Hypermobility & hEDS

Bendy joints, chronic pain and fatigue are a real, documented overlap, not three unrelated complaints. Joint-protective strengthening (not stretching) helps, but it has to be paced around post-exertional malaise if ME/CFS or POTS also overlap.

Every claim below carries an evidence grade. What do these grades mean?

SATISH R. RAJ, MD, MSCI, FRCPC POTS

Why hypermobile joints often mean POTS too

the expert's own view, educational, not medical advice, not endorsed by us

ModerateJoint hypermobility, including hEDS, overlaps with POTS and orthostatic intolerance far more often than chance would predict
ModerateWhen hypermobility and fatigue occur together, the check is heart rate and blood pressure lying down, then again after ten minutes standing
ModerateCompression garments and increased salt and fluid intake are first line non drug POTS management, hypermobile or not
StrongHypermobility on its own does not diagnose POTS. Formal autonomic testing is what settles it

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Linda Bluestein, MDAnesthesiologistHypermobility MD / Bendy Bodies Linda Bluestein, MD

LINDA BLUESTEIN, MD HYPERMOBILITY EDS

Can you strengthen if you crash the next day?

1Answer one question before anything else: do you get a delayed crash a day or two after exertion? That is post exertional malaise, and it changes every line belowStrong
2If you do NOT have that crash pattern, the published joint stability work applies: two to three sessions a week, guided by a physiotherapist, building control rather than rangeModerate
3If you DO have that crash pattern, pacing comes first. Keep any strengthening well under your known energy envelope and treat the next day, not the session itself, as the verdictStrong
4A crash the day after is never a signal to push harder. It is the signal to scale back. There is no fixed escalating schedule here, and we do not recommend oneStrong
5Taping can give useful sensory feedback for joint position, taught by a physiotherapist who knows your joint pattern, and it is independent of the pacing questionLimited

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Linda Bluestein, MDAnesthesiologistHypermobility MD / Bendy Bodies Linda Bluestein, MD

HYPERMOBILITY EDS

hEDS: Pacing the Strengthening Work Around PEM

1Ask: does exertion cause a delayed crash (worsening hours to days later), not just immediate fatigue that resolves with rest? (n/a, self-assessment, confirm with your clinician)
2Closed-chain, low-range proprioceptive strengthening as already described in this site's hEDS strengthening protocol, 2-3x/week with a PT familiar with hEDS (2-3x/week, PT-guided)
3Keep strengthening sessions shorter and less frequent than a non-PEM hEDS patient would use, and treat any sign of a crash the following day as the stop signal to scale back further (Individualized, well under your known energy envelope; stop and scale back at the first sign of delayed worsening)

What to buy

Resistance bands / basics ~$14

Kinesiology tape ~$15

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Kelly Starrett

MOBILITY

Built to Move: Daily Mobility

1Hit a daily movement minimum (Aim for 8,000 to 10,000+ steps and frequent position changes)
2Sit on the floor (10 to 30 min of floor sitting (cross-legged, 90/90), changing positions)
3Couch stretch for hip extension (~2 min per side)

What to buy

Resistance / floss bands ~$15

Mobility tool kit ~$20

Guided mobility app

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AUTOIMMUNE

Calm inflammation, protect joints

1Keep moving and strengthen the muscles around the joint (Regular low-impact activity plus strength work; no single exercise type is superior, just do it consistently)
2Lose excess weight if relevant (For knee/hip pain, even a 5% reduction in body weight notably eases symptoms)
3Eat a whole-food, omega-3-rich diet (More fish, vegetables, olive oil; fewer ultra-processed foods and excess sugar)

What to buy

Resistance bands / basics ~$14

With piperine ~$25

Nordic Naturals Ultimate Omega ~$32

Vital Proteins Collagen Peptides ~$45

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Vonda Wright

MENOPAUSE

The Musculoskeletal Syndrome of Menopause

1Recognize the pattern (If you are in your 40s or 50s and dealing with new body-wide aches, stiff or painful joints, tendon problems or a frozen shoulder, know these can be driven by the hormone changes of menopause, not a personal failing or your imagination.)
2Get a DEXA scan for your bones (Ask your doctor for a DEXA scan to check your bone density, since bone loss during this time is silent until something breaks.)
3Strength train to protect bone and muscle (Do progressive resistance training and weight-bearing exercise most weeks. This is the single most powerful thing you can do to defend your bones and muscle.)

What to buy

Protein powder ~$60

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Aaron HorschigDPTFounder, Squat University Aaron Horschig

INJURY REHAB

Fix Weak, Stiff Hips: The Squat University Hip-Mobility & Stability Sequence

1Test your current pattern before picking drills (Perform a bodyweight overhead squat or deep squat hold and note exactly where it breaks down (heels lift, knees cave inward, torso collapses forward))
290/90 hip stretch (2 rounds of 60-90 seconds per side, daily)
3Anterior hip (couch) stretch (2 rounds of 60-90 seconds per side, daily)

What to buy

Resistance bands / basics ~$14

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Linda Bluestein, MDAnesthesiologistHypermobility MD / Bendy Bodies Linda Bluestein, MD

INJURY REHAB

Hypermobile EDS: Joint-Protective Strengthening, Not Stretching

1Skip end-range stretching and avoid hyperextending joints, even when it feels easy or habitual (Ongoing, daily awareness)
2Work with a physical therapist familiar with hEDS on closed-chain exercises (hand or foot fixed against a surface) within a low, controlled range (As prescribed by your PT, typically starting with short, low-load sessions)
3Notice and avoid locking joints into their full range during everyday tasks (standing with locked knees, hyperextended elbows when carrying things) (Ongoing awareness)

What to buy

Kinesiology tape ~$15

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What is hypermobile EDS, and how is it different from just being flexible?▾

Hypermobile EDS (hEDS) is a connective-tissue condition causing joint hypermobility along with features like tissue fragility and chronic pain, distinct from simply being naturally flexible. It is diagnosed clinically, since there is no genetic test for hEDS specifically, unlike some other Ehlers-Danlos subtypes. Linda Bluestein, MD, an anesthesiologist and hEDS specialist who has hEDS herself, is a member of the Allergy and Immunology Working Group for the International Consortium on EDS and HSD.

Why do hypermobility, POTS, and fatigue so often show up together?▾

This is a documented clinical overlap, not a coincidence: connective-tissue laxity, autonomic dysfunction and chronic fatigue frequently co-occur in the same patients. If you have hEDS and are also dealing with POTS symptoms or fatigue that worsens after exertion, pacing (never pushing through) comes first whenever post-exertional malaise is present. This is informational only, not a diagnosis.