Joint hypermobility syndromes

Hypermobility arises from the make-up of your connective tissue, the collagen-rich material that gives ligaments and other supporting structures their strength and elasticity. When this tissue is naturally more stretchy, joints move beyond the usual range. This tendency is largely inherited, so it often runs in families, and it is part of normal human variation rather than a disease in most people.

Several factors influence who is affected:

• It is more common in children and younger adults, and flexibility tends to reduce gradually with age
• It is seen more often in women and in some ethnic groups
• Occasionally it is one feature of a broader connective tissue condition

For most people there is no underlying illness to find, and the hypermobility simply reflects how their tissues are built.

Where hypermobility causes symptoms, these may include:

• Joint pain, particularly after activity
• Joints that feel unstable, or that dislocate or partially dislocate easily
• Frequent sprains or soft-tissue injuries
• Fatigue, and sometimes other symptoms in more extensive forms

Assessment involves a history of your symptoms and how the joints behave, an examination of joint movement, and consideration of whether the hypermobility is isolated or part of a broader pattern. Where symptoms are more extensive, the broader patterns you may hear named include hypermobility spectrum disorder (HSD) and the hypermobile type of Ehlers-Danlos syndrome (hEDS), both of which are diagnosed clinically. Part of the value of assessment is distinguishing simple, harmless hypermobility from the situations that need a more structured approach.

Where specific joints are painful, ultrasound can help assess the soft tissues around them. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.

Management centres on strengthening the muscles that support and stabilise the joints, usually through a structured exercise and physiotherapy programme, alongside advice on protecting the joints and managing pain. This approach is often very effective. Where appropriate, other specialists may be involved. The plan is tailored to you.

Day to day, the aim is to keep your joints strong and steady without overloading them. Low-impact activity such as swimming, cycling or Pilates builds supporting muscle while being kind to the joints, and keeping gently active between physiotherapy sessions helps the gains hold.

Helpful everyday measures include:

• Pacing activity and varying tasks, rather than holding one position for long periods
• Avoiding pushing joints to their extreme range, including end-of-range stretching
• Supportive footwear, and good posture at desks and screens
• Attending to sleep and managing fatigue, which often accompanies symptoms

The outlook is generally reassuring. Symptoms tend to settle as strength and confidence build, and many people manage well over the long term once they find a sustainable routine. If pain affects mood or sleep, the principles in the fibromyalgia guide may also be useful.

Most hypermobility-related symptoms can be reviewed routinely, but some warrant prompter attention.

Call 999 or go to A&E if you have:

• Chest pain, or sudden breathlessness
• Sudden weakness, numbness or pins and needles, which may point to a nerve being affected
• New severe swelling or deformity after an injury, or you cannot use a limb

Arrange an urgent or same-day assessment if you have:

• A joint that has fully dislocated and will not relocate
• Repeated fainting

Seek a routine specialist review if you notice:

• Joints that dislocate or partly dislocate repeatedly, or feel persistently unstable
• Pain that is steadily worsening, or new symptoms beyond the joints such as marked fatigue or digestive upset

When you are unsure how quickly to act, it is always reasonable to be checked. Prompt review of recurrent instability helps protect the joint and guides the right plan.

For symptomatic hypermobility, a clear assessment and a structured plan can make a real difference to pain and stability, and provide reassurance where the hypermobility is harmless. If your joints are very flexible and also painful or unstable, a specialist review can help.

Is joint hypermobility always a problem?

No. Hypermobility is common, affecting around one in ten people, and for many it causes no difficulties at all and can even be an advantage. Only a minority of people with hypermobile joints develop symptoms such as pain or instability, and part of the assessment is establishing which situation applies to you.

How is hypermobility assessed?

The assessment is clinical rather than scan-based. It includes a history of how your joints behave, an examination of joint movement, often using a simple set of manoeuvres known as the Beighton score, and consideration of whether the hypermobility is isolated or part of a broader pattern. Where individual joints are painful, ultrasound can be used during the consultation to look at the soft tissues around them.

What does treatment involve?

The mainstay is a structured exercise and physiotherapy programme to build up the muscles that support and steady the joints, alongside advice on joint protection and managing pain. Most people respond well to this approach, though the benefits build gradually as strength develops, so consistency matters more than speed.

Could my hypermobility be part of a wider condition?

Occasionally hypermobility forms part of a broader syndrome with features beyond the joints, and the assessment is designed to consider this. For most people that is not the case, and the reassurance of a clear assessment is valuable in itself. Where a wider pattern is suspected, other specialists can be involved as appropriate.

When should I seek help for hypermobile joints?

If your flexible joints are also painful or feel unstable, dislocate or partially dislocate, or you are having frequent sprains and soft-tissue injuries, a specialist review is worthwhile. Assessment can confirm whether hypermobility is contributing and set out a structured plan to improve comfort and stability.