Pilates for Hypermobility & Ehlers-Danlos Syndrome: A Safer, Stabilizing Approach

Estimated reading time: 9 minutesYou’ve probably been told to ‘try Pilates’ at some point – maybe by a well-meaning doctor or physio.

I certainly was, especially after a physio bluntly told me I was ‘hanging off my joints’ and had zero stability.

I’d always been a huge fan of yoga (still am), but Pilates? I wasn’t even sure what it involved back then. I’d seen a few studios popping up in my area, but honestly, I hadn’t been brave enough to venture inside.

What I didn’t know then was that I was dealing with undiagnosed Ehlers-Danlos Syndrome (EDS) and hypermobility, conditions that make that simple suggestion of “try Pilates” both incredibly helpful and potentially problematic.

That well-meaning advice ended up putting me on the most life-changing journey, not just for my own body, but eventually allowing me to help thousands of people around the world navigate similar challenges.

But here’s what I’ve learned: not all Pilates is created equal, especially when you’re dealing with joints that move too much, chronic pain, or that frustrating combination of feeling both loose and tight at the same time.

Is Pilates Safe for People with Ehlers-Danlos Syndrome or Hypermobility?

Pilates is a powerful tool, but it is important to remember that not all Pilates is created equally. I think that it can be safe for EDS/HSD when we modify it.

Doctors do tend to suggest Pilates as it is seen as a safe, low-impact form of exercise, but that can be misleading.

Hypermobile people do still get injured and overdo it in Pilates classes. Without the right adaptations or instructor awareness of EDS or HSD, things can go wrong, potentially worsening symptoms like pain, fatigue, and instability.

There is also a bit of disbelief amongst patients that Pilates can actually help.

I saw a comment just last week in an EDS Facebook group – someone was asking this very question: “My doctor told me to take up Pilates but has anyone tried it?”

This is understandable, many of us have tried exercise before only to end up hurting ourselves. Even the word exercise can be triggering for many people. I like to refer to it as movement.

I have been on this same journey, as a new person in a Pilates mat class with undiagnosed hypermobility and EDS.

I did learn the hard way that certain aspects of the traditional Pilates method needed to change for it to work for me.

I have spent the last two decades researching, experimenting, and cultivating a gentle, fascia-informed approach to Pilates called The Integral Movement Method (IMM) that honors and understands the unique needs of our hypermobile bodies.

The IMM centres on making movement feel safe and accessible. I have seen thousands of people find pain relief, stability, and strength using this approach.

What is Pilates? Joseph Pilates’ Original Method

Pilates was developed by Mr. Joseph Pilates (1883 – 1967), who initially developed a method called Contrology. His original method focused on controlled, precise movements to build strength, flexibility, and postural alignment.

He set up a studio in 1926 in New York, where his clients were largely dancers, gymnasts, and circus performers. He went on to develop a series of mat-based exercises referred to now as the Classical Repertoire.

He also created studio equipment like the Reformer, the Cadillac, the Wunda Chair, and the Spine Corrector. He really was a genius in that regard.

He spread the word of his work through his many disciples, who then went on to teach their clients and gave Pilates their own unique twist.

Today, it is estimated that there are over 100,000 Pilates teachers worldwide. The major training schools are Polestar Pilates (where I am honored to educate for hypermobility), STOTT, BASI, Balanced Body, Body Control, and APPI.

You can probably find a studio or village hall offering Pilates classes in most places in the world.  In-person classes on a mat or studio are common, online options via Zoom and apps, or clinical settings like physiotherapy or physical therapy clinics.

Why traditional Pilates needs to be adapted for hypermobility

There were many things I loved (and still love) about this practice when I started taking classes in 2007. Pilates is very much at the heart of my modified method.

What I loved about traditional pilates

• Pilates offered my lack of body awareness a chance to learn.
• There was an emphasis on precision and control, which I needed.
• It was mat-based, which made it mostly accessible.

