People with hypermobility often receive generic exercise advice that, at best, produces no benefit and, at worst, makes things considerably worse. "Just stretch more." "Build your core." "Try yoga." The problem is not that exercise is unhelpful for hypermobility — it is one of the most evidence-supported interventions available. The problem is that the type, load, and progression of exercise matter significantly in this population, and generic programmes are rarely designed with hypermobile joints in mind.
Why Hypermobile Joints Respond Differently to Exercise
In a typical joint, the passive stabilisers — ligaments, joint capsule, cartilage — provide resistance at end range and contribute meaningfully to joint stability. In hypermobility, these structures are more compliant than usual, which means the joint relies more heavily on the active stabilisers — muscles and the nervous system's ability to coordinate them — to maintain control. This has two important implications:
- Muscle fatigue matters more: when the active stabilisers tire, a hypermobile joint has less passive backup than a typical joint. This is why symptoms often worsen as the day progresses or after prolonged activity.
- Proprioception is frequently impaired: research consistently shows reduced proprioceptive accuracy in hypermobile joints — the brain receives less reliable position-sense information, which impairs motor control and increases injury risk.
Hypermobile joints are not unstable because the muscles are weak in isolation — they are often unstable because the nervous system's ability to coordinate those muscles around an unpredictable joint is impaired. This is a neuromuscular problem, not simply a strength problem.
What to Avoid — and Why
Passive Stretching
Stretching already-hypermobile tissue does not provide any therapeutic benefit and may reduce the load capacity of already-compliant ligaments and joint capsules over time. People with hEDS or HSD do not need more range of motion — they need better control of the range they already have. Yoga styles that emphasise end-range flexibility (Bikram, Yin) are generally not recommended as primary exercise for this population.
High-Impact, High-Load Activity Without Foundation
Running, HIIT, CrossFit, and high-impact aerobics are not inherently contraindicated in hypermobility — but they are high risk when introduced before adequate joint stability has been established. The combination of fatigue, repetitive loading, and reduced proprioception creates a high injury-risk environment for hypermobile joints.
Programmes That Progress Too Quickly
Connective tissue adapts more slowly than muscle. A person with hEDS or HSD may develop muscle strength quickly enough to take on more load — but the ligaments, tendons, and joint surfaces have not adapted at the same rate. Aggressive progression is a common cause of setbacks in this population.
What the Evidence Supports
1. Proprioceptive and Neuromuscular Control Training
The first phase of any exercise programme for hypermobility should focus on joint position sense and controlled movement. This includes:
- Single-leg balance and perturbation training
- Slow, controlled closed-chain movements (e.g. wall squats, step-ups) with attention to joint alignment
- Isometric exercises that train muscle co-contraction without stressing end range
- Pelvic and spinal stability work (not generic "core exercises" — specific stabilisation targeting deep local muscles)
2. Progressive Resistance Exercise
Once neuromuscular control is established, progressive resistance exercise can be introduced. Key principles for hypermobility:
- Avoid locking out joints at end range — maintain a slight bend at the knee and elbow during loading exercises
- Prioritise slow eccentrics — slow lowering phases build both tendon capacity and neuromuscular control
- Progress load conservatively — increase weight or resistance no faster than every two to three weeks, allowing connective tissue to adapt
- Monitor recovery closely — post-exercise soreness lasting more than 24–48 hours suggests too much load too soon
3. Low-Impact Aerobic Exercise
Cardiovascular fitness is important for energy management, autonomic function, and mood — all of which affect pain in hypermobility. Swimming and cycling are generally well-tolerated low-impact options. Walking programmes, progressed gradually, are accessible for most. For people with POTS alongside hEDS, recumbent or semi-recumbent exercise (rowing, recumbent cycling) may be better tolerated in the early stages of reconditioning.
Pacing and Fatigue Management
Fatigue in hEDS and HSD is not simply tiredness — it is a complex phenomenon involving connective tissue load, sleep disruption, autonomic dysfunction, and central sensitisation. Boom-and-bust patterns (doing too much on good days, crashing on bad ones) are extremely common and actively counterproductive. Pacing — maintaining a consistent, sustainable activity level regardless of how good or bad a day feels — is a core skill that a physiotherapist experienced in hypermobility can help establish.
The goal is not to exercise as hard as possible on good days. It is to exercise consistently every day — at a level your body can recover from reliably.
How Velca Approaches Exercise for Hypermobility
This article is intended for general information purposes only and does not constitute medical advice. Please consult a qualified health professional for assessment, diagnosis, and treatment tailored to your individual circumstances. Velca Allied Health, 10 Wellington Street, Howick, Auckland 2014.
