Hypermobility Syndrome

Overview

Some people have joints that move further than usual, often described as being double-jointed. Joint hypermobility on its own is common and frequently causes no problems. Hypermobility syndrome describes the situation where this extra flexibility is linked to ongoing symptoms such as joint pain, frequent sprains, dislocations, and a sense that the joints are unstable.

It is related to a group of conditions sometimes called hypermobility spectrum disorders and overlaps with certain inherited connective tissue conditions such as Ehlers-Danlos syndrome. The connective tissue that supports the joints is more elastic than usual, which allows the extra movement. With the right mix of strengthening, joint protection, and pacing, most people manage their symptoms well.

Symptoms

Symptoms vary widely and can affect joints throughout the body, along with other systems in some people.

• Joint pain, especially after activity, often in the knees, fingers, hips, and shoulders
• Frequent sprains, strains, or joint dislocations
• A feeling that joints are loose, unstable, or may give way
• Clicking or clunking joints
• Easy fatigue and poor stamina
• Soft, stretchy skin or slow-healing bruises in some people
• Dizziness on standing or digestive symptoms in some people

Symptoms may be worse during growth in children and teens and can fluctuate over time.

Causes

Hypermobility syndrome is caused by differences in the connective tissue that supports joints.

• Genetic and inherited factors: The trait often runs in families, reflecting inherited differences in collagen, a key connective tissue protein.
• Connective tissue makeup: More elastic ligaments and joint capsules allow joints to move further.
• Associated conditions: Some people have a defined inherited disorder such as Ehlers-Danlos syndrome or Marfan syndrome.
• Muscle control and conditioning: Weakness or poor control around lax joints can worsen symptoms, though it is not the underlying cause.

Hypermobility is more common in children, women, and certain ethnic groups, and flexibility tends to decrease with age.

Risk Factors

• A family history of hypermobility or connective tissue conditions
• Younger age, as flexibility is greater in childhood
• Female sex
• An associated inherited disorder such as Ehlers-Danlos syndrome
• Poor muscle conditioning around lax joints

Diagnosis

Diagnosis is clinical, based on flexibility, symptoms, and excluding other conditions.

• Beighton score: A simple set of movements (such as bending the thumb to the forearm or hyperextending the elbows and knees) used to measure generalized hypermobility.
• Symptom assessment: Reviewing joint pain, sprains, dislocations, fatigue, and other features and how they affect daily life.
• Examination: Checking multiple joints, skin, and overall pattern.
• Tests for related disorders: Considered when features suggest a specific inherited connective tissue condition, sometimes including genetic testing.

Treatment

There is no cure, but symptoms can be managed effectively, with the focus on protecting and supporting the joints.

• Strengthening and physical therapy: Building muscle strength and control around lax joints is the most important measure for stability and pain.
• Low-impact exercise: Swimming, cycling, and graded activity to improve fitness while protecting joints.
• Joint protection and pacing: Avoiding overstretching joints, using good posture and technique, and balancing activity with rest.
• Pain management: Simple pain relief, heat, and a graded activity approach; avoiding long-term inactivity.
• Bracing or supports: For unstable joints during activity in some cases.
• Managing associated symptoms: Such as dizziness on standing or digestive issues, when present.

A coordinated approach, often involving physical therapy, helps most people stay active and comfortable.

Prevention

• Keep the muscles around the joints strong with regular exercise
• Choose low-impact activities that build control without overstretching joints
• Use good technique and avoid pushing joints to their extreme range
• Pace activities and balance exertion with rest
• Warm up before exercise and progress gradually
• Seek early help for recurrent sprains or instability

When to See a Doctor

See a clinician if flexible joints cause ongoing pain, frequent sprains or dislocations, or a sense of instability that limits daily life. Mention any easy bruising, very stretchy or fragile skin, a family history of connective tissue disease, or fainting and palpitations, as these may prompt assessment for a specific inherited disorder. Seek prompt care for a dislocation that will not go back, severe pain, or loss of sensation in a limb.

Related Topics

Frequently Asked Questions

References

1. The Ehlers-Danlos Society. Hypermobility Spectrum Disorders.
2. Mayo Clinic. Joint hypermobility.
3. MedlinePlus, U.S. National Library of Medicine. Hypermobility of joints.
4. National Health Service (NHS). Joint hypermobility syndrome.