My problems with standard pilates classes

In traditional pilates, I struggled with:

• Altered movement patterns.
  • Hypermobile people are very good at “cheating”(and not intentionally) because we can hyperextend and reach positions easily. The body will always find the path of least resistance – and that’s what I would do.
• I found the breath to be troublesome and difficult to manage – it often led me to feel more stressed and anxious.
  • The traditional Pilates method (certainly in my training) focused on lateral breathing. I wasn’t taught anything about the physiological impact of breathing and how breath impacts our movement. I found myself tensing and bracing in order to do this breath pattern, whilst at the same time ‘holding in my core’ or ‘bracing my core’.
• It became too mechanical for my needs.
  • I was too in my head, worrying about when I should be inhaling or exhaling. Was I doing it right? There can be an emphasis on perfection in choreography, which further increased my anxiety.

How I discovered the need for tailored movement for hypermobility

The reasons I listed above for struggling with Pilates led me to research and look at how to adapt Pilates to suit my hypermobile body.

I discovered Vanda Scaravelli’s book very early on, Awakening the Spine, and I wondered if I could adopt some of her beautiful work into the Pilates method. And that’s how I started.

• This led to introducing the concepts that:
  • Nervous system regulation before movement even begins. Breath and Relaxation are the first two principles of the IMM.
  • Stability and control first – flexibility second. Just because someone is flexible doesn’t mean they have the stability to do big movements.
  • Small, intentional, and mindful movements. Being present – getting out of our heads and into sensation. I say to my clients, leave your thinking brain outside the room, and let’s tap into our sensory brains.

How Modified Pilates Benefits EDS and Hypermobility Symptoms

Hypermobility modified Pilates is a great option, especially for those people who may be afraid of movement, have had a bad experience with exercise, or have chronic pain or fatigue. It is a great place to start to learn control and improve proprioception.

I have many clients who get so stable and strong, they can join group Reformer classes, but by that time, they really understand how to control their bodies, how to control the range of movement without injury.

When adapted for hypermobility, Pilates can offer huge benefits.

Here’s how pilates can benefit people with EDS and HSD:

Joint stability

My approach focuses on building stability without forcing it. Slow, intentional movements with a reduced range of motion are a great way to start building stability safely.

Core stability

I avoid bracing or gripping, which can backfire for hypermobility. We tend to already be tense with holding patterns. We actually want to remove those patterns and learn to stabilize in a more functional way. I take an entirely different approach to “core stability”

Chronic fatigue considerations

We do need to include fatigue into our planning of a Pilates session. Many clients and members of The Zebra Club need energy conservation and pacing. Too much can lead to crashes and flares. We must learn to pace.

Addressing Chronic pain

Most people come to see me because they are in pain. Pain is a key part of EDS and HSD for most people. I was in pain until I started working on my own body in this way with the IMM. We need to introduce an understanding of neuroscience and pain, and nervous system regulation, to help this aspect of living with EDS.

Common Mistakes in Traditional Pilates for Hypermobile Bodies

There are many common mistakes that hypermobile individuals are prone to making when practicing traditional Pilates, including:

• Overstretching already lax joints.
  • It is confusing that many people with hypermobility often feel tight. This tightness is compensatory and shouldn’t be ‘stretched out’ in class. Stretching may feel good at the time, but it can destabilize the whole system.
• Hyperextending joints.
  • I was so guilty of this. With a lack of awareness and decreased proprioception, we can fall into what I call ‘false stability’. We hang off our end ranges and in weight-bearing positions like bird dog, plank, etc. These loaded movements can cause strain.
• Gripping and bracing the core.
  • Navel to spine hollowing and tightening the core can lead to dysfunction and unhelpful muscle patterning, over recruitment, and breathing pattern disorders, and potentially impact the pelvic floor. I lean towards more functional, fascia-informed language around this common Pilates cue.
• Ignoring pacing and pushing through
  • I did it especially in my Pilates training. It’s not something to be encouraged in hypermobility, as this can easily lead to pain and flares.

Which Pilates Exercises Should Hypermobile People Avoid?

There are certain exercises I never teach to a hypermobile client, like roll-overs with neck issues, an unsupported series of five, unless they’ve been working with me a long time. Inversions also may not be great with POTS.

But generally, it is about finding a way to move the body that suits each person. You can create the same benefits without doing these specific exercises.

If these are working for you, that’s great. Everyone is different! I do them myself, but I have been working on these since 2007.

Is Reformer Pilates Safe for EDS?

I often get asked if the reformer is good for EDS or safe. The Reformer is a great piece of equipment for hypermobility – BUT – it needs to be modified and used with care.

