Jennifer Richards

Ehlers Danlos and Pelvic Congestion Syndrome

By Jennifer Richards, LMT 2026

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome (PCS) is a chronic condition caused by dilated, poorly functioning veins in the pelvis, similar to varicose veins that occur in the legs.

Normally, veins contain one-way valves that keep blood flowing upward toward the heart. When those valves weaken or fail, blood can pool in the pelvic veins, causing pressure and inflammation.

This leads to chronic pelvic pain and vascular congestion.

Why PCS Can Occur in People with Ehlers–Danlos Syndrome

People with Ehlers-Danlos Syndrome have weaker connective tissue, including the collagen that supports blood vessels and vein walls.

This can lead to:

• Venous laxity (veins stretch more easily)

• Valve dysfunction

• Poor vascular tone

• Blood pooling

Because the veins become overly stretchy, they may enlarge and twist, creating pelvic varicosities.

Many hypermobile patients also experience autonomic dysfunction, such as Postural Orthostatic Tachycardia Syndrome, which can worsen blood pooling in the lower body.

Common Symptoms

Symptoms often worsen after standing for long periods or at the end of the day.

Typical symptoms include:

Chronic pelvic pain

Dull, aching pain in the pelvis Pain worse after standing or sitting long periods

Pressure or heaviness

Feeling of pelvic fullness

Pain during or after intercourse

Lower back or hip pain

Visible varicose veins

Buttocks Upper thighs Vulva or vaginal area

Urinary or bowel pressure

Many people with EDS report that symptoms fluctuate with:

• Hormonal changes

• Menstrual cycle

• Pregnancy

• Long periods of upright posture

Why It Is Often Missed

PCS is frequently underdiagnosed, especially in hypermobile patients.

Reasons include:

• Symptoms overlap with endometriosis

• Symptoms resemble IBS or bladder disorders

• Pain is often dismissed as “normal pelvic pain”

Diagnosis may involve:

Pelvic ultrasound Doppler imaging MRI or CT Venography (gold standard)

Treatment Options

Treatment depends on symptom severity.

Conservative management

Often first approach:

• Compression garments

• Pelvic floor physical therapy

• Avoid prolonged standing

• Anti-inflammatory support

• Hormonal therapy in some cases

Medical procedures

If symptoms are severe:

• Pelvic vein embolization

• Sclerotherapy

• Rarely surgical vein ligation

Embolization is currently one of the most common treatments.

Massage Therapy Considerations

Because you are a massage therapist specializing in hypermobility, these points are important for your clients.

Massage can help secondary symptoms, but cannot treat the vascular problem itself.

Helpful approaches may include:

Lymphatic drainage

Supports fluid movement

Gentle abdominal work

Avoid deep pressure over pelvic veins

Myofascial release

Address compensatory muscle tension

Hip and lumbar work

Reduce referred pain patterns

Important precautions

Avoid:

• Deep abdominal pressure

• Aggressive psoas work

• Intense heat over the pelvis

• Excessive intra-abdominal pressure

Clients with PCS may also experience:

• POTS-related dizziness when standing up after massage

• Increased pelvic pressure when prone too long

Position changes should be slow and supported.

Evidence and Support

Information about vascular involvement in EDS can be found through:

• The Ehlers-Danlos Society

• Vascular and autonomic complications documented in connective-tissue disorders

Studies show increased rates of venous insufficiency and pelvic varicosities in connective-tissue disorders due to collagen weakness.

Quick Summary

EDS can increase risk of pelvic congestion because:

• Connective tissue is weaker

• Veins stretch more easily

• Valves fail more easily

• Blood pools in the pelvis

This can lead to chronic pelvic pain, pressure, and vascular symptoms.

Disclaimer

This article is for educational purposes only and is not intended to diagnose or treat medical conditions. Individuals experiencing pelvic pain or suspected pelvic congestion syndrome should consult a qualified healthcare professional for evaluation and appropriate care. Massage therapists should practice within their scope of practice and modify techniques as needed for clients with connective tissue disorders such as Ehlers–Danlos Syndrome.

