Many people think being flexible is a good thing. Being able to touch your toes, bend your fingers backwards, or effortlessly perform stretches that others struggle with can seem like an advantage. For some people though, being “double-jointed” or unusually flexible is accompanied by persistent pain, fatigue, recurrent injuries, and a sense that their body simply isn’t as stable or reliable as it should be.
Increasingly, researchers and healthcare professionals are recognising the relationship between joint hypermobility and chronic pain. While not everyone who is hypermobile develops symptoms, some people experience significant physical challenges that affect their quality of life.
Understanding why this happens is often the first step towards finding effective ways to manage it.
What Does “Hypermobility” Actually Mean?
Joint hypermobility refers to joints that move beyond the typical range of motion expected when considering a person’s age, sex, and ethnicity.
Some people are naturally more flexible than others. This can be influenced by genetics, age, hormonal factors, and training. Dancers, gymnasts, and yoga practitioners often demonstrate high levels of flexibility without experiencing significant problems. However, hypermobility is not simply about being flexible. A key distinction exists between flexibility and stability.
A joint may move through a large range of motion, but if the structures responsible for controlling that movement are unable to provide adequate support, the joint may become unstable. This can increase the demands placed on muscles, tendons, and other soft tissues, potentially contributing to pain and injury.
So Why Can Being Flexible Lead to Pain?
For many years, hypermobility-related pain was viewed primarily as a mechanical problem. It seemed straightforward: looser ligaments allow more movement, leading to increased strain on muscles and joints, leading to pain. And there is certainly some truth in this.
Research continues to show that joint instability can contribute to:
· Recurrent sprains and strains
· Tendon irritation
· Joint overload
· Muscle fatigue
· Increased risk of subluxations, dislocations or other injuries.
However, modern research suggests that the story may be more complex. Studies published over the last decade have shown that many people with hypermobility-related disorders experience changes in how their nervous system processes sensory information and pain. Some develop features of central sensitisation, where the nervous system becomes more responsive to pain signals.
This means that pain may sometimes persist even when there is no obvious tissue injury occurring, and also in the absence of joint instability or damage.
Many people who are hypermobile, also experience difficulties with proprioception—the body’s ability to sense joint position and movement. If the brain receives less reliable information about where joints are in space, muscles may need to work harder to maintain stability, contributing to fatigue and discomfort.
Pain in hypermobility is therefore often best understood through a combination of biomechanical and nervous system factors rather than a single explanation.
What Does Hypermobility-Related Pain Feel Like?
Symptoms vary considerably from person to person.
Common experiences include:
· Aching joints
· Muscle soreness
· Widespread body pain
· Fatigue
· Frequent sprains or injuries
· Sensations of instability or joints “giving way”
· Neck and back pain
· Headaches
Some people notice symptoms worsen after prolonged standing, repetitive activity, or maintaining one position for long periods. Others find that pain fluctuates unpredictably, with good days and bad days that can be difficult to explain.
Many individuals report feeling exhausted even after activities that seem relatively minor to others. This fatigue is increasingly recognised as a significant part of hypermobility-related conditions rather than simply a consequence of pain.
Is Hypermobility a Condition or Just a Trait?
Not everyone with hypermobile joints has a medical condition. Many people are hypermobile and experience no symptoms whatsoever. Problems arise when hypermobility is associated with pain, instability, fatigue, injuries, or other symptoms that affect daily life.
Healthcare professionals now recognise a spectrum that includes:
Generalised Joint Hypermobility
Increased flexibility without significant symptoms or disability.
Hypermobility Spectrum Disorders (HSD)
Conditions where hypermobility is associated with pain, instability, fatigue, or functional difficulties but does not meet the criteria for a hereditary (genetic) connective tissue disorder.
Hypermobile Ehlers-Danlos Syndrome (hEDS)
A hereditary connective tissue disorder characterised by hypermobility alongside broader symptoms that may include chronic pain, skin changes, autonomic dysfunction, gastrointestinal symptoms, and fatigue.
The distinction between these diagnoses can be complex, but what matters most is understanding how symptoms affect the individual rather than focusing solely on labels.
Why Is It So Often Missed or Dismissed?
Many people spend years searching for answers before receiving a diagnosis. There are several reasons for this.
Firstly, symptoms are often widespread and may involve multiple body systems. Someone might experience joint pain, headaches, fatigue, dizziness, digestive symptoms, and poor sleep without an obvious explanation linking them together. Secondly, standard imaging scans may appear relatively normal despite significant symptoms.
Thirdly, flexibility is frequently viewed as an advantage rather than a potential contributor to health problems. As a result, people may be told that their symptoms are unrelated, exaggerated, or simply due to stress.
While stress can certainly influence pain—as it can in any chronic condition—it is important to recognise that hypermobility-related pain is a biopsychosocial phenomenon supported by a growing body of research.