With this machine, you are adding additional load and resistance. We must be able to control that before jumping and doing big movements. A reformer can facilitate a greater range, so we need to be sure we can control it first. 

I have a course called Reformer Foundations that is great for learning this. It can also be purchased as an add-on in The Zebra Club for a lower price.

How do I Modify Pilates for EDS and HSD?

As I’ve mentioned many times so far, pilates can be great for Hypermobility, EDS, and chronic pain, but I believe it needs to be modified. Hypermobility conditions can create unique movement challenges.

Having studied and worked with the EDS population for 17 years, I came to see certain patterns that need to be addressed, including nervous system dysregulation.

This is crucial and is rarely taken into account before starting a movement practice.

The Integral Movement Method

I developed the Integral Movement Method over two decades to support EDS and HSD. It is rooted in research, science, lived experience, and clinical experience.

It is the only evidence-based movement method specifically designed for our community. We recently published the results of a qualitative analysis of a large-scale clinical trial of a 5-video online program, Strengthen Your Hypermobile Core, developed using the IMM. We have a quantitative analysis under review.

The IMM includes a 5-stage approach to movement, and within this are 6 essential hypermobility principles.

The 6 principles are how we progress with hypermobility:

1. Breath: an incredible tool for nervous system regulation and movement.
2. Relaxation: We integrate relaxation into your movement practice to release stress and tension
3. Proprioception: Improve body awareness and proprioception (the sense of where we are in space that is often altered in EDS/HSD)
4. Stability: Stabilize your joints in an effective and functional way
5. Balance: Challenge and improve balance and awareness in dynamic movement
6. Posture: Create dynamic posture with stamina for everyday living

One participant had this to say:

“‘It is designed and already modified for EDS. I love that she showed what we CAN (and are likely to do) and then showed what we SHOULD do. I definitely would have done what she showed us not to do otherwise! It was so nice to see someone like me, who could show me how to move like we are supposed to, so it was SO easy to understand what I have been doing wrong and how to fix it. . .” Female, 46

Where to Begin: A Supportive Pilates Path with Jeannie

Starting a safe movement journey can feel overwhelming.

I know, because it happened to me. I tried classes and ended up in more pain. I tried to strengthen my core, but it just didn’t feel right. It made me feel tense and unable to breathe.

This is why I created the IMM and The Zebra Club, a digital space where you can access modified Pilates for EDS. Our research study helped us determine what is really needed in a digital program developed specifically for EDS/HSD and chronic pain.

• All TZC classes are tailored for EDS and HSD, and it meets you where you are today.
• I encourage you to pursue a no-pain, no-strain approach. Movement should make us feel better, not scared. Some muscle soreness when getting started is normal, but increases in pain are not encouraged.
• The classes are fascia-friendly and support nervous system regulation with meditation and mindful movement.
• Accessible 24/7 with a global community of zebras on hand to support you

Ready to feel stronger and more supported in your body? Try a beginner-friendly class in The Zebra Club today.

I was recently interviewed by Nic from the Beyond The Reformer Podcast, all about my approach to Pilates with Hypermobility and EDS. Take a watch or listen to learn more!

FAQ

Is Pilates good for Ehlers-Danlos Syndrome?

Not all approaches to pilates will be good for Ehlers-Danlos. I have found a modified approach to Pilates that takes into account the different challenges we face is great for EDS.

Can Pilates help with fatigue in hypermobility?

A modified approach to Pilates, including gentle, paced movements, can help improve energy levels by calming the nervous system.

Should I use a reformer or do mat Pilates?

Both the reformer and mat approaches can be helpful – it may come down to cost, availability, accessibility, and the knowledge the teacher has of EDS and hypermobility.

What’s the safest way to start Pilates with EDS?

The safest way to start pilates with EDS is to start low and go slow. We need a different approach than the typical pilates student. Finding a teacher who knows about EDS or is prepared to learn about it is essential, or join The Zebra Club!

How often should I do Pilates if I’m hypermobile?

How often to do any exercise really depends on each individual. Some people enjoy short daily sessions (10 mins) whilst others can attend a couple of hour-long sessions a week. Find a pace that suits you without flaring you, and build from there.

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.