Living With Hypermobility: Exercises and Physio for EDS, hEDS and Joint Instability

If everyday activities such as walking around Cornwall Park, commuting across Auckland, exercising, or sitting through a long workday leave you with aching joints, muscle fatigue or a feeling of instability, joint hypermobility may be part of the picture.

Many people live with hypermobility without realising that their symptoms may be connected to how their joints and connective tissues move and respond to load. This guide focuses on what actually helps day to day — the exercise and physiotherapy approach for symptomatic hypermobility, EDS and hEDS.

Not sure whether you're hypermobile in the first place? Start with our guide: Am I hypermobile? Signs of hypermobility, EDS & hEDS.

What happens when joints are hypermobile?

Ligaments and other connective tissues contribute to joint stability. When a joint moves excessively, the surrounding muscles may need to provide additional control. For some people, this can contribute to increased muscular workload and fatigue.

You may notice that you:

• Frequently lock your knees or elbows
• Stand with your joints at their end range
• Roll your ankles easily
• Feel unstable during exercise
• Experience recurring