Gaining Strength with Hypermobility

Estimated reading time: 8 minutesIf you live with hypermobility, EDS, or HSD, chances are you’ve been advised that you need to ‘get stronger’ to manage your condition.

I don’t know about you, but I used to find this quite scary and intimidating. Given that there are no official exercise guidelines about symptomatic hypermobility and Ehlers-Danlos Syndrome (EDS), the prospect of doing strength training with my hypermobility was a concept I initially didn’t know how to approach.

Through research and personal experience, I realized that if certain principles were in place FIRST, before strength training began, I could actually do it safely and without causing flare-ups.

I implemented this with my movement therapy clients, culminating in the development of the Integral Movement Method.

Strength training can be beneficial for people with hypermobility, but safety and appropriate progressions are key.  

This blog will explore hypermobility strength training in more detail, looking at some of the recent research into this topic and sharing those principles for safe strengthening practices.

Are people with hypermobility weaker?

According to a recent review paper, a number of studies found that people with hEDS had lower muscle strength and endurance compared to non-hypermobile controls (1).

It was also recently observed in a small study that there was no difference in muscle strength, functioning, and muscle mass between adults with HSD and hEDS, but both had significantly lower endurance and strength than non-hypermobile controls (2).

Research by Scheper and colleagues (2016) found that people with hypermobility (EDS-HT, now called hEDS) have less muscle strength than people without this condition.

Why might this happen? One theory they had is that the difference in muscle strength is due to the connective tissue. People with hypermobility have more elastic and potentially more fragile connective tissue, resulting in hypermobile joints and stretchier skin.

This stretchier tissue might create a problem: when muscles try to generate force, some of that force might get “lost” or not be transferred efficiently because the connective tissue (fascia) that helps transmit force is too elastic.

This isn’t just about deconditioning. Even physically fit people with hypermobility, like professional dancers, have shown this same pattern of muscle weakness (3).

We can strengthen with Ehlers-Danlos Syndrome

The important thing is that while people with hEDS have less muscle strength to begin with, they can still gain it.

In fact, one study found that people with joint hypermobility syndrome can gain strength at a similar rate as the non-hypermobile controls performing the same exercise intervention. However, it took them the 12-week intervention to reach the starting point of the controls (1, 4)

So, while we can strengthen, and we can do it at a similar rate, we may just be starting from a different place.

I think this is really key because it gives us hope. It gives hope that strengthening our bodies is possible. Of course, it depends on how we do the strength training.

I am not suggesting we all sign up for a gym or weights class without preparation. Preparation is the key to success in strengthening. You would not run a marathon, for example, without months and months of preparation. We have to approach strengthening work in much the same way.

The importance of strength training in hypermobility

Strength training is important, but what does strength really mean?

When we think of strengthening practice, an image of someone lifting weights or a dumbbell may come to mind. With hypermobility, there is much more to consider in strengthening work.

Building strength is not about becoming a bodybuilder or pushing through intense workouts (unless that’s something you want!).

For me, it is about creating stability, resilience, and confidence in our bodies. If our bodies often feel unpredictable and fragile, and small steps can help change this narrative so that we can feel empowered, too.

Reasons why strength is something to work on if you have symptomatic hypermobility:

• Joint protection – stronger muscles can support and protect hypermobile joints, reducing the risk of subluxations.
• Improved proprioception – strength work can enhance body awareness.
  • A study discovered that while muscle strength was the biggest factor affecting what activities hypermobile people could do, there was another important piece to the puzzle. The connection between muscle strength and activity limitations was complicated by reduced proprioception (3)
• Reduced pain and fatigue – with better movement patterns, the body can move more efficiently with greater control. It will use less energy, and this could improve fatigue.
• Better postural control – strength can improve overall postural tone and muscle imbalances, which can help reduce pain.
• Daily functional activities – walking, standing or reaching into a cupboard, carrying the shopping, picking up children – improved strength can help us move safely and with less pain in everyday life.
• Emotional support – that feeling of empowerment that we are capable, makes us feel more resilient and less afraid of movement or exercise.
• Better overall tone – this makes the tissues stronger and less injury-prone.
• Bone density – especially as we age and try to avoid osteopenia or osteoporosis or fractures from falls – loading the bones through strengthening work can really be beneficial.

So, how should we strengthen with hypermobility?

There are currently no generally accepted guidelines when it comes to how to approach increasing strength, despite it being generally accepted that strengthening is needed.

For example, Henriksen et al. (2022) found that supervised, heavy resistance training was well tolerated and could be beneficial in a study on young women with hypermobility.

This study focused on knee pain and found that knee pain was reduced and lower extremity muscle strength improved in all the subjects.

Another study or intervention looking specifically at the shoulder found that high loading exercises of the shoulder were more effective than low loading exercises in hypermobility (6).

However, there were some adverse effects, such as increased symptoms and headaches. They also found in the year follow-up on this study that there was no significant difference between high load and low load exercises for the shoulder (6).

We recently published a qualitative analysis of the research we did on my IMM based program, Strengthen Your Hypermobile Core. Qualitative analysis is a method of assessing themes in written feedback from the participants.