Please nominate

The Ehlers-Danlos Society has opened nominations for its 2026 Community Choice Awards, recognizing advocates and healthcare professionals who have made a difference in the lives of those living with EDS, HSD, and related conditions. Winners will be announced during the 2026 Global Learning Conference, taking place July 24–26 in Dallas, Texas and online. (The Ehlers Danlos Society)

As someone living with hypermobility and dedicating my career to educating massage therapists and supporting clients with connective tissue disorders, this community holds a special place in my heart. Every conversation, class, blog post, and client session is part of a larger mission: helping people feel seen, understood, and supported.

If my work has made a difference in your journey, I would be honored if you would consider submitting a nomination. More importantly, I encourage everyone to take a moment to recognize the advocates, clinicians, researchers, and community members who are helping move awareness and care forward for all of us.

Together, we continue to educate, advocate, and create change—one zebra at a time. 🦓

Community Choice Awards

Jennifer Richards

Instagram: @lmt.jen
Facebook: Jennifer-Richards-LMT
LinkedIn: http://www.linkedin.com/in/jennifer-richards-86296b5
Website: https://jenniferrichardslmt.com

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 Connective Tissue Disorders

Many massage therapists are already working with hypermobile clients — whether they realize it or not.

I am a Licensed Massage Therapist, instructor, and author specializing in hypermobility and connective tissue disorders.

My passion is educating massage therapists on how to work safely with hypermobile clients and adapt treatment appropriately for this often misunderstood population.

Unfortunately, traditional massage education frequently does not adequately cover:
• hypermobility
• connective tissue disorders
• contraindications
• nervous system considerations
• treatment modifications

Years ago, estimates suggested hypermobility affected approximately 1 in 5,000 people. More recent research suggests it may be far more common — possibly closer to 1 in 500.

As awareness grows, it is becoming increasingly important for massage therapists and other wellness professionals to understand how these conditions can affect pain, instability, fatigue, proprioception, nervous system regulation, and recovery.

Through continuing education, writing, and advocacy, my goal is to help therapists provide safer, more informed, and more compassionate care.

Jennifer Richards, LMT

#MassageTherapy #Hypermobility #EhlersDanlosSyndrome #hEDS #EDS #Bodywork #ContinuingEducation #MassageEducation #ConnectiveTissueDisorders #ChronicIllness #ManualTherapy

jennifer.richards.lmt@gmail.com

Hypermobility, Deep Tissue, and Deep Pressure Massage

By Jennifer Richards, LMT 2026

Many people with hypermobility seek massage because they feel tight, sore, and fatigued. Often they request deep tissue massage because they believe stronger pressure will relieve the tension.

However, with hypermobility, it is important to understand the difference between deep pressure and deep tissue, and why certain techniques may help some clients but harm others.

Understanding the Terms

Hypermobility

Hypermobility refers to joints that move beyond the normal range of motion due to differences in connective tissue.

Connective tissue—especially collagen—provides structure and stability to joints, ligaments, tendons, and skin. When collagen is more elastic, joints may become loose or unstable.

Hypermobility can occur on its own or as part of conditions such as Hypermobility Spectrum Disorders (HSD) or Ehlers-Danlos Syndrome (EDS).

The Ehlers-Danlos Society explains that hypermobile EDS involves joint hypermobility, joint instability, chronic pain, and soft connective tissue fragility.

Hypermobile EDS (hEDS)

Deep Tissue Massage

Deep tissue massage is a therapeutic technique designed to reach deeper layers of muscle and fascia.

Therapists often use:

• slow strokes

• sustained pressure

• friction techniques

• work along muscle fibers

Deep tissue massage is typically used to treat:

• chronic muscle tension

• adhesions

• scar tissue

• postural imbalances

• repetitive strain injuries

The goal is to release deeper restrictions in the soft tissue.

