Jennifer Richards

Dysautonomia and Hypermobility: Understanding the Missing Piece

“My heart races when I stand up.”

“I’m always too hot or too cold.”

“I feel exhausted after taking a shower.”

“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)

Other Forms

Less common forms include:

Pure Autonomic Failure
Multiple System Atrophy
Autoimmune Autonomic Ganglionopathy
Familial Dysautonomia

There are at least 15 recognized forms of dysautonomia. (The Dysautonomia Project)

The Hypermobility Connection

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.

Hypermobility: Achalasia and Hiatal Hernias

By Jennifer Richards, LMT 2026

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.

Your Hypermobile Client

By Jennifer Richards, LMT 2026

How massage can affect a Hypermobile client.

Interested in learning more?

Hypermobility vs Flexibility

By Jennifer Richards, LMT

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.

CE Classes

Hypermobility and the Nervous System

A deeper look at connection, sensitivity, and clinical care

By Jennifer Richards, LMT

What Does the Nervous System Do?

The nervous system is your body’s communication network—it gathers information, processes it, and tells your body how to respond.

It has two main divisions:

Central Nervous System (CNS)
Brain and spinal cord — the command center
Peripheral Nervous System (PNS)
Nerves that branch throughout the body

Within the PNS, two key players matter here:

Somatic Nervous System → voluntary movement and sensation
Autonomic Nervous System (ANS) → automatic functions like heart rate, digestion, breathing

The ANS has two branches:

Sympathetic (“fight or flight”)
Parasympathetic (“rest and digest”)

A healthy system constantly balances between these states—this is called autonomic regulation.

What Is Hypermobility?

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

It exists on a spectrum:

Generalized Joint Hypermobility (GJH)
Hypermobility Spectrum Disorders (HSD)
Ehlers-Danlos Syndrome (especially hypermobile type, hEDS)

Hypermobility isn’t just about flexibility—it’s a whole-body condition that can affect:

Joints and ligaments
Fascia
Blood vessels
Internal organs
The nervous system

How the Nervous System and Hypermobility Are Connected

This is where things get interesting—and clinically important.

1. Proprioception Challenges

Proprioception = your body’s sense of position in space.

In hypermobile individuals:

Ligaments are more lax
Joint receptors provide less reliable feedback

👉 The nervous system has to work harder to figure out where the body is

This can lead to:

Clumsiness
Poor coordination
Increased injury risk

2. Autonomic Nervous System Dysregulation

Many hypermobile individuals experience dysautonomia, including:

Postural Orthostatic Tachycardia Syndrome (POTS)
Orthostatic intolerance
Blood pressure instability

Common symptoms:

Dizziness when standing
Rapid heart rate
Fatigue
Brain fog

👉 Blood vessels (made of connective tissue) may not constrict efficiently, affecting circulation.

3. Nervous System Sensitization

Chronic joint instability + microtrauma = ongoing sensory input

Over time, this can contribute to:

Central sensitization
Heightened pain perception
Increased nervous system reactivity

The system becomes more protective—and sometimes overprotective

4. Fascia + Nerve Interaction

Fascia surrounds and supports nerves.

In hypermobility:

Fascia may be more elastic but less supportive
Nerves may experience altered glide and tension

👉 This can contribute to:

Nerve irritation
“Zingy” sensations
Diffuse or hard-to-pinpoint pain

The Pluses (Yes, There Are Some)

Hypermobility isn’t all downside.

Neurologically and physically, some advantages include:

Greater flexibility and adaptability
Potential for enhanced movement creativity (dance, yoga, athletics)
Often heightened body awareness over time (learned, not automatic)
Some individuals report increased interoception (awareness of internal states)

The Negatives

This is where most clients seek help.

Nervous system fatigue from constant stabilization demands
Chronic pain and central sensitization
Autonomic dysfunction (POTS, dizziness, fatigue)
Poor proprioception → injury cycles
Anxiety and stress reactivity (linked to ANS imbalance)

👉 Important note: this is not “just anxiety”—it is often physiological dysregulation

Massage Therapy Considerations

This is where your work becomes powerful—and nuanced.

1. Prioritize Nervous System Safety

Slow, predictable movements
Clear communication
Avoid overstimulation

👉 The goal is regulation, not intensity

2. Stability Over Mobility

Avoid aggressive stretching
Avoid joint traction unless clinically appropriate

Focus on:

Grounding techniques
Compression
Mid-range work

3. Pressure: Less Can Be More

Deep pressure isn’t always better
Hypermobile clients may feel relief from deep work—but can flare later

👉 Watch for delayed responses

4. Support Proprioception

Broad, slow strokes
Joint approximation
Gentle holds

These help the nervous system map the body more clearly

5. Be Aware of Dysautonomia

Gradual position changes (supine → seated → standing)
Watch for dizziness
Keep hydration in mind

6. Pace the Session

The nervous system may fatigue quickly
Shorter, consistent sessions may be more effective than intense, infrequent ones

Clinical Insight

Many hypermobile clients are told:

“You’re just anxious”
“It’s all in your head”

In reality, their nervous system is often:
👉 Working overtime to create stability in an unstable system

Your role is not to “fix” them—
It’s to support regulation, safety, and function

Evidence & Resources

The Ehlers-Danlos Society
https://www.ehlers-danlos.com
GeneReviews – Hypermobile EDS (2024 update)
https://www.ncbi.nlm.nih.gov/books/NBK1279/
Dysautonomia International
https://www.dysautonomiainternational.org
National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov
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.

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!