We found that people reported they felt stronger with these exercises (that were predominantly body weight focused) (7).

One participant said, “Physically I increased strength considerably. I struggled to complete one rep of many of the exercises at the beginning. I can now do 10 reps on both sides of all the exercises. The strength I have gained has allowed me to increase my walking ability.’

The message is this: we can get stronger and do not have to feel the pressure to jump into using weights immediately or at all if we don’t want to. We need to find the approach that works for us.

My approach to gaining strength with hypermobility

As I mentioned above, I think we need to do some prep work before jumping straight into strength training – especially if have been in pain for a long time.

My key principles that need to be in place before strength training are:

• Relaxation – releasing habitual tension. We can’t train a tired or fatigued muscle that is held in constant contraction. It will let us down and flare up. Let it have the chance to let go before loading it.
• Breath awareness – try to be conscious of your breath when exercising and adding load to a workout.
• Alignment – if we don’t have some degree of body awareness and proprioception in place before we start strength training, we could potentially be working the muscles in the wrong joint alignment.
  • This encourages poor joint positioning and potential injury. Spend time getting to know where the bones are and how they sit in the joints. I have plenty of videos about this on my YouTube channel and in The Zebra Club.
• Resistance starts low – we need to build tolerance. We may start with isometric exercises with a band or a magic circle. Isometric exercises are the first step when I introduce strength work to my clients and The Zebra Club members.
• Understand the pull of gravity – if we can’t resist gravity in daily life, adding a heavy weight to our training program is going to cause potential issues like pain, subluxations, and poor alignment.
• It’s not about the range, it’s about the control – If we haven’t established safe, controlled movements, adding a weight to that could be disastrous. Uncontrolled movements with additional weight could cause pain, joint misalignment, and injury. Build control before adding weights.
• Stability is essential – if I don’t have trunk stability, for example, and I try to throw some kettlebells up and down, my back will feel that pressure.
• Build up slowly – we can’t jump from zero weight to lifting heavy hand weights or dumbbells. You can start with your own body weight, too. You can build up to heavy weights if you want.

In my approach, we emphasize control, stability, and awareness over lifting heavy weights.

What about sports like weightlifting with hypermobility?

I know several people with hEDS/HSD who enjoy weight lifting as part of their training regime.

With the right approach, it can be safe and beneficial if that is something you want to pursue. It is not, of course, essential for everyone. You can work on strength training in other ways.

There is no need to feel pressure about doing heavy weights.

Progressive resistance training can be a good way to build joint stability, but it must be done with care. Safe weight lifting considerations if you have hypermobility are

• Prioritize form over load. Never sacrifice your alignment or control to lift heavier.
• Mirrors can be useful if you are training alone to check your alignment.
• Work with a hypermobility-aware trainer or PT.
• Watch for locking joints or going to the end of range without appropriate control.
• Midrange movements are safer and highly effective.
• Build foundational control – start light and slowly build up over months.
• Isometric and eccentric muscle control are essential for injury prevention in hypermobility.
• Listen to your body – don’t push through. Stop if you start experiencing more joint pain, excessive fatigue, or you lose control.

My favorite Hypermobility Strength exercises

My favorite strength exercises for hypermobility don’t necessarily involve weights. We can also use our own body weight to get stronger, and this can be a great place to start for many people.

• Bridges – they activate the posterior chain, an area often underactive in hypermobility.
• Supine heel slides – a great accessible exercise for everyone that helps build trunk stability, hip stability, and leg strength. You can add leg weights to this if looking for a progression. The aim is to slide the leg along the floor without disturbing the spine or pelvis.
• Dead bugs – A great supine strengthening exercise that builds coordination of limbs away from the center of the body. Spinal stability and control are key.
• Isometric holds with a band – for shoulder strength and alignment.
• Isometric holds for the hip joints- using bands and a pillow.
• TheraBand rows – Seated work on the floor or a chair with the band around the banister – start to strengthen the upper back and shoulder stability.
• Seated bicep curls – start with a light weight and build up. Seated on a chair, start to build upper body strength while maintaining good posture.
• Lateral Raises – with hand weights – this exercise strengthens the shoulder girdle. Raise arms to shoulder height only whilst maintaining good form.
• Weight dead bugs or arm rolls – adding a light weight to an exercise you have already mastered can add a great challenge to build strength. Remember, don’t sacrifice the spine for the range.
• Four point kneeling and planks – build whole body strength with exercises that require you to support your own body weight.

Ready to dive deeper into strengthening? Check out this class on Strengthening the Posterior Chain muscles.

FAQ

Does EDS affect strength?

According to the research into strength training and resistance training in EDS, it is definitely related to decreased muscle strength compared to non-hypermobile control groups. However, research also shows this can be improved!

Can strength training help hypermobility?

Strength training can absolutely help with joint hypermobility symptoms. However, the approach to strength training needs to be appropriate and modified for hypermobility.

Is it harder to build muscle with hypermobility?

The research has shown it may take longer to build muscle if you have hypermobility, and this may be due to starting from a weaker place. You will get 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.