How to Recognize Hypermobility Symptoms and Diagnostic Criteria

Estimated reading time: 7 minutesHave you ever noticed that your joints move way more than other people’s? Maybe you can easily place the palms of your hands on the floor or bend your fingers back further than seems normal.  

Were you someone who entertained your friends and family with party tricks? Or perhaps the best in the class at yoga?  Were you called a fidget or clumsy as a child?

We often end up living with our ‘normal’ without realizing it could be a sign of hypermobility. I certainly didn’t realize I was hypermobile until very late in life – largely because I was stiff in certain areas like my hips (I could never do the splits or put my leg behind my head) and I was very mobile in other places like hands, elbows and shoulders and knees, ankles and feet.

No one had ever mentioned I had excessive movement in those joints, despite seeing many physiotherapists and doctors for pain issues.

This can be a great asset, but it can also come with unexpected challenges like joint pain, frequent injuries, and even unexplained fatigue. If any of this sounds familiar to you, you may be dealing with hypermobility.

Being hypermobile does not mean you have a connective tissue disorder like Ehlers-Danlos Syndrome. Some people are naturally flexible and experience zero pain or issues with that.

However, you may realize you have symptoms that go beyond your joints – more of a multi-system issue like digestion, neurological, respiratory, or gynecological. Then, we may want to start investigating a connective tissue disorder, like  EDS.

In this blog, we will walk you through the key symptoms of hypermobility, how it is diagnosed, and how we can manage it.

Whether you are just starting to wonder about your flexibility or looking for answers to your chronic pain, this blog will help guide you.

Understanding Hypermobility, what it is

Hypermobility simply means a joint can move beyond a typical range of motion. It is not the same as instability – you can have hypermobility but still have stable joints that are adequately stabilized by muscles and tendons (1).

This can be an asset in sports or performing arts. However, for some people, it is a symptom of a more body-wide connective tissue syndrome. This is due to laxity in the tendons, fascia, ligaments, and even bones due to the altered production of structural proteins (2).

Distinguishing Between Normal Flexibility and Hypermobility

Flexibility and hypermobility are often used interchangeably, but they are not the same thing. Flexibility refers to how far a joint can move within a normal, healthy range of motion. Many athletes, dancers, and yoga practitioners actively work on this flexibility to improve it.

However, hypermobility occurs when joints move beyond what is considered a normal range of motion due to increased ligament laxity.  This excess movement can often be achieved without any effort – the individual can easily move into these excessive ranges.

I believe a key difference between the two comes from control of the range of motion.

Someone with good flexibility and training can usually stabilize and control their movements – think of ballet dancers. But a hypermobile person may struggle to stabilize their joints. They may struggle to even feel their joints or where they are in space.

They may make large, uncontrolled movements, which can lead to pain, subluxations, dislocations, and even fatigue from overcompensating muscles.

How do you know if you have hypermobility or flexibility?  It is always good to have a movement professional or physical therapist assess you, although make sure they are not just using the Beighton Score to do that.

If you personally find your joints can move easily without any resistance, or you experience joint pain and instability, you could have hypermobility. The great news is that control and muscle tone and strength can be achieved through appropriate movement practices.

Key Symptoms of Hypermobility to Watch For

Back in 2019, I wrote an article for The Mighty about my early childhood symptoms that I did not know were related . A recent social media post about this raised some interesting symptoms that many people with hypermobility have. Here are just some symptoms associated with hypermobility (2, 3, 4):

• “Double-jointed”
• Frequent sprains
• Subluxations (partial dislocations) and/or dislocations
• Muscle spasms
• Widespread chronic pain
• Common to be diagnosed with Fibromyalgia
• Clumsiness – falls, tripping, bumping into things
• Headaches & Migraines
• Easy bruising
• Slow healing
• Chronic fatigue
• Brain fog
• Heat intolerance
• Stretch marks
• Frequent infections like ear, throat, chest
• Digestive issues
• Allergic reactions
• Fatigue
• Stretchy skin and scarring
• Symptom flares

One validated questionnaire for Generalized Joint Hypermobility (GJH) asseses historical presentation that can be used as a screening tool. This is called the 5 Part Hypermobility Questionaire (5):

• Can you (or could you ever) touch the floor with flat palms without bending your knees?
• Can you (or could you ever) bend your thumb to touch your forearm?
• As a kid, did you amuse your friends by contorting your body into strange shapes, or could you do the splits?
• As a child or teenager did your kneecap or shoulder dislocate on more than one occasion?
• Do you consider yourself double jointed?

It is vitally important that whoever is doing the assessment reflects on the patient’s medical history. If someone is older and still seeking a diagnosis, they may not be as flexible as they once were. This is why these questions are very validating and key to accurate diagnosis.

Diagnosing Hypermobility: Criteria and Process

The most common types of connective tissue disorders are hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD). hEDS accounts for 95% of all presentations of EDS (there are 13 other types of EDS)(1).

These conditions exist on a wide spectrum of severity. There is currently no identified genetic cause for hEDS/HSD, so diagnosis is purely clinical and based on the 2017 diagnostic criteria (6).

Genetic testing is recommended if another type of EDS is suspected, like classical EDS, which has significant skin involvement (3).