Deep Pressure

Deep pressure simply refers to the amount of pressure applied during massage, not the technique itself.

A massage can be:

• light pressure

• moderate pressure

• deep pressure

Deep pressure can occur during many techniques including:

• Swedish massage

• myofascial work

• trigger point therapy

Deep pressure can sometimes feel comforting because it stimulates pressure receptors in the nervous system, which may create a calming effect.

Why Deep Pressure Can Feel Helpful for Hypermobile Clients

Many hypermobile individuals report feeling chronically tight.

This happens because muscles often work harder to stabilize joints that ligaments cannot fully support.

As a result, muscles may develop:

• trigger points

• fatigue

• protective guarding

Deep pressure can sometimes feel beneficial because it:

• temporarily relieves muscle tension

• stimulates proprioceptors

• helps the nervous system feel grounded

• increases body awareness

For some clients, moderate pressure massage can provide significant relief.

Why Deep Tissue Massage Can Be Problematic for Hypermobile Bodies

While deep pressure may feel good, aggressive deep tissue work can create problems in hypermobile individuals.

This happens for several reasons.

1. Ligaments are already lax

Ligaments stabilize joints. In hypermobile bodies, ligaments may already be more elastic or fragile.

Aggressive deep tissue work near joints can increase instability.

2. Muscles may be compensating for instability

Muscle tightness in hypermobile bodies is often protective.

Those muscles are working to stabilize joints.

If deep tissue techniques release them too aggressively, joints may become more unstable, increasing the risk of:

• subluxations

• joint irritation

• post-treatment pain

3. Connective tissue may be more fragile

People with Ehlers-Danlos Syndrome can have more fragile connective tissue, meaning aggressive pressure may lead to:

• bruising

• inflammation

• prolonged soreness

The Ehlers-Danlos Society notes that individuals with EDS may experience joint instability, soft tissue injury, and chronic pain, requiring careful management of physical therapies.

What is EDS?

A Balanced Approach for Massage Therapists

Massage can be extremely beneficial for hypermobile clients when applied thoughtfully.

Many therapists find success with techniques that focus on supporting the nervous system and improving muscle balance rather than aggressively releasing tissue.

Helpful approaches may include:

• moderate pressure Swedish massage

• myofascial techniques

• trigger point therapy used carefully

• lymphatic techniques

• slow, controlled neuromuscular work

Communication during the session is essential. What feels good during treatment may not always feel good 24 hours later, so checking in about post-treatment response is important.

Key Takeaway

Deep pressure and deep tissue are not the same thing.

Deep pressure can sometimes feel supportive and grounding for hypermobile clients, but aggressive deep tissue work may increase joint instability and tissue irritation.

Understanding this distinction helps massage therapists provide safer, more effective care for hypermobile individuals.

Disclaimer

Hypermobility and Aging

By Jennifer Richards, LMT 2026

Many people with hypermobility hear the same comment growing up:

“You’ll grow out of it.”

While it is true that joint flexibility often decreases with age, the story is more complicated for people with hypermobility or Ehlers-Danlos Syndrome (EDS).

Understanding how a hypermobile body changes over time is important not only for clients—but also for massage therapists working with them.

What happens to a hypermobile body over time

Hypermobility occurs when the body’s connective tissue—primarily collagen—is more elastic than usual. Connective tissue supports joints, ligaments, skin, blood vessels, and organs. When collagen is weaker or more elastic, joints may move beyond their normal range of motion.

As people age, several changes can occur.

1. Joints may become less flexible—but not more stable

Many hypermobile individuals become less flexible with age, but this does not necessarily mean their joints become stable.

The Ehlers-Danlos Society notes that someone may have been very flexible earlier in life and gradually become stiffer with age while still experiencing musculoskeletal problems related to their past hypermobility.

This means that even when flexibility decreases, joint instability and pain can remain.

