassionate, individualized care.
Hope Through Understanding
Not every person with hypermobility has ME/CFS.
Not every person with ME/CFS has hypermobility.
But for those living with both, understanding the connection can be life-changing.
Recognizing that profound fatigue is not laziness—and that symptoms have a physiological basis—can help people seek appropriate care, pace their activities, and better understand their own bodies.
As research continues, we’re learning that hypermobility is far more than flexible joints. It can affect the nervous system, circulation, immune system, sleep, digestion, and overall quality of life.
The more we understand these connections, the better we can support those living with them.
Disclaimer: This article is intended for educational purposes only and should not be considered medical advice. Individuals experiencing persistent fatigue, post-exertional malaise, dizziness, or other concerning symptoms should consult a qualified healthcare professional for evaluation and diagnosis.
This article is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Always consult a qualified healthcare professional regarding your individual medical concerns. MCAS is a complex condition that requires medical evaluation and individualized treatment.
What Is MCAS?
Mast Cell Activation Syndrome (MCAS) is a condition in which mast cells become overly reactive and release excessive amounts of inflammatory chemicals, often inappropriately or in response to triggers that would not normally cause a significant reaction.
Mast cells are immune cells found throughout the body, especially in:
Skin
Respiratory tract
Gastrointestinal tract
Blood vessels
Connective tissues
Nervous system
Their job is to protect us from infection, parasites, toxins, and injury. They act as “first responders” in the immune system.
When functioning normally, mast cells release chemical messengers only when needed. In MCAS, they can release these chemicals too frequently, too intensely, or at inappropriate times.
What Do Mast Cells Release?
Mast cells contain hundreds of biologically active substances, including:
Histamine
Tryptase
Prostaglandins
Leukotrienes
Cytokines
Heparin
These chemicals affect:
Blood vessels
Digestion
Heart rate
Blood pressure
Breathing
Pain signaling
Temperature regulation
Brain function
This is why MCAS can affect nearly every body system.
Why Does the Body Do This?
Researchers do not yet have a complete answer.
Current theories include:
Genetic Predisposition
Some people appear genetically prone to having more reactive mast cells.
Connective Tissue Differences
Changes in connective tissue may influence how mast cells behave and communicate with surrounding tissues.
Immune Dysregulation
The immune system may become overly sensitive after:
Viral infections
Chronic inflammation
Environmental exposures
Physical trauma
Significant stressors
Nervous System Involvement
Mast cells communicate directly with the nervous system.
When the autonomic nervous system becomes dysregulated, mast cells may become easier to trigger.
How Do People Get MCAS?
MCAS is generally not considered something you “catch.”
Rather, it appears to develop through a combination of:
Genetics
Immune system susceptibility
Environmental triggers
Infections
Hormonal changes
Physical or emotional stress
Many people report symptoms worsening after:
Viral illnesses
Surgery
Pregnancy
Major stress
Significant injuries
What Are Common Symptoms?
Symptoms vary dramatically from person to person.
Skin
Hives
Itching
Flushing
Rashes
Dermatographia (“skin writing”)
Respiratory
Wheezing
Shortness of breath
Nasal congestion
Throat tightness
Cardiovascular
Rapid heart rate
Palpitations
Lightheadedness
Blood pressure fluctuations
Fainting
Gastrointestinal
Nausea
Reflux
Diarrhea
Abdominal pain
Bloating
Neurological
Brain fog
Headaches
Migraines
Anxiety
Dizziness
General
Fatigue
Temperature intolerance
Chemical sensitivities
Medication sensitivities
Severe Reactions
Some individuals experience episodes resembling allergic reactions or even anaphylaxis despite no obvious allergy trigger.
Common Triggers
Triggers are highly individual but may include:
Heat
Cold
Exercise
Stress
Infections
Fragrances
Smoke
Alcohol
Certain medications
High-histamine foods
Hormonal fluctuations
A trigger that affects one person may not affect another.
Why Is MCAS Associated with Hypermobility?
One of the most discussed relationships in recent years is the overlap among:
Hypermobile Ehlers-Danlos Syndrome
Hypermobility Spectrum Disorder
Postural Orthostatic Tachycardia Syndrome
MCAS
Researchers continue to investigate why these conditions frequently occur together.
Proposed explanations include:
Mast Cells Live in Connective Tissue
Mast cells are abundant within connective tissues.
Since connective tissue is altered in hypermobility disorders, mast-cell behavior may also be affected.
Blood Vessel Effects
Histamine causes blood vessels to dilate.
This can worsen symptoms commonly seen in POTS and dysautonomia, including:
Dizziness
Tachycardia
Blood pooling
Fatigue
Nervous System Interaction
Mast cells and the autonomic nervous system constantly communicate.
Both dysautonomia and MCAS involve disruptions in these regulatory systems.
