Bohan PT & Training, PLLC by Emily Bohan, PT, DPT

We’ve all been told being flexible is a good thing. However, for some of us, being bendy can come with its own set of challenges. If your joints move beyond a typical range and you deal with recurring pain, instability, frequent injuries, or muscles that constantly feel tight, your approach to exercise and rehabilitation may need to look a little different.

Hypermobility exists on a spectrum. Some people are simply more flexible than average and never experience symptoms. Others may have generalized joint hypermobility, Hypermobility Spectrum Disorder (HSD), or a connective tissue disorder such as hypermobile Ehlers-Danlos syndrome (hEDS).

Regardless of the label, having a hypermobile body doesn’t equate to pain, but there can be some good exercise considerations.

So you may be wondering…

Why do I feel so tight if I'm hypermobile?

This is one of the most common questions I hear from people with hypermobility.

You can have joints that move excessively while simultaneously having muscles that feel incredibly tight.

Your muscles aren't just responsible for moving your joints—they also help stabilize them. If the passive structures around a joint aren't providing enough stability, your muscles may have to work harder to create that stability.

Over time, those muscles can feel tight, stiff, or overworked.

That's why repeatedly stretching an area simply because it feels tight doesn't always solve the problem. You may temporarily feel better, but if the underlying issue is poor joint control or stability, that sensation can keep coming back. We aren’t addressing the muscle strength, control, or joint proprioception which will keep the sensation of tightness at bay.

Strength training can be incredibly valuable for hypermobility

Should people with hypermobility avoid lifting heavy weights or challenging exercises?

Absolutely not!

Strength training can actually be one of the most useful tools for a hypermobile person because stronger muscles can provide more active support around your joints. We want to build up your tolerance to load, so you can handle more load throughout your daily activities without pain or fatigue.

If your maximum weight you can lift is 20lbs, how many times in life do you get close to that 20lb limit? Think about how much your toddler weighs, the laundry basket, groceries, etc. We are constantly on the edge of your body’s tolerance level.

Now if we can use strength training to improve that capacity to 50lbs (or even 100lbs!) you won’t be living at your 1 rep max anymore. Those daily tasks are no longer as taxing, and we are a lot less likely to get hurt.

Proprioception matters

Proprioception is your brain's ability to understand where your body is in space. Basically, your brain gets really fuzzy signals from your joints on where your body actually is (hello, running into counter tops!)

For some people with hypermobility, proprioceptive awareness can be reduced. That can make it harder to tell where the middle of a joint's range actually is. That’s why many of us end up locking out joints—it gives us more “feedback” at end range joint position.

This is why a lot of people with hypermobility hang out on hyperextended knees.

Or you may have difficulty controlling and feeling stability in your shoulders during an overhead movement because your shoulder has so many different positions available to it.

This is one reason slow, controlled strength training can be so useful.

We can use mirrors, external feedback, tactile cues, tempo exercises, balance challenges, and different positions to help improve your awareness and control.

Your exercise program shouldn't stay easy forever

Being cautious at the beginning of rehabilitation makes sense, especially when we’re managing pain.

Staying at the same easy resistance forever doesn't.

If you want your body to tolerate hiking, running, lifting weights, carrying groceries, playing sports, or simply getting through a busy day without feeling wrecked, your training eventually needs to prepare you for those demands.

That means progressive overload still matters for people with hypermobility, just sometimes the pace looks different.

We may progress more gradually. We may pay closer attention to fatigue and technique. We factor in other diagnoses (POTS, MCAS, digestive issues, etc.). We may modify the range of motion or exercise selection initially.

But your body still needs an appropriate training stimulus if you want it to become stronger and more resilient.

Rehabilitation shouldn't just teach you how to avoid aggravating your body.

It should help you increase what your body is capable of doing.

Form matters—but there isn't one “perfect” posture

Hypermobile people are often given an enormous list of positions they're supposedly never allowed to use.

Don't round your back or shoulders.

Don't lock your knees.

Don't let your pelvis tilt.

And on and on…

Our bodies aren’t that fragile.

Instead of chasing one perfect posture, I generally care much more about whether you can control different positions and tolerate the demands you're placing on your body.

Sometimes we'll modify your technique because a particular strategy is contributing to symptoms.

But exercise and body awareness should be about being able to tolerate being in MORE positions, not fewer.

Hypermobility can affect more than just your joints

For some people, hypermobility exists alongside other symptoms that can influence exercise tolerance and rehabilitation.

This may include things like autonomic symptoms, fatigue, headaches, pelvic floor dysfunction, gastrointestinal symptoms, POTS, or MCAS.

However, that doesn't mean every symptom is caused by hypermobility.

So your exercise program needs to consider the whole person and your current “stress bank.” It also needs to change with the current stressors in your life—so exercise is creating positive change, not pain or fatigue.

So what should exercise for hypermobility actually look like?

A good program should be based on your symptoms, your current capacity, and what you actually want your body to be able to do.

For many people, that means some combination of:

• progressive, controlled strength training
• proprioception and body-awareness work
• improving control through your available ranges of motion
• gradually increasing load and exercise complexity
• addressing specific areas of pain or instability
• managing fatigue and recovery
• building confidence with movements you've previously avoided

The goal isn't to spend the rest of your life doing tiny corrective exercises because you're hypermobile. If the goal is to improve your resiliency, get rid of pain, and improve energy levels, we need your workouts to reflect these goals.

Hypermobility doesn't mean you're fragile

Having hypermobile joints may change the way we approach certain exercises, especially if you're experiencing pain or instability.

But it doesn't mean your body is incapable of becoming strong. We all know that muscles need load to strengthen—but so does other connective tissue like our joints!

You may simply need a more individualized approach that helps you develop the strength, proprioception, control, and capacity to use the mobility you already have.

If you're struggling with recurring injuries, joint pain, instability, or figuring out how to exercise with hypermobility or EDS, I offer in-person physical therapy in Denver as well as remote options to help you build a program around your body and your goals.

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This article is educational and is not a substitute for individualized medical care. New, severe or unexplained symptoms should be evaluated by an appropriate healthcare professional.