2. Increased joint wear and early degeneration

Because hypermobile joints move beyond normal limits, they often experience repeated micro-trauma over time.

This can lead to:

• chronic joint pain

• tendon and ligament injuries

• joint instability

• early osteoarthritis

People with EDS frequently experience recurrent subluxations, dislocations, and chronic musculoskeletal pain due to connective tissue fragility.

Over decades, this repeated stress can cause joints to feel older than a person’s actual age.

3. Muscle fatigue and compensation patterns

Muscles often work harder in hypermobile bodies because they must compensate for lax ligaments and unstable joints.

Over time this can lead to:

• chronic muscle tension

• trigger points

• fatigue

• protective muscle guarding

Ironically, many hypermobile clients report feeling tight, even though their joints are highly mobile.

4. Multisystem symptoms may appear with age

Hypermobile EDS is considered a multisystem connective tissue disorder, meaning it can affect many body systems.

With age, people may experience symptoms such as:

• chronic fatigue

• gastrointestinal issues

• dysautonomia

• headaches

• mast cell activation disorders

These symptoms can influence pain levels, recovery time, and tolerance for physical stress.

Why this matters for massage therapists

Massage therapy can be extremely beneficial for people with hypermobility—but it requires thoughtful adaptation.

Understanding how hypermobility changes with age helps therapists avoid treatments that may worsen instability.

Important massage considerations

1. Avoid excessive joint stretching

Hypermobile joints often do not need more flexibility.

Instead, focus on muscle support and stability.

2. Work with the nervous system, not against it

Gentle approaches that calm the nervous system may help reduce protective muscle guarding.

Examples:

• slow Swedish techniques

• myofascial work

• lymphatic techniques

• gentle neuromuscular therapy

3. Stabilize rather than mobilize

Encourage strategies that promote joint support, including:

• strengthening exercises

• physical therapy referrals

• mid-range movement practices such as Pilates or stability-focused yoga.

4. Avoid aggressive pressure on unstable areas

Certain areas may require extra caution:

• cervical spine

• sacroiliac joint

• shoulders

• knees

Overly aggressive work may increase joint irritation rather than relieve it.

Why clients should understand this too

Many hypermobile individuals spend years believing their pain is simply “normal aging.”

Understanding hypermobility can help clients:

• seek appropriate medical care

• avoid harmful stretching habits

• build strength for joint stability

• choose bodywork practitioners familiar with hypermobility

Education empowers people to support their bodies before long-term damage occurs.

Learn more

The Ehlers-Danlos Society provides information about hypermobile EDS and hypermobility spectrum disorders here:

Hypermobile EDS (hEDS)

The site explains that hypermobile EDS involves joint hypermobility, instability, and chronic pain, and may affect multiple systems throughout the body.

Takeaway

Hypermobility does not simply disappear with age. Instead, the body often shifts from extreme flexibility to chronic instability, muscle fatigue, and joint degeneration.

For massage therapists, understanding these changes allows treatments to focus on supporting stability, reducing pain, and protecting vulnerable joints.

Disclaimer

Hypermobility and Chemical Sensitivity

By Jennifer Richards, LMT 2026

Many people with hypermobility or Ehlers-Danlos Syndrome (EDS) report unusual reactions to everyday substances such as perfumes, cleaning products, lotions, medications, or smoke. These reactions are sometimes described as chemical sensitivity.

While not every hypermobile person experiences this, it is common enough that clinicians and researchers have begun exploring possible connections.

Why chemical sensitivity may occur in hypermobility

One possible explanation involves mast cells, which are immune cells found throughout the body—especially in the skin, gastrointestinal tract, and connective tissues.

Mast cells release chemical mediators such as histamine, prostaglandins, and leukotrienes when they detect a threat. These chemicals are part of the body’s defense system and cause inflammatory reactions like itching, flushing, swelling, and digestive symptoms.