The 2017 diagnostic criteria for hEDS are based on 3 components:

1. Criterion 1: Generalized Joint Hypermobility is defined by the Beighton Score greater or equal to 6 for children pre-puberty and adolescents, greater or equal to 5 for men and women under the age of 50, and greater or equal to 4 for men and women over 50.
2. Criterion 2 Symptoms that point to a systemic condition. You must have 2 of the 3 groups of features listed.
3. Criterion 3: Exclusion of other conditions

You can see the full list here

It is important to remember that these criteria for hEDS were created to create a strict set of guidelines for the inclusion in research studies to identify a genetic marker for hEDS. Many people do not meet these strict criteria and will fall under the umbrella of HSD.

The five joints assessed by the Beighton Score:

Aleksandra Lacheta, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

HSD

There are 4 types of HSD:

• Generalized HSD (G-HSD): Generalized joint hypermobility or hypermobility throughout the body. This is likely the category that many who do not meet the strict hEDS diagnosis fall into.
• Peripheral HSD (P-HSD): Hypermobility in only the hands and feet
• Localized HSD (L-HSD): Hypermobility is only present in a single joint or group of joints.
• Historical HSD (H-HSD): History of generalized hypermobility throughout the body

Many practitioners clarify that HSD does not mean someone is less affected by their systemic hypermobility or less symptomatic; they simply don’t meet the current criteria. G-HSD and hEDS can be “managed identically” (1).

This is why these conditions are often referred to HSD/hEDS (3) from specialists like physical therapist, researcher, and The Zebra Club scientific advisor Dr. Leslie Russek.

Importantly, updates are coming. Lara Bloom, CEO of The Ehlers-Danlos Society, updated members of The Zebra Club on upcoming changes to the criteria estimated to happen in 2026/2027. She said:

I don’t mean to over-dramatize it, but I think it will be the most significant transformational moment in this condition’s history. Because for the first time, there has been the robust work that really needs to go into this. The funding that needs to go into this. – Lara Bloom

The Role of Genetics in Hypermobility Syndromes

Both EDS and HSD have a strong genetic basis, often inherited through families in an autosomal dominant pattern (meaning it is passed genetically from parents, and children have a 50% chance of inheritance) (7).

EDS comprises a group of genetic conditions with different types of genetic causes due to altered genes within the extracellular matrix of connective tissues. hEDS is the only type of EDS that does not have a known genetic marker, yet (7). Research is ongoing.

Complications and Comorbidities Associated with Symptomatic Hypermobility

Because connective tissue is found in every system in the body, HSD/hEDS can present with both a wide range of symptoms and a wide range of severity from mild to complex and multisystemic (3).

Associated Conditions: From Digestive Issues to Cardiovascular Impacts

There are many conditions associated with systemic connective tissue disorders like hEDS and HSD. This varies widely from person to person. Some associated conditions include: (3,4):

• Dysautonomia (Autonomic nervous system dysfunction)
• Digestive issues like delayed gastric emptying (gastroparesis), constipation, reflux, dysphagia (difficulty swallowing)
• Cardiac issues like mitral valve prolapse
• Mast Cell Activation Disorders like MCAS
• Gynecologic issues like pelvic organ prolapse, heavy menstruation, pelvic floor dysfunction, stress incontinence
• The skin can be impacted by atrophic scarring and easy bruising
• Fibromyalgia
• Scoliosis
• Headaches and Migraines
• Sleep disturbances
• Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS)
• ADHD
• Autism
• Anxiety
• Depression

Helpful resources

If you recognize yourself in the symptoms we have discussed in this blog post, know that you are not alone. Understanding this condition is the first step towards managing it. I know it can take a very long time to get correct diagnosis and help. Many people are not given the support they need post-diagnosis to help manage this condition.

Please be assured that it is a manageable condition. It may take time to find the right balance and combination of treatments that work for you. We are all different.

The spider tool was recently validated to help prioritize care and may help determine how to approach this multi-systemic condition with your providers.

You don’t have to navigate hypermobility alone. At The Zebra Club, we offer specialized movement classes designed specifically for hypermobility, HSD, and hEDS. Created using my Integral Movement Method (IMM), which I used to rehab both myself and help thousands of clients 1 on 1 with chronic pain. This approach helps us regulate the nervous system, gently build strength and stability, and manage pain. We have a deep library of expert presentations to help you learn about different aspects of hEDS/HSD.

If you are looking for further guidance, I also have a book, Hypermobility Without Tears, a course called Strengthen Your Hypermobile Core online, and a YouTube channel of classes and educational content. With this, you can learn to move safely and start to build confidence in how to manage your hypermobility.

The main charities –

• The Ehlers Danlos Society has many resources, including a Provider Directory
• EDS UK
• The Hypermobility Syndromes Association (HMSA) also has a wealth of information you can tap into to learn more about hypermobility.

FAQ

What is the 9 point scale for hypermobility syndrome?

This is the nine-point Beighton scale – a simple screening tool used to assess generalized joint hypermobility (GJH). A high Beighton score can indicate GJH, but it’s important to note that a low score does not mean a person is not hypermobile; it does not cover a number of joints and was not designed to be a stand-alone diagnostic tool.

What are 7 signs you have hypermobility?

There are several signs to suggest you may have hypermobility but here are 7 common key signs: Joint hypermobility, Joint pain and instability, frequent injuries or slow healing, soft or stretchy skin, chronic pain or fatigue, digestive issues, and autonomic nervous system symptoms.

How do you know if you have hypermobility?

If your flexibility comes with pain, instability, frequent injuries, or systemic symptoms, it may be more than just flexibility.   It could indicate hypermobility and possibly a connective tissue disorder like EDS. Seeking professional guidance and assessment is key to getting a formal diagnosis and treatment plan.

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.