What is Joint Hypermobility Syndrome? Symptoms, Causes, and Treatment

What Is Joint Hypermobility Syndrome (JHS)?

Joint Hypermobility Syndrome (JHS), now classified under the broader term Hypermobility Spectrum Disorder (HSD), is a connective tissue condition in which joints move beyond their normal range. Unlike simple flexibility, it is associated with chronic pain, joint instability, and recurrent injuries that may interfere with daily activities.

The condition is linked to an altered collagen structure, causing ligaments and tendons to become excessively elastic and less supportive. It often runs in families, affects females more commonly, and typically begins in childhood or adolescence, with many individuals describing their joints as feeling "loose" or "unstable," especially after physical activity.

Joint Hypermobility vs Joint Hypermobility Syndrome

How Common Is Joint Hypermobility?

Joint hypermobility is fairly common: studies often place it around 10–20% of children/adolescents and young adults, and it tends to decline with age as tissues naturally stiffen.

In contrast, joint hypermobility syndrome (symptomatic hypermobility) is much less common, and prevalence estimates vary depending on the diagnostic criteria used.

Females are affected more often, with studies suggesting they are up to three times more likely to be affected, and many studies note higher rates of hypermobility in people of African-Caribbean/African and Asian descent, suggesting a strong genetic influence.

Symptoms are also frequently missed, especially in children, because pain may be labeled as ‘"growing pains" or attributed to other causes, delaying diagnosis and support.

Causes of Joint Hypermobility Syndrome

Joint hypermobility syndrome stems from multiple interconnected factors, including:

• Genetic collagen defects: Weak or abnormal collagen reduces connective tissue strength and joint stability
• Inherited connective tissue disorders: Often run in families within the hypermobility spectrum
• Ligament laxity: Loose ligaments allow excessive joint movement, causing pain and injury
• Connective tissue protein abnormalities: Defects in elastin and fibrillin weaken tissues overall

Risk Factors for JHS

Several factors can increase the risk of developing joint hypermobility syndrome, including:

• Family history: Hypermobility runs in families
• Female sex: Higher risk due to hormonal effects on connective tissue
• Ethnicity: More common in Asian and Afro-Caribbean groups
• Early onset: Often starts in childhood/adolescence
• Linked conditions: Can overlap with Ehlers-Danlos syndrome
• Hormonal shifts: Puberty and pregnancy may worsen laxity and symptoms

Symptoms of Joint Hypermobility Syndrome

Joint hypermobility syndrome symptoms extend well beyond increased flexibility and can significantly impact your quality of life:

• Chronic joint + muscle pain: Worse after activity/late day; commonly knees, ankles, shoulders, spine
• Persistent fatigue: Ongoing tiredness and reduced stamina, even after adequate rest
• Frequent injuries: Recurrent sprains, strains, subluxations, dislocations with minor trauma
• Poor coordination/balance: Reduced proprioception → clumsiness and falls
• Digestive issues: Reflux, irritable bowel syndrome (IBS)-like symptoms, and constipation
• Autonomic symptoms: Dizziness, palpitations, temperature regulation problems
• Skin changes: Thin/stretchy skin, easy bruising, slow healing, abnormal scarring

Joint Hypermobility in Children

Children with joint hypermobility may appear unusually flexible, often sitting or bending in positions that seem uncomfortable to others. While many children remain symptom-free, some develop pain, clumsiness, or difficulty with prolonged physical activity. Monitoring is important to prevent injuries during growth years.

Complications of Joint Hypermobility Syndrome

Joint hypermobility syndrome complications can affect multiple body systems and significantly impact quality of life:

• Postural orthostatic tachycardia syndrome (POTS): Causing dizziness, fainting, and rapid heart rate upon standing

• Chronic pain syndromes: Persistent pain that may become centralized (amplified by the nervous system) and difficult to treat

• Digestive disorders: Including gastroparesis, chronic constipation, and food intolerances

• Anxiety and depression: Often secondary to chronic pain and functional limitations

• Soft tissue injuries: Recurring muscle strains, tendon problems, and ligament damage

• Autonomic dysfunction: Problems with temperature regulation, blood pressure control, and heart rate variability

• Pelvic organ prolapse: Particularly in women, due to weakened pelvic floor support

Joint Hypermobility & Ehlers-Danlos Syndrome (EDS)

Joint hypermobility syndrome may overlap with genetic connective tissue disorders such as Ehlers-Danlos syndrome. However, not all individuals with JHS have EDS. A proper clinical evaluation helps distinguish between benign hypermobility and inherited syndromes involving skin, blood vessels, or organs.

Beighton Score: How Hypermobility Is Measured

Healthcare providers use the Beighton Score to assess joint hypermobility through a nine-point scale:

• Thumb flexibility: Thumb touches forearm (1 point each hand)
• Little finger extension: Bends beyond 90° (1 point each hand)
• Elbow hyperextension: Elbows bend backwards (1 point each arm)
• Knee hyperextension: Knees bend backwards (1 point each leg)
• Forward flexion: Palms flat on floor with straight legs (1 point)

How Joint Hypermobility Syndrome Is Diagnosed

Diagnosing joint hypermobility syndrome requires a comprehensive approach combining clinical assessment with symptom evaluation:

• Medical history: Family history, symptom pattern, impact on daily life
• Physical exam: Joint range, skin features, muscle strength
• Beighton Score: Standard hypermobility measurement
• Symptom assessment: Pain, fatigue, and functional limitation questionnaires
• Rule-outs: Exclude inflammatory arthritis, autoimmune disease, and other connective tissue disorders

As per the Journal of the Canadian Chiropractic Association, NCBI, Benign Joint Hypermobility Syndrome (BJHS), an older term now largely replaced by HSD terminology, is a heritable connective tissue disorder marked by generalised ligament laxity, chronic musculoskeletal pain, and possible extra-articular features. Diagnosis is primarily clinical, using tools such as the Brighton Criteria and Beighton Score, since there are no definitive laboratory tests; early recognition helps prevent delayed diagnosis and prolonged symptoms.

