Hypermobility spectrum disorders are a group of conditions affecting the tissues that connect body parts. HSDs cause increased flexibility in joints throughout the body. People are born with HSDs, but the symptoms may not become apparent until later in life.

Some degree of joint hypermobility in children is typical. Joints gain stability as they mature. However, people with HSDs have joint looseness that persists throughout the life span. They may also have other musculoskeletal symptoms, such as:

• Chronic pain.
• Altered balance or sense of joint position (proprioception).
• Flat feet.
• Scoliosis.
• Kyphosis.
• Frequent injuries due to joint instability.
• Early onset osteoarthritis.

Symptoms of HSDs vary from person to person and can range from mild to severe. There are four different types of HSD. Their diagnosis depends on the body parts and joints affected. The types of HSD are:

Generalized. With G-HSD, most joints are hypermobile. Adults with HSD score 5 or greater out of 9 points, and children score 6 or greater out of 9 points on the Beighton scale,* a measure to specifically screen for joint hypermobility. They have at least two additional musculoskeletal (muscle, bone, joint, tissue) symptoms. These can include frequent joint dislocations, frequent ankle sprains, chronic joint pain, easy bruising, and early onset joint arthritis.

Peripheral. Joint looseness is predominantly found in a person’s hands and feet. They also have at least one other musculoskeletal symptom.

Localized. Excessive joint laxity is found in a small grouping of joints or in one particular area of the body. There are one or more musculoskeletal symptoms.

Historical. H-HSD is diagnosed later in life based on a self-report of generalized joint hypermobility. However, the person does not score high on the Beighton* scale. They have one or more musculoskeletal symptoms. They may also have a rheumatologic condition (inflammation).

*The Beighton scale assesses for hypermobility at nine different joints in the body with each joint scoring one point if excessive mobility is demonstrated on testing.

Another condition affecting joint hypermobility is hypermobile Ehlers-Danlos syndrome. hEDS can range from mild to severe. hEDS is a genetically linked, systemic syndrome that results in more severe and wide-ranging symptoms than HSD. With hEDS all connective tissues in the body, not just joints and ligaments, can be involved. Those with hEDS often have digestive and circulatory issues in addition to joint hypermobility. To be diagnosed with hEDS, a person must demonstrate an additional system involvement, in addition to hypermobile joints, and have a positive family history of the disease. hEDS is a specific “type” of EDS. “Ehlers-Danlos” is a group of 13 genetically linked connective tissue disorders. Depending on the specific genetic type, different tissues of the body are significantly affected or impaired. Not all those with EDS have joint hypermobility.

People with hypermobile joints should seek an evaluation by their physician or physical therapist.

Hypermobility spectrum disorders are not genetic conditions. While people are born with HSD, they are not the result of an altered gene. Therefore, they cannot be diagnosed through genetic testing. They are diagnosed through a process of elimination. HSD diagnosis is based on the patient’s medical history and a physical exam. It is made after other conditions have been ruled out. In some states, a physical therapy diagnosis of the condition is sufficient for treatment. In other states, your physical therapist may also refer you to your PCP or an orthopedic specialist for additional evaluation.

Because hypermobility conditions are inherited, they cannot be prevented. Early detection and treatment (before pain develops) may help minimize pain or other impairments. This can enhance your long-term well-being.

All physical therapists are prepared through education and experience to treat conditions such as HSDs. When seeking a provider you may want to consider:

• A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your, or your child’s, condition.

• A physical therapist who is well-versed in the treatment of hypermobility, chronic pain, or other connective tissue disorders.

You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.

• General tips when you're looking for a physical therapist (or any other health care provider):
• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience in helping people manage pain and hypermobile joint conditions when making an appointment.

Be prepared to describe your symptoms in as much detail as possible. Keep a journal of when you experience pain to help your physical therapist identify the best treatment options for you.

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The APTA Academy of Pediatric Physical Therapy contributed to this consumer resource. It is for informational purposes only and is not intended to represent the position of APTA Pediatrics.