Hypermobile Hips: Symptoms, Signs, and How to Manage Them

Estimated reading time: 9 minutesHip hypermobility is a condition in which the hip joint moves beyond its normal range of motion which can lead to pain, instability, and compensatory movement patterns that affect the whole body. What many people call being double jointed in the hips is part of this same picture.

In people with hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorder (HSD), and other connective tissue disorders, hip hypermobility is one of the most commonly reported joint issues, and in my experience, one of the most responsive to the right movement approach.

This post covers how to recognise the signs, how a physiotherapist can help with assessment, and what movement strategies can support the hip and the whole kinetic chain.

The hip joint is one of my favourite joints,  although it can be a cause of many problems in hypermobility. It is such a key joint in the body – it is one of the largest and most important joints for several reasons.

• It is a weight-bearing joint during standing, walking, and running.
• It transfers weight from the upper body to the lower limbs, too.
• It has a wide range of mobility in multiple directions – it can flex, extend, abduct, adduct, and internally and externally rotate
• It is designed to provide a lot of stability.
  • The ball and socket joint, like the shoulder joint, offers mobility, but strong ligaments and muscles around the hip should provide stability. We know, of course, this may not always be the case in hypermobility.
• The hip joint has an important postural role too – it helps with the balance of the pelvis and spine on top of the legs. It helps keep equilibrium when moving.
• Finally, it is a shock absorber that distributes forces through the whole structure during movement.

Lack of movement at the hip joint can have big implications for our movement and pain levels, as I know personally.

Back in 2010, I tore my right hip labrum whilst attempting a beginner ski lesson. I developed instability in the hip joint, which then led to low back pain. My low back muscles had to start working much harder to compensate for the lack of stability on that hip.

After a thorough assessment, I was advised to undergo surgery (this was before my hEDS diagnosis), and the surgery was a huge success. My back pain resolved almost instantly, and my hip pain and impingements disappeared.

A few months of physical therapy rehabilitation, walking on crutches, and not loading the joint followed the operation. Today, the hip is much stiffer and lacks the mobility it had, but it is pain-free and stable.

In 2016, I tore the left hip labrum. This time, I decided not to go for surgery and try the rehab-only route.

This included lots of hip stabilization, foot-to-hip connection, and whole-body integration. I managed to get it under control. Of course, everyone is different, and surgery may be the only option in some cases.

What is Hip Hypermobility?

Hip hypermobility is defined as excessive range of motion in the joint. What many people call being double jointed in the hips is the same thing clinically described as hip hypermobility. Hypermobility can happen without pain and other symptoms – you can be hypermobile and stable.

However, when symptoms related to hypermobile hips are present, hip instability is considered (1).

This can be due to inherited connective tissue disorders like Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder, or can be a result of micro or macro-trauma to the joint, like injury or dislocations (1).

Authors of a review paper focusing on hip hypermobility state, “hypermobility is becoming an increasingly recognized source of pain and instability of the hip joint ” (1). I am glad this is being recognized.

The anatomy of the hip joint

Let’s take a look at the anatomy of the hip joint. The hip joint is a ball and socket with the head of the femur (ball) articulating with the acetabulum (socket) of the pelvis.

As mentioned above, the joint allows for flexion and extension of the leg, internal and external rotation of the thigh, and abduction (away from the center of the body) and adduction (towards the center of the body).

It is also involved in supporting the weight of the trunk and transmitting force for walking (2).

There 3 ligaments that form the capsule around the joint (the iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament).

At the point of connection between the socket and the head of the femur is the labrum, composed of fibrous cartilage. This cartilage surrounds the rim of the acetabulum, or the socket part of the hip. It serves as a shock absorber, helps with stability, lubricates, and distributes pressure in the joint (3).

What hip problems are associated with hypermobility?

My clients and members of The Zebra Club report hip pain regularly, and the research supports what I see in practice. Hip issues are common in symptomatic hypermobility, though not everyone will experience all of these, and this is not an exhaustive list.

An observational study on patients with hip or knee pain found hypermobility was high in this group (43.2%). The prevalence was even higher in patients who had hip dysplasia — 66.7% based on the Beighton score, or 83.3% based on the Hakim-Grahame criteria (4). The connection between hip dysplasia and hypermobility is well documented, though not yet fully understood.