In some people with hypermobility or Ehlers-Danlos Syndrome, mast cells may become overactive or dysregulated, a condition often called Mast Cell Activation Syndrome (MCAS).

Research suggests that connective tissue differences in EDS may affect the extracellular matrix (ECM)—the structural network surrounding cells. Mast cells interact with this matrix, so changes in connective tissue may alter how mast cells behave.

When mast cells activate too easily, even mild exposures can trigger symptoms such as:

• headaches

• skin flushing or itching

• nasal congestion

• digestive upset

• dizziness

• fatigue

• sensitivity to perfumes, smoke, or chemicals

These reactions may explain why some hypermobile individuals report feeling unwell in environments with strong scents, cleaning agents, or synthetic fragrances.

This does not mean the person is “allergic” to everything, but rather that their immune and nervous systems may be more reactive to environmental triggers.

What this means for massage therapy

For massage therapists, chemical sensitivity is an important consideration.

Many massage environments contain potential triggers.

Examples include:

• essential oils

• scented lotions or creams

• laundry detergents on sheets

• room sprays or candles

• cleaning products used on tables

For clients with hypermobility or suspected mast cell issues, these exposures may cause headaches, skin irritation, flushing, or dizziness.

Practical massage considerations

A few simple adjustments can make sessions much safer and more comfortable.

1. Choose unscented products

Use hypoallergenic or fragrance-free massage lotions when possible.

2. Avoid strong aromatherapy

Even therapeutic essential oils can trigger reactions in sensitive individuals.

3. Ask before using new products

A simple intake question can help:

“Do you have sensitivities to scents, lotions, or essential oils?”

4. Maintain good ventilation

Fresh airflow can reduce exposure to chemical triggers.

5. Keep sessions calm and predictable

Stress and nervous system activation can also worsen mast cell reactions.

6. Be aware of skin reactions

If redness, itching, or hives appear during a session, discontinue the product immediately.

Massage therapists should remember that chemical sensitivity is not always visible, but respecting client triggers can dramatically improve comfort and safety.

Learn more

The Ehlers-Danlos Society provides information on mast cell disorders and their possible connection with EDS.

You can learn more here:

https://www.ehlers-danlos.com/mast-cell-disorders-ehlers-danlos-syndrome/

Mast cell activation disorders involve excess release of inflammatory chemicals such as histamine, which can produce allergy-like symptoms throughout the body.

Takeaway

For some hypermobile individuals, the body’s immune and nervous systems may be more reactive to environmental triggers.

Understanding chemical sensitivity helps massage therapists create a safer, more supportive environment for clients living with hypermobility and related conditions.

Small adjustments—like fragrance-free products and open communication—can make a significant difference.

Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or replace medical care. Individuals with suspected mast cell disorders, chemical sensitivities, or Ehlers-Danlos Syndrome should consult a qualified healthcare professional for evaluation and treatment. Massage therapists should work within their scope of practice and collaborate with appropriate healthcare providers when supporting clients with complex medical conditions.

Hypermobility and Temperature Control

By Jennifer Richards, LMT 2026

Why some hypermobile bodies struggle with heat and cold

Many people with hypermobility notice that their bodies respond differently to temperature. They may feel extremely hot, unusually cold, or have difficulty regulating body temperature during exercise, stress, or environmental changes.

These symptoms are often connected to the autonomic nervous system and circulation.

Hypermobility conditions such as Ehlers-Danlos Syndrome (EDS) can affect connective tissue throughout the body, including structures that help regulate blood vessels and circulation. When these systems behave differently, temperature regulation can sometimes be affected.

The Autonomic Nervous System

The autonomic nervous system controls many automatic body functions, including:

heart rate

blood pressure

sweating

body temperature regulation

Many individuals with hypermobility also experience autonomic nervous system dysregulation, sometimes diagnosed as Postural Orthostatic Tachycardia Syndrome (POTS).

When this system becomes dysregulated, the body may have difficulty adjusting to temperature changes.

