Managing hypermobility syndrome and other chronic conditions

If you live with a hypermobility syndrome, you likely also experience symptoms that seem to extend well beyond your joints. 

Pain, fatigue, dizziness, and other difficulties can make it hard to know which condition is responsible or where to begin with treatment.

Managing hypermobility syndrome and other chronic conditions means looking at the whole picture, not just joint stability. At Heal & Thrive, I regularly work with people who have overlapping conditions, and I start by understanding how those conditions affect your daily life and capacity.

Why does hypermobility often come with other conditions?

What conditions often overlap with hypermobility?

Why might hypermobility overlap with pain and fatigue?

Why can treating hypermobility in isolation be difficult?

How can you balance strength work with symptom limits?

How does pacing help with overlapping conditions?

What my approach to managing overlapping conditions involves

Frequently asked questions

Finding an approach that considers the whole picture

A preview of managing hypermobility and other conditions 

• Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) can occur alongside other conditions, including POTS, MCAS, chronic pain, and fatigue-related conditions.

• These associations are recognised, but the reasons why some conditions occur together are not fully understood.

• Connective tissue differences, joint instability, and nervous system processing may help explain some symptoms, although several proposed mechanisms remain unproven.

• Treating joint stability alone may not address the broader difficulties caused by pain, fatigue, or other co-existing conditions.

• Strength and movement strategies may need to be adapted to your symptoms, including reducing load, duration, or upright activity.

• A whole-person approach begins with assessment, identifying barriers, and developing safeguards before introducing exercise.

Why does hypermobility often come with other conditions?

In my clinical experience, people with symptomatic hypermobility often have other health conditions that affect their pain, fatigue, and ability to manage daily activities. This means treatment often needs to consider more than joint movement alone.

Understanding HSD and hEDS

Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are among the most common conditions that often go hand in hand with symptomatic joint hypermobility. They involve connective tissue differences and can affect your joint stability, movement, and other aspects of your health.

Connective tissue supports the whole body, including around joints. When that support is affected, muscles and other systems need to work harder to maintain stability.

What conditions often overlap with hypermobility?

HSD and hEDS are often discussed alongside other conditions that can affect the nervous system, pain, fatigue, and daily functioning. However, having hypermobility does not mean you necessarily have or will develop any of these conditions.

POTS, MCAS, pain, and fatigue

As The Ehlers-Danlos Society explains, fatigue in people with EDS and HSD can have several contributing factors, including:

• POTS: Postural orthostatic tachycardia syndrome, which can cause symptoms such as dizziness, rapid heart rate, and difficulty tolerating upright positions

• MCAS: Mast cell activation syndrome, which involves episodes of symptoms associated with mast cell mediator release

• Chronic pain conditions: Persistent pain can occur alongside joint instability and other symptoms

• Fatigue-related conditions: Some people also experience ME/CFS or other conditions with significant fatigue and reduced exertion tolerance

• Neurodivergence: In my clinical experience, ADHD and autism are also commonly reported among people I support with hypermobility

The combination of EDS, POTS, and MCAS is sometimes informally called the ‘trifecta’. However, this term doesn’t establish that the three conditions share a single cause.

A 2020 review by Kohn and Chang found insufficient evidence to establish a relationship between hEDS, POTS, and MCAS. While these conditions are often discussed together, there’s still no clear answer as to why they often seem to come in sets.

Why might hypermobility overlap with pain and fatigue?

There are several potential explanations for why people with symptomatic hypermobility may experience pain and fatigue. These involve connective tissue, joint stability, and nervous system processing, but we don’t understand the exact mechanisms just yet.

Connective tissue and pain processing

Connective tissue contains sensory nerves that provide information about joint position, movement, and tissue health. One theory is that differences in connective tissue affect this sensory information, potentially contributing to altered pain processing.

Joint instability can also contribute more directly to pain. For example, repeated hyperextension, subluxations, or dislocations can place stress on surrounding tissues.

These explanations might help explain some symptoms, but they don’t mean all pain in hypermobility has the same cause.

Why fatigue can be part of the picture

Fatigue may partly relate to how much effort is required to maintain joint stability. When connective tissue provides less support, muscles may need to work harder to control movement and maintain posture.

Pain, nervous system activity, and co-existing conditions can also contribute to fatigue. This is why it’s important to understand the full symptom picture rather than assuming fatigue is simply caused by weak muscles or a lack of fitness.

Why can treating hypermobility in isolation be difficult?

Strengthening muscles and improving proprioception can be important parts of managing symptomatic hypermobility. However, a joint-only approach usually doesn’t address the broader symptoms that affect someone’s ability to participate in treatment.