Femoroacetabular impingement syndrome (FAIS), or hip impingement, also seems more common in hypermobility, particularly in dancers and those who work in external rotation. This happens when there is abnormal contact of the femoral head with the edge of the socket (1, 5).

Labral tears are thought to be more common in EDS (6). One small study of 34 patients found that those with generalized joint hypermobility had significantly thinner labra when assessed by MRI, which may help explain why hypermobile hips are more prone to labral injury (7).

Lateral hip pain is another common finding. This can occur when the iliotibial band subluxes over the greater trochanter of the femur, producing a painful, loud clunking sensation. This can contribute to trochanteric bursitis and often causes pain when lying on that side. It is worth knowing that this clunking is sometimes interpreted as a dislocation by the person experiencing it, though it is not (6).

Finally, SI joint instability, whilst not the hip joint itself, is considered very common in EDS, with physical therapy being the first recommendation for relief (6).

How can you tell if your hips are hypermobile?

Several signs and symptoms can help identify hypermobility and potential instability in the hip joint. These include excessive range of motion, a feeling of looseness or the hip giving way, joint subluxations or dislocations, clicking or locking sensations during movement (7), ongoing pain and discomfort, and stiffness after activity. Some people also notice apprehension in certain positions, particularly those that put the hip at end range (1)

If these symptoms are familiar,  working with a physical therapist, physiotherapist, or clinician who has experience with hypermobility and connective tissue disorders is an important next step. They will be able to carry out a structured assessment that looks not just at your range of motion, but at the muscular control and stability around the joint (1).

If you are looking for support, seeking out a physical therapist or clinician who understands hypermobility will make a real difference. Hypermobile joints often need a different approach to assessment and rehabilitation than you might encounter in a standard clinic.

Why do hypermobile hips cause pain?

In many sports like gymnastics and dance, hip hypermobility can be beneficial and even necessary at high levels of performance or competition. However, repetitive loading at extreme ranges of motion can contribute to instability of the joint (1).

Ultimately, instability leads to an increased risk of dislocations and subluxations with soft tissue injuries and joint pain. Microtrauma (subtle injuries that may build up over time, leading to pain) as a result of instability may lead to persistent joint pain.

For example, repetitive microtrauma with occasional macrotrauma (like a dislocation or other large injury) may contribute to labral tears (8).

Symptomatic hip hypermobility may feel like dull aching after prolonged standing or walking; sharp catching or pinching in the groin (common in labral involvement); pain on the outer hip when lying on that side (trochanteric bursitis); pain that worsens with fatigue; pain at night. In my experience, my hip pain also contributed to low back pain because those muscles were trying to stabilize my hip.

How do you manage hypermobile hip pain?

The good news is we can address instability and pain through movement therapy.

Step 1: Address pain first. This can look like nervous system regulation to address chronic pain and nociplastic pain.

Step 2: We can then address the feet and ankles. The whole foot-to-pelvis relationship is super key to addressing this. As I always say, the hip (or any joint) is not working in isolation. The hip is impacted by the alignment of the foot, so any misalignment at the ground level impacts the hip. This is one of the reasons I always start with the feet when working with my clients.

Step 3: Next, we can work on balance and proprioception exercises. Proprioception is the sense of where we are in space, which is altered in people with hEDS. We can work on this, which will help us understand our posture and alignment to support the hips.

Step 4: From there, we can work on strengthening the muscles around the pelvis. The glutes, hip flexors, and deep stabilizers are key. Sleepy glutes are very common in hypermobility — we tend to be front body dominant, sitting too much, hanging on our joints in standing, and running compensatory patterns around the hips and pelvis that cause the glutes to simply switch off. We can address this through targeted stabilisation work and loading that helps the glutes learn to engage and support the joint effectively, as part of a whole body approach that considers how the hip relates to the pelvis, the spine, and the feet.

Step 5: There are also some movements worth approaching with care. Hugging the knees hard to the chest can cause impingement pain in hypermobile hips. High-impact activities may need to be modified, at least initially, while we build the stability and control the hip needs first.