Tests Used to Rule Out Other Conditions

Several tests help distinguish joint hypermobility syndrome from other medical conditions:

• Blood tests: Inflammatory markers (e.g., CRP), autoimmune markers, and relevant biochemical tests to exclude arthritis or autoimmune disease
• Genetic testing: Targeted tests when inherited connective tissue disorders (e.g., Ehlers-Danlos syndrome) are suspected
• Imaging studies: X-ray, MRI, or ultrasound to assess joint structure and rule out structural abnormalities
• Cardiac evaluation: Echocardiogram (2D) to check for heart valve or connective tissue–related cardiac issues
• Specialist review: Referrals to rheumatologists, geneticists, or cardiologists based on test findings and symptoms

Treatment Options for Joint Hypermobility Syndrome

Joint hypermobility syndrome treatment focuses on managing symptoms and preventing complications through a multidisciplinary approach:

• Physiotherapy: Strengthening to improve joint stability and muscle support
• Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs), topical options, and other pain-relief strategies as advised by a physician
• Occupational therapy: Daily-living aids and workplace/activity modifications
• Psychological support: Counselling and stress management for chronic pain impact
• Nutrition support: Adequate intake to support overall connective tissue health
• Activity modification: Safe movement patterns; avoid high-risk activities
• Bracing/supports: Joint stabilizers when needed to reduce injury risk

Lifestyle Tips for Managing Joint Hypermobility

Daily management strategies can significantly improve symptoms and quality of life:

• Low-impact exercise: Swimming, walking, gentle yoga
• Strength training: Core and joint-supporting muscles
• Good ergonomics: Proper posture and supportive seating
• Heat/cold therapy: Heat for stiffness, cold for pain/swelling
• Stress control: Relaxation to limit symptom flare-ups
• Quality sleep: Practicing good sleep hygiene to aid recovery
• Activity pacing: Break tasks to avoid overexertion
• Joint protection: Avoid overstretching and injury

When Is Surgery Needed?

Surgery for joint hypermobility syndrome is rare and usually considered only for severe problems that don’t improve with conservative care, such as recurrent dislocations that limit function or significant prolapse affecting quality of life.

Because connective tissue may heal poorly, surgery can carry higher risks and complication rates in people with hypermobility. When needed, it should be planned in consultation with specialists experienced in connective tissue disorders, while most patients improve with physiotherapy, lifestyle changes, and medical support.

How to Prevent Complications of Joint Hypermobility

Preventing complications requires proactive management and lifestyle adjustments:

• Regular exercise: Build muscle strength and cardiovascular fitness
• Early care: Address new symptoms or injuries promptly
• Education: Understand the condition and self-management strategies
• Ongoing monitoring: Track symptoms with healthcare guidance
• Healthy habits: Good nutrition, sleep, and stress control
• Joint protection: Safe lifting and movement techniques
• Support network: Family, peers, and healthcare professionals

When to See a Doctor

Seek medical attention if you experience any of these concerning symptoms:

• Persistent joint pain: Especially if it interferes with daily activities or sleep

• Frequent injuries: Recurring sprains, strains, or dislocations from minor activities

• Severe fatigue: Overwhelming tiredness that doesn't improve with rest

• Digestive problems: Ongoing stomach pain, reflux, or bowel irregularities

• Dizziness or fainting: Particularly when standing up or changing positions

• Skin changes: Unusual bruising, slow healing, or abnormal scarring

• Family history: If relatives have been diagnosed with connective tissue disorders

Conclusion

Joint hypermobility syndrome is a manageable condition when identified early and supported with the right medical guidance, lifestyle adjustments, and ongoing monitoring. Timely diagnosis helps reduce pain, prevent complications, and improve joint stability, allowing individuals to maintain mobility and quality of life through personalised treatment and rehabilitation strategies.

Accurate diagnosis plays a key role in effective management. With over 4,000 advanced diagnostic tests, comprehensive full body checkups, and specialty testing, Metropolis Healthcare supports clinicians and patients with reliable insights. Its strong home sample collection network spanning 10,000+ touchpoints, quick turnaround times, and high accuracy standards ensure convenience without compromising quality. Test bookings are seamless via the website, mobile app, call, or WhatsApp, making proactive joint and musculoskeletal health monitoring simple and accessible.

FAQs

What causes joint hypermobility syndrome?

• Genetic factors
• Altered connective tissue structure
• Increased ligament elasticity

Is joint hypermobility syndrome serious?

Joint Hypermobility Syndrome is usually not life-threatening but can significantly affect quality of life if untreated.

Can joint hypermobility be cured?

There is no cure, but symptoms can be effectively managed with appropriate care.

What is the best treatment for hypermobility?

• Physiotherapy
• Muscle strengthening
• Pain management
• Lifestyle modification

Is hypermobility linked to Ehlers-Danlos syndrome?

Yes, some cases overlap with Ehlers-Danlos syndrome, but many people with JHS do not have EDS.

Can you exercise with joint hypermobility?

Yes. Low-impact, controlled exercises are recommended to improve joint stability.

Does hypermobility get worse with age?

Joint flexibility may decrease with age, but pain and stiffness can persist without proper management.

What are the signs of hypermobility in children?

Excessive flexibility, frequent falls, joint pain, and difficulty with endurance.

Does hypermobility cause fatigue?

Yes. Muscle overuse to stabilize joints can lead to fatigue.

Can hypermobility cause anxiety?

Chronic pain and physical limitations may contribute to anxiety in some individuals.