Looking beyond joint stability

For example, someone may need to improve their shoulder or knee stability but also experience POTS, significant fatigue, or chronic pain. A standard exercise program may be difficult to tolerate if it doesn’t account for those additional symptoms.

This means treatment may need to consider:

• How pain affects movement and recovery

• Whether fatigue limits activity duration or frequency

• Whether upright positions increase POTS symptoms

• Whether MCAS or other conditions create additional limitations

• How several conditions interact during everyday activities

The aim is to develop an approach that supports joint stability without unnecessarily aggravating other symptoms.

How can you balance strength work with symptom limits?

Strength training can build muscular support around hypermobile joints, but the amount and type of exercise needs to be within your overall capacity. When you have other conditions, this may mean adapting the usual approach to strengthening.

Adjusting exercise to your tolerance

Depending on your symptoms, we may need to:

• Reduce exercise intensity or resistance

• Shorten the duration of a session

• Allow more recovery between activities

• Modify movements that aggravate pain or instability

• Avoid or reduce upright positions when orthostatic symptoms are a concern

The goal isn’t to avoid movement altogether, but to find a starting point that lets you work on stability without repeatedly triggering pain or fatigue flares.

How does pacing help with overlapping conditions?

Pacing involves working within your capacity and tolerance. When several conditions overlap, it can help you balance activity and rest without repeatedly aggravating one condition while managing another.

Finding a sustainable balance

For example, an exercise may feel manageable for your joints but still trigger significant fatigue or orthostatic symptoms. Pacing means considering the overall response rather than judging an activity by joint pain alone.

This may involve:

• Identifying how much activity you can currently tolerate

• Recognising early signs that symptoms are increasing

• Stopping or adjusting before overexertion

• Planning rest and recovery around activity

• Reviewing your response before changing the load or duration

It can be a tricky balance to get right. The aim is to work within your current capacity and avoid repeated flare-ups, rather than follow a fixed progression.

What my approach to managing overlapping conditions involves

My approach begins with a thorough assessment of your health conditions, symptoms, and main challenges. Before exploring exercise, I want to understand what may be limiting your capacity and what safeguards you need in place.

Starting with the whole picture

We may begin by discussing:

1. Your health conditions: Which diagnoses and symptoms are affecting you?

2. Your main challenges: What is making daily life or movement difficult?

3. Your current capacity: What activities can you manage, and what tends to aggravate symptoms?

4. Barriers to progress: Are pain, fatigue, POTS, MCAS, or other factors limiting what you can safely tolerate?

5. Appropriate safeguards: What needs to be considered before introducing or changing exercise?

From there, we can explore movement and strength strategies that reflect your overall health, rather than treating hypermobility on its own.

Frequently asked questions about managing hypermobility

• Is it common to have POTS and hypermobility together?

  Many people with POTS frequently report having HSD and hEDS, but the reasons for this aren’t fully understood. Having one condition doesn’t mean you will necessarily develop another.

• What is the EDS, POTS, and MCAS trifecta?

  The ‘trifecta’ is an informal term used to describe EDS, POTS, and MCAS together. It’s not a separate diagnosis, and research hasn’t established a single mechanism linking all three conditions.

• Can hypermobility cause chronic pain?

  Symptomatic hypermobility can contribute to pain through joint instability, repeated hyperextension, and altered movement control. However, pain can have several factors contributing to it and should be assessed individually.

• Why am I so tired if I have hypermobility?

  Fatigue can relate to the effort required to maintain joint stability, pain, or co-existing conditions. It’s important to consider the full symptom picture rather than assuming fatigue is simply caused by a lack of fitness.

• Can I strength train if I have hypermobility and POTS?

  Strength training can still be appropriate, but you might need to adapt exercises to your symptoms and overall capacity. This can include reducing load or duration and modifying upright positions.

• How does pacing help when I have several conditions?

  Pacing helps you work within your overall tolerance rather than focusing on one symptom alone. It can help you balance activity and rest while reducing the risk of aggravating pain, fatigue, or other symptoms.

• What if exercise makes my symptoms worse?

  You may need to modify exercise if it causes pain or makes your symptoms worse. A thorough assessment can help identify whether you need to adjust the load, duration, position, or type of movement.

Finding an approach that considers the whole picture

Managing hypermobility syndrome and other chronic conditions can be challenging when several symptoms affect your capacity at once. You don’t need to approach each condition as though it exists in isolation.

At Heal & Thrive, I provide personalised telehealth support that considers your health conditions, current capacity, and goals. By identifying barriers and finding ways to work around them safely, we can explore practical ways to manage symptoms and build towards activities that matter to you.