How Is Hypermobility Diagnosed?
Diagnosis begins with a detailed clinical assessment. Healthcare professionals may use tools such as the Beighton Score, which evaluates flexibility at specific joints. However, diagnosis should never rely solely on a score, and it is entirely possible to have joint hypermobility despite a negative Beighton score.
A comprehensive assessment must also consider:
· Pain history
· Injury history
· Joint instability
· Family history
· Fatigue
· Functional limitations
· Associated symptoms affecting other body systems
Because hypermobility exists on a spectrum, understanding the person’s overall experience is often more important than any single measurement.
What Can You Do to Manage the Pain?
As with most other complex pain conditions, there is no single treatment that works for everyone. The most effective approach is often individualised and may involve a combination of rehabilitation, medical management, lifestyle modifications, and, in selected cases, interventional procedures.
Exercise and Rehabilitation
Current evidence strongly supports appropriately prescribed exercise as a cornerstone of management.
The goal is not to become more flexible.
Instead, treatment focuses on:
· Improving strength
· Enhancing joint stability
· Building endurance
· Improving movement control
· Developing confidence in movement
Physiotherapy programmes that emphasise progressive strengthening and proprioceptive training have demonstrated benefits for pain, function, and quality of life.
Occupational therapy can also help people identify practical strategies to manage symptoms, conserve energy, maintain participation in meaningful activities, and navigate work or daily life demands.
Medications
Medication may help some individuals manage symptoms, particularly during pain flare-ups, but there is no medication that will change the inherent integrity of the joints or connective tissue.
Depending on the individual’s symptoms, options may include:
· Simple analgesics
· Anti-inflammatory medications
· Neuropathic pain medications
· Medications targeting associated symptoms such as headaches or sleep disturbances
The evidence for medication specifically in hypermobility-related pain remains limited, and medications are generally considered one component of a broader management plan rather than a complete solution.
Interventional Pain Management
For some people, particularly those with specific pain generators or significant symptoms that limit rehabilitation, interventional pain management procedures may be considered.
Potential options can include:
· Trigger point injections
· Image-guided joint injections
· Peripheral nerve blocks
· Radiofrequency procedures in carefully selected cases
The evidence base for interventions in hypermobility-related pain is still evolving. While some individuals report meaningful symptom relief, procedures are generally most effective when integrated into a broader rehabilitation strategy rather than used in isolation. Reducing pain may allow greater participation in exercise, rehabilitation, work, and daily activities, which are often key long-term goals.
Psychological Support
Modern pain science recognises that chronic pain affects—and is affected by—the nervous system, emotions, stress levels, sleep, and behaviour.
This does not mean the pain is psychological.
Rather, it acknowledges that pain is a whole-person experience.
Approaches such as cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and pain education may help some people better understand and manage persistent symptoms.
Should You Avoid Exercise If You’re Hypermobile?
This is one of the most common questions people ask.
For most individuals, the answer is no.
Avoiding movement completely can lead to reduced strength, reduced fitness, and greater instability over time. The key is choosing the right type of exercise.
Many experts recommend focusing on:
· Strength training
· Controlled movement
· Balance and proprioceptive exercises
· Gradual progression
Repeated stretching of already hypermobile joints may not always be beneficial and, in some cases, can aggravate symptoms. A healthcare professional specializing in rehabilitation exercise who is familiar with hypermobility can help tailor an exercise programme to individual needs.
Can Lifestyle Changes Make a Difference?
Often, yes.
While lifestyle changes are unlikely to eliminate symptoms entirely, they can influence how the body copes with hypermobility and chronic pain.
Helpful strategies may include:
· Prioritising sleep
· Managing stress
· Pacing activities
· Avoiding prolonged static postures
· Building regular movement into daily routines
· Using joint protection techniques when appropriate
Many people find that small, sustainable changes produce meaningful improvements over time.
When Should You Seek Professional Help?
Consider seeking assessment if you experience:
· Persistent joint pain
· Frequent sprains or injuries
· Recurrent joint dislocations or subluxations
· Significant fatigue
· Symptoms affecting work, exercise, or daily activities
Early recognition can help people access appropriate support and avoid years of frustration and uncertainty.
Final Thoughts
Being highly flexible is not always a problem. For many people, it is simply part of who they are. However, when hypermobility is accompanied by pain, fatigue, instability, or reduced function, it deserves proper attention.
Modern research increasingly shows that hypermobility-related pain is influenced by a combination of connective tissue differences, biomechanics, nervous system sensitivity, and lifestyle factors. Understanding this complexity opens the door to more effective and personalised care. Whether treatment involves exercise, medication, interventional procedures, lifestyle changes, or a combination of approaches, the goal remains the same: helping people move with greater confidence, participate in the activities that matter most, and improve their quality of life.