Blood Vessel Regulation

Blood vessels play an important role in controlling body temperature.

When the body becomes too warm, blood vessels expand to release heat.

When the body becomes cold, vessels constrict to conserve heat.

In hypermobile individuals, blood vessels may be more elastic due to connective tissue differences. This can affect circulation and the body’s ability to regulate temperature effectively.

Common Temperature Symptoms

Some individuals with hypermobility report:

Heat intolerance

feeling overheated quickly

dizziness in warm environments

difficulty exercising in heat

Cold intolerance

cold hands and feet

sensitivity to cold temperatures

circulation changes

Sweating differences

excessive sweating

reduced sweating in some cases

These experiences vary widely and do not occur in every hypermobile person.

Why This Matters for Bodywork

Temperature sensitivity can influence how hypermobile clients respond to massage therapy.

Because massage affects circulation and the nervous system, therapists may notice clients who feel unusually warm, chilled, or lightheaded during treatment.

Massage Therapy Considerations

Massage therapists do not treat autonomic disorders, but session adaptations can improve comfort.

Temperature Awareness

Some clients may feel overheated under heavy blankets or table warmers. Others may become cold easily.

Adjusting room temperature, sheets, and table warmers can help maintain comfort.

Gradual Position Changes

Individuals with autonomic symptoms may feel dizzy when sitting or standing quickly.

Allowing extra time to sit up slowly can reduce symptoms.

Hydration

Clients who experience dysautonomia may benefit from adequate hydration before and after sessions.

Gentle Nervous System Support

Techniques that encourage relaxation and parasympathetic activity may help support nervous system regulation.

Many hypermobile clients respond well to slower, calming massage approaches rather than aggressive deep pressure.

Awareness Matters

Temperature regulation is one of many ways the nervous system and connective tissue interact in hypermobile bodies.

Understanding these patterns can help individuals recognize symptoms and communicate their needs during healthcare or bodywork sessions.

Education helps both practitioners and clients create safe and supportive treatment experiences.

Helpful Resource

For additional information about autonomic dysfunction in connective tissue disorders, visit The Ehlers-Danlos Society:

Autonomic dysfunction in Ehlers-Danlos syndromes

https://www.ehlers-danlos.com/autonomic-dysfunction/

This resource explains how the autonomic nervous system can affect circulation, heart rate, and temperature regulation in hypermobile individuals.

Educational Disclaimer

Hypermobility and Ehlers-Danlos Syndrome exist on a spectrum. Every individual experiences connective tissue disorders differently, and not everyone will experience the symptoms or challenges discussed in this article.

The information shared here is intended for educational and awareness purposes only. It is not intended to diagnose, treat, or replace medical advice from a qualified healthcare professional.

Massage therapists do not diagnose medical conditions. If you are experiencing significant temperature intolerance, dizziness, or symptoms related to autonomic dysfunction, please consult an appropriate healthcare provider.

— Jennifer Richards, LMT

Craniocervical Instability and Hypermobility

By Jennifer Richards, LMT 2026

Understanding the relationship between connective tissue and the upper cervical spine

The upper cervical spine is responsible for supporting the head and protecting the brainstem. In individuals with hypermobility or **Ehlers-Danlos Syndrome (EDS), connective tissue differences can sometimes affect the ligaments that stabilize this region.

One condition that may occur in some hypermobile individuals is craniocervical instability (CCI).

Craniocervical instability refers to excessive movement between the skull and the upper cervical vertebrae. This instability can occur when ligaments responsible for stabilizing the upper neck become lax or weakened.

It is important to note that CCI is not present in everyone with hypermobility, but awareness of the condition can help individuals recognize symptoms and seek appropriate evaluation.

The Role of Ligaments in the Upper Cervical Spine

The head rests on two specialized vertebrae:

• Atlas (C1)

• Axis (C2)

These vertebrae allow the head to nod and rotate. They are stabilized by several ligaments that help control movement and protect the brainstem.