Step 6: Orthotics and braces can be helpful to support the hip joint. Especially if it helps improve pain so you can be more active and move more. We always want to work on strengthening in conjunction with support. Using good supportive footwear can also ensure the hip gets good support from the ground up. Sophie Roberts gave a great talk on podiatry for The Zebra Club members that can be found in the Expert Insights of the platform.

We have a whole collection of classes in The Zebra Club to address the hips. You can find it in the programs section under Hips and Pelvis.

How do hypermobile hips affect movement and gait?

Gait can be significantly impacted by hip joint instability due to the hip joint’s role in alignment, balance, proprioception, and strength.

We may start to see altered gait patterns as we compensate for the lack of strength and stability in the hip. Limping, uneven stride lengths, and lack of hip extension are something I commonly observe.

You may feel stiff in your hips, which leads to a gait pattern that is less smooth as the weight of the body is transferred from one leg to another. It makes sense – if you have hip pain, you are unlikely to want to put weight through that joint, even at a subconscious level.

Your body will find a compensatory pattern to avoid the hip. This, of course, will then load other joints and may lead to pain in other areas. The whole body can be impacted, and we may start to see muscle imbalances and pain.

Hip instability may make people fearful of falling. A recent study found that fear of falling in hypermobile patients was a very limiting factor and predictor for disability (9).

When should you seek professional help for hypermobile hips?

At the Ehlers-Danlos Society Global Learning Conference this summer of 2024, Dr. Dacre Knight said it is a good idea to see your doctor if anything is new, different, or profound.

This is a great rule of thumb when it comes to seeking care. Proper assessment and treatment of hip instability are important so that other joints do not start to compensate for it. Physical therapy is often recommended, as well as orthotics and braces to support as needed.

When seeking assessment, asking specifically for a physiotherapist or clinician with experience in hypermobility or connective tissue disorders will help ensure the approach is appropriate — hypermobile joints often respond differently to standard protocols.

Video

If you want to dive deeper into movement for the hips check this live class I did all about Stabilizing Hypermobile hips. Another video you may find helpful is The Best Exercises for Hip and Low Back Pain from my 5-a-day video series.

FAQ

How can you tell if your hips are hypermobile?

Several signs and symptoms can help identify excessive flexibility or instability in the hip joint. Excessive range of motion, joint subluxations or dislocations, ongoing pain and discomfort,  and stiffness after activity could be signs. Working with a physiotherapist or clinician experienced in hypermobility and connective tissue disorders will ensure the assessment approach is appropriate for hypermobile joints

How do you sleep with hypermobile hips?

Lateral hip pain when lying on your side is often related to trochanteric bursitis. A pillow between the knees or under the knees on your back can help offload the hip. Trial and error is needed — what helps varies person to person.

Can hypermobility cause hip pain?

Yes. When hip hypermobility is symptomatic, the surrounding soft tissues must work harder to compensate for excessive joint range. Over time, this leads to microtrauma, instability, and pain, even without a specific injury triggering it.

Is hip impingement related to hypermobility?

Yes. Femoroacetabular impingement (FAI) appears to be more common in people with hypermobility, particularly in those with dance or gymnastics backgrounds. Repetitive loading at extreme hip ranges can cause abnormal contact between the femoral head and the socket rim.

What are hypermobile hip exercises to avoid

With hypermobile hips, the priority is building stability rather than increasing range. Deep hip stretches, extreme hip flexion (like pulling knees hard to chest), and high-impact loading without adequate hip stability are worth approaching with care rather than avoiding outright.

What is the connection between hip dysplasia and hypermobility?

Research suggests hypermobility is significantly more prevalent in people with hip dysplasia than in other hip conditions, found in 83.3% of dysplasia patients in one study (4). The connection is thought to relate to connective tissue laxity affecting the structural stability of the hip socket.

Jeannie Di Bon

Jeannie Di Bon is a movement therapist, educator and author specializing in hypermobility, Ehlers-Danlos Syndrome and chronic pain. She is the founder of The Zebra Club app and the creator of the Integral Movement Method.