hEDS vs HSD: What’s the Difference and Why Does It Matter?

If you have been researching hypermobility, you have almost certainly come across two terms that are often used interchangeably but are clinically distinct: hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD). Understanding the difference — and the considerable overlap — between them can help you make sense of your symptoms and have more productive conversations with your health practitioners.

This article explains both conditions in plain language, outlines how they are diagnosed, and discusses what the distinction may mean for your care.

Part 1: What They Have in Common

Both hEDS and HSD share the same underlying feature: generalised joint hypermobility — joints that move beyond their typical range of motion due to lax connective tissue. Both conditions can cause:

• Persistent joint pain and instability

• Recurring sprains or subluxations

• Fatigue that is often disproportionate to activity levels

• Poor proprioception — a reduced sense of joint position in space

• A range of systemic symptoms, including digestive issues and autonomic dysfunction

The conditions sit on a spectrum. Neither is caused by trauma, and neither is the result of being “too flexible.” They are structural and systemic in nature, rooted in how the body’s connective tissue is built.

Part 2: How hEDS Is Diagnosed

hEDS is diagnosed using the 2017 International Classification criteria, developed by an international consortium of clinicians and researchers. To receive a diagnosis of hEDS, a person must meet all three of the following criteria simultaneously.

Criterion 1: Generalised Joint Hypermobility

A Beighton Score of 5 or more out of 9 (or 4 or more in people aged 50 and over, or those with reduced mobility). This is the foundational requirement.

Criterion 2: Two or more of the following features

• Feature A: Five or more musculoskeletal findings, including chronic widespread pain, recurring joint dislocations, or a positive family history of hEDS

• Feature B: At least one systemic manifestation, such as skin that is soft or slightly stretchy, pelvic floor dysfunction, or dental crowding with a high palate

• Feature C: A positive family history — a first-degree relative who also meets the hEDS criteria

Criterion 3: All other conditions excluded

Other heritable connective tissue disorders — such as Marfan syndrome, classical EDS, or vascular EDS — must be excluded. hEDS is currently the only subtype of EDS without a known genetic marker, which makes exclusion of other conditions part of the diagnostic process.

Diagnosis of hEDS is made by a medical practitioner, often a rheumatologist or clinical geneticist with experience in connective tissue conditions. Physiotherapists assess and manage hypermobility-related symptoms but do not make a formal medical diagnosis.

Part 3: How HSD Is Diagnosed

Hypermobility Spectrum Disorder is a clinical diagnosis given when a person has symptomatic generalised joint hypermobility but does not meet the full criteria for hEDS. It was formally introduced in 2017 to replace older, inconsistently used terminology such as “joint hypermobility syndrome” (JHS).

HSD is not a lesser diagnosis. It is an acknowledgement that hypermobility-related symptoms are real, clinically significant, and warrant active management — even when the full hEDS picture is not present.

HSD is further classified into subtypes depending on where hypermobility is present (generalised, peripheral, or localised) and whether it is symptomatic.

Part 4: What the Distinction Means in Practice

This is the question most people are really asking: does the label change how I am cared for?

In terms of physiotherapy, the honest answer is: not significantly. Both hEDS and HSD are managed with a similar approach — joint stabilisation, proprioceptive training, load management, and education. The physiotherapy goals are the same regardless of which diagnosis applies.

Where the distinction may matter:

• Access to referrals. An hEDS diagnosis may support onward referral to other practitioners, including cardiologists (for POTS screening) or gastroenterologists, given the systemic nature of the condition.

• Family awareness. Given the hereditary component of hEDS, a formal diagnosis can prompt screening conversations for other family members.

• Personal validation. For many people, a diagnosis — of either kind — provides a framework for years of unexplained symptoms. This should not be underestimated.

• Research and advocacy. hEDS is an area of active research. A formal diagnosis may open access to patient registries and research participation.

Part 5: Why Getting an Assessment Matters

Whether or not a formal medical diagnosis is in place, the physiotherapy starting point is the same: a thorough assessment of how hypermobility is affecting your joints, your strength, your proprioception, and your daily life.

Without that picture, it is difficult to know which joints are most at risk, what is driving your current symptoms, or where to focus your energy in rehabilitation.

At Velca in Howick, physiotherapy is offered for people with hypermobility-related symptoms. Our physiotherapy assessment includes a clinical hypermobility screen, a review of your symptom history, and a discussion of what options may be appropriate for your situation.

You do not need a GP referral and you do not need a formal diagnosis to book an appointment.