In connective tissue disorders, ligaments may be more elastic. When these ligaments do not provide sufficient stability, the skull and upper cervical spine may move more than intended.

This excessive motion can sometimes irritate surrounding structures such as nerves, the spinal cord, or blood vessels.

Symptoms Sometimes Associated with CCI

Symptoms can vary widely depending on the individual and the degree of instability.

Possible symptoms reported by some patients include:

neck pain or pressure at the base of the skull

headaches that worsen when upright

dizziness or balance issues

visual disturbances

brain fog or cognitive fatigue

sensitivity to head movement

Because many of these symptoms overlap with other conditions, proper medical evaluation is important.

Why Hypermobility May Increase Risk

Connective tissue provides stability throughout the body, including in the ligaments of the cervical spine.

In individuals with hypermobility:

ligaments may stretch more easily

joint stability may be reduced

muscles may compensate by tightening

This muscle guarding can sometimes cause chronic neck tension.

For this reason, the neck can be an area of particular sensitivity in hypermobile clients.

Massage Therapy Considerations

Massage therapists working with hypermobile clients should be aware that the upper cervical spine may be more vulnerable in some individuals.

Massage therapists do not diagnose craniocervical instability, but awareness of potential instability can help guide safe bodywork.

Avoid Excessive Neck Movement

Aggressive neck stretching or strong rotational techniques may not be appropriate for hypermobile individuals.

Gentle Cervical Techniques

If working near the neck, gentle techniques that support muscular relaxation without forcing range of motion are generally safer.

Avoid Cervical Traction

Manual traction or pulling on the neck may increase instability in some individuals with ligament laxity.

Support the Head

Proper head support during massage is important to prevent strain on the upper cervical structures.

Encourage Medical Evaluation

If a client reports symptoms such as severe dizziness, neurological changes, or worsening symptoms with neck movement, referral to a healthcare provider may be appropriate.

Why Awareness Matters

Craniocervical instability is one example of how connective tissue disorders can affect areas of the body that are not immediately obvious.

Understanding these connections can help individuals with hypermobility make informed decisions about movement, exercise, and bodywork.

Education also helps practitioners modify techniques to ensure treatments remain safe and supportive.

Remember: neck tightness is indicating that the neck is trying to stabilize loose ligaments and tendons. So, releasing the muscles without a treatment plan for strengthening the muscles would be contraindicated.

The Hypermobility Pain Cycle

Many people with Ehlers-Danlos Syndrome or hypermobility do not experience pain simply because their muscles are “tight.”
Often, the body is attempting to create stability in joints that lack adequate structural support.

This can create a repeating cycle:

Joint instability or excessive movement
Muscle guarding and protective tension
Pain, stiffness, and fatigue
Aggressive treatment aimed at “releasing” the tension
Temporary relief
Rebound guarding as the body attempts to restabilize
Increased soreness, flares, or worsening symptoms

For many hypermobile clients, the goal should not always be to force muscles to completely relax. Instead, treatment may be more effective when it focuses on:

nervous system regulation
improving proprioception
gentle stabilization
reducing threat perception
pacing and recovery
supporting functional movement

In these cases, muscles are often acting as protective stabilizers rather than simply dysfunctional tissue.

Helpful Resources

For more information about hypermobility and cervical spine involvement, visit The Ehlers-Danlos Society

Neurological and spinal manifestations of EDS

Dr. Clair Francomano

Hypermobility Therapy

Hypermobile Fitness with Dr Melissa Koehl

EDS Clinic

Educational Disclaimer

The information shared here is intended for educational and awareness purposes only. It is not intended to diagnose, treat, or replace medical advice from a qualified healthcare professional.

Massage therapists do not diagnose medical conditions. If you are experiencing neurological symptoms, persistent neck pain, or concerns related to cervical spine stability, please consult an appropriate healthcare provider.

— Jennifer Richards, LMT