Shared Genetic Factors
Researchers suspect there may be overlapping genetic and biological pathways, though definitive answers remain under investigation.
How Is MCAS Diagnosed?
Diagnosis can be challenging.
Typically, physicians look for:
Symptoms involving multiple body systems
Evidence of mast-cell mediator release
Improvement with mast-cell-targeted treatments
Testing may include:
Serum tryptase
Urinary histamine metabolites
Urinary prostaglandin metabolites
Because mast-cell mediators fluctuate, normal testing does not always rule out MCAS.
Who Treats MCAS?
Depending on symptoms, care may involve:
Allergists/Immunologists
Gastroenterologists
Cardiologists
Dermatologists
Neurologists
Primary care physicians familiar with mast-cell disorders
Many patients ultimately require a team approach.
Can MCAS Be Fixed?
Currently, there is no universally accepted cure.
Treatment focuses on reducing symptoms, minimizing triggers, and stabilizing mast cells.
Common approaches include:
Trigger Management
Identifying and avoiding triggers when possible.
Medications
Under physician supervision:
H1 antihistamines
H2 antihistamines
Mast-cell stabilizers
Leukotriene inhibitors
Lifestyle Support
Stress management
Sleep optimization
Hydration
Electrolyte support
Pacing activities
Nutritional Strategies
Some individuals benefit from temporary reduction of high-histamine foods under guidance from knowledgeable healthcare professionals.
Why Massage Therapists Should Know About MCAS
Clients with hypermobility frequently report symptoms suggestive of mast-cell dysfunction.
A therapist may notice:
Flushing during treatment
Unexpected reactions to lotions or essential oils
Heat intolerance
Chemical sensitivities
Unusual post-treatment fatigue
Dizziness when changing positions
Understanding MCAS can help therapists:
Modify environmental triggers
Reduce overwhelming sensory input
Adjust heat applications
Pace treatments appropriately
Improve client safety and comfort
Experts and Organizations to Cite
For educational materials, consider citing:
The Mast Cell Disease Society (TMS)
The Ehlers-Danlos Society
Lawrence Afrin
Anne Maitland
Cem Akin
Key Takeaway
MCAS is a disorder of mast-cell overactivation that can affect nearly every body system. While researchers are still uncovering exactly why it occurs, it appears to overlap significantly with hypermobility disorders, dysautonomia, and related connective tissue conditions. For people with hypermobility, understanding mast-cell dysfunction may help explain symptoms that otherwise seem unrelated—from hives and digestive issues to rapid heart rate, fatigue, and medication sensitivities.
Jennifer Richards, LMT Educating massage therapists about hypermobility, connective tissue disorders, and client safety.
“Doctors keep telling me my tests are normal, but I feel terrible.”
If these statements sound familiar, you may have encountered dysautonomia—a common but often misunderstood condition that frequently occurs alongside hypermobility and Ehlers-Danlos Syndrome (EDS).
What Is Dysautonomia?
Dysautonomia is an umbrella term for disorders that affect the autonomic nervous system (ANS). The autonomic nervous system controls all the things your body does automatically, without you having to think about them.
These include:
Heart rate
Blood pressure
Breathing
Digestion
Body temperature regulation
Sweating
Bladder function
Pupil dilation
Sleep-wake cycles
Think of the autonomic nervous system as your body’s automatic operating system. When it functions properly, your body adjusts seamlessly to changes in position, temperature, stress, activity, and rest.
With dysautonomia, those automatic adjustments become inefficient, delayed, or excessive. (Cleveland Clinic)
Why Does Dysautonomia Happen?
There is no single cause of dysautonomia.
It may develop after:
Viral infections
Autoimmune conditions
Concussions or trauma
Surgery
Pregnancy
Genetic connective tissue disorders such as Ehlers-Danlos Syndrome
Diabetes and other neurological diseases
Researchers continue to investigate the exact mechanisms, but many people with hypermobility disorders appear to have autonomic nervous systems that struggle to regulate blood flow, heart rate, and other automatic functions efficiently. (Dysautonomia International)
Common Symptoms of Dysautonomia
Symptoms can vary widely from person to person.
Common complaints include:
Rapid heart rate
Dizziness or lightheadedness
Fainting or near-fainting
Exercise intolerance
Chronic fatigue
Brain fog
Temperature intolerance
Excessive sweating or inability to sweat
Digestive issues
Nausea
Shortness of breath
Sleep disturbances
Anxiety-like symptoms
Many people describe feeling as though their body is constantly working harder than it should. (The Ehlers Danlos Society)
Types of Dysautonomia
Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is one of the most recognized forms of dysautonomia.
When a person stands up, their heart rate rises excessively in an attempt to maintain blood flow to the brain. Symptoms often include dizziness, palpitations, fatigue, brain fog, and exercise intolerance. (Dysautonomia International)
Neurocardiogenic Syncope (Vasovagal Syncope)
This is the most common cause of fainting. Blood pressure and heart rate suddenly drop, leading to loss of consciousness or near-fainting episodes. (Dysautonomia International)
Orthostatic Hypotension
Blood pressure drops significantly upon standing, causing dizziness, weakness, and sometimes fainting. (PubMed Central)
Inappropriate Sinus Tachycardia (IST)
Individuals experience an unusually fast heart rate even at rest or with minimal activity. (Dysautonomia International)
This is where things become especially important for massage therapists and bodyworkers.
Many people with hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD) also experience dysautonomia. The Ehlers-Danlos Society notes that dysautonomia is common among people with EDS and HSD. (The Ehlers Danlos Society)
Research suggests:
Approximately two-thirds of people with hypermobile EDS experience orthostatic intolerance.
Among those individuals, approximately 41–49% have POTS.
Dysautonomia is considered highly prevalent in people with hEDS and HSD. (PubMed Central)
Why?
One theory is that connective tissue abnormalities affect the blood vessels themselves. Blood vessels rely on connective tissue for support. When vessels become more compliant or “stretchy,” blood may pool in the legs and lower body when standing, forcing the heart to work harder to maintain circulation to the brain.
This may help explain why so many hypermobile individuals report:
Racing heart
Dizziness
Heat intolerance
Fatigue
Exercise intolerance
Brain fog
The overlap is so common that many clinicians now routinely screen hypermobile patients for autonomic dysfunction. (PubMed Central)
Managing Dysautonomia
Management is highly individualized and should always be guided by a healthcare provider.
Strategies commonly recommended include:
Hydration
Increasing fluid intake can help support blood volume.
Electrolytes
Many individuals benefit from increasing sodium and electrolyte intake under medical guidance.
Compression Garments
Compression socks or abdominal compression may reduce blood pooling.
Gradual Exercise
Recumbent biking, rowing, swimming, and carefully progressed strengthening programs are often better tolerated than upright exercise.
Pacing
Learning to work within energy limits can help reduce crashes and symptom flares.
Sleep Support
Adequate sleep is essential for autonomic regulation.
Stress Management
The autonomic nervous system is highly responsive to stress. Breathwork, mindfulness, meditation, and nervous-system regulation strategies may help.
Medical Treatment
Some individuals require medications to help regulate heart rate, blood pressure, or blood volume.
What Massage Therapists Should Know
Clients with dysautonomia may:
Become dizzy when changing positions
Need extra time getting on or off the table
Struggle with temperature regulation
Experience post-treatment fatigue
Be sensitive to prolonged standing
Have fluctuating symptoms from day to day
For hypermobile clients, dysautonomia may be one of the hidden reasons they feel exhausted despite appearing healthy.
Understanding this connection allows therapists to provide safer, more effective care and helps clients feel seen and understood.
Final Thoughts
For many people with hypermobility, dysautonomia is the missing puzzle piece that explains years of unexplained symptoms.
The racing heart, dizziness, fatigue, temperature sensitivity, brain fog, and exercise intolerance are not “all in their head.” They are often signs of an autonomic nervous system struggling to maintain balance.
As awareness grows, more individuals are finally receiving answers—and finding strategies that help them live fuller, more functional lives.
Disclaimer
This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional regarding diagnosis, treatment, or changes to your healthcare plan. If you experience fainting, chest pain, shortness of breath, or other concerning symptoms, seek immediate medical attention.
When we talk about Ehlers-Danlos Syndrome, hypermobility, and connective tissue disorders, most people think of joints: knees, shoulders, hips, ankles, and spines that move too much.
But connective tissue is everywhere — including the digestive tract.
Newer research continues to show that people with hypermobile EDS and Hypermobility Spectrum Disorders have higher rates of gastrointestinal symptoms, including reflux, dysphagia, delayed gastric emptying, esophageal dysmotility, and structural findings such as hiatal hernia. One study of 218 people with hEDS found that 62.3% had at least one GI symptom at diagnosis, and among those tested for motility issues, esophageal dysmotility was found in some patients. Another Mayo Clinic review found that in EDS patients who had endoscopy, common findings included gastritis, hiatal hernia, and reflux esophagitis.
What is achalasia?
Achalasia is a rare swallowing disorder where the esophagus does not move food properly and the lower esophageal sphincter does not relax normally. Food and liquid can become stuck instead of passing easily into the stomach. Symptoms may include difficulty swallowing, regurgitation, chest pain, coughing at night, weight loss, vomiting, and even pneumonia from aspiration.
This can be dangerous because swallowing problems can lead to dehydration, malnutrition, choking, aspiration pneumonia, and weight loss.
What is a hiatal hernia?
A hiatal hernia happens when part of the stomach pushes upward through the diaphragm into the chest cavity. Small hiatal hernias may cause few symptoms, but others can contribute to reflux, chest pressure, difficulty swallowing, regurgitation, nausea, and discomfort after eating. Larger or paraesophageal hernias can become more serious if the stomach becomes trapped, twisted, or loses blood supply.
Why does this matter in hypermobility?
In hypermobility populations, symptoms are often dismissed as “just reflux,” “anxiety,” or “stress.” But hEDS/HSD are multisystem conditions. The digestive tract depends on connective tissue support, nerve signaling, smooth muscle coordination, and autonomic regulation. The Ehlers-Danlos Society notes that connective tissue abnormalities in the digestive tract may affect how the gut moves, and dysautonomia such as POTS may also contribute to GI symptoms.
For massage therapists, this matters.
Especially for therapists trained in abdominal massage, visceral work, lymphatic work, or deep abdominal techniques, we need to remember: not every abdominal complaint is muscular tension. Not every “tight diaphragm” is simply a soft tissue restriction. A client with hypermobility may also have reflux, hiatal hernia, esophageal dysmotility, gastroparesis, or other GI involvement.
This does not mean massage therapists diagnose these conditions. We do not.
But we can ask better questions.
Before abdominal work, consider asking:
“Do you have reflux, difficulty swallowing, hiatal hernia, nausea, bloating, gastroparesis, unexplained chest pressure, or food that feels stuck?”
“Have you ever been evaluated by a gastroenterologist?”
“Do your symptoms worsen after eating or lying down?”
“Do you ever cough or choke at night?”
If a client reports progressive difficulty swallowing, unexplained weight loss, vomiting undigested food, choking, aspiration, severe chest pain, black stools, or symptoms that are worsening, that is not a massage issue — that is a medical referral.
The bigger picture
Hypermobility is not just “being flexible.” It can affect joints, fascia, blood vessels, nerves, the autonomic nervous system, and the gastrointestinal tract. Massage therapists are often the most hands-on professionals a client sees. We may notice patterns before anyone else does.
Our role is not to diagnose.
Our role is to work safely, listen carefully, avoid aggressive techniques when risk factors are present, and refer out when symptoms suggest something beyond our scope.
For hypermobile clients, gentler, nervous-system-aware work is often the safer starting point — especially when the abdomen, diaphragm, ribs, and pelvis are involved.
Disclaimer
This post is for educational purposes only and is not medical advice. Massage therapists do not diagnose or treat achalasia, hiatal hernia, EDS, POTS, MCAS, gastrointestinal disease, or swallowing disorders. Clients with difficulty swallowing, unexplained weight loss, chest pain, vomiting, aspiration, severe reflux, or worsening GI symptoms should be referred to a qualified medical provider or gastroenterologist.
Not everyone who is flexible is hypermobile, and not everyone with hypermobility has a medical condition. Many people live their entire lives without significant problems.
However, if someone you care about has unusually flexible joints and experiences things like frequent sprains, recurring joint pain, joints that “pop out,” chronic fatigue, dizziness when standing, digestive issues, easy bruising, or other unexplained symptoms, it may be worth encouraging them to learn more.
You don’t need to diagnose them. Simply sharing information can be enough.
You might say:
“I recently learned that hypermobility is different from flexibility. Some people with hypermobile joints also experience symptoms that can be treated or managed. If any of this sounds familiar, it might be worth mentioning to your healthcare provider.”
Ultimately, it’s their decision whether to pursue an evaluation. Respect their autonomy, avoid pressuring them, and remember that not every hypermobile person needs medical care.
Sometimes the greatest gift isn’t having all the answers—it’s helping someone ask the right questions.
Looking to better understand hypermobility, Ehlers-Danlos syndrome (EDS), and related connective tissue disorders?
I’m Jennifer Richards, LMT, an NCBTMB Approved Continuing Education Provider, author of Working Safely with Hypermobility: Evidence-Informed Bodywork for Connective Tissue Disorders, and a massage therapy instructor.
Through my continuing education classes, book, and weekly evidence-informed articles, my goal is to help massage therapists, healthcare professionals, and individuals living with hypermobility better understand these often misunderstood conditions. I combine current research, clinical experience, and practical strategies—while clearly distinguishing established evidence from emerging hypotheses.
Whether you’re a therapist looking to expand your skills or someone searching for reliable information, you’re welcome here. Join our growing community as we learn, share, and advocate together.
Russek, L. (Physical therapy & central sensitization in hypermobility)
Hakim, A. et al. (Clinical understanding of EDS and systemic involvement)
Disclaimer
This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Always consult with a qualified healthcare provider regarding any medical condition. Massage therapists should work within their scope of practice and adapt techniques based on individual client needs, medical history, and response to treatment.
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”
To
“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.
Tranquil Touch Wellness: Jennifer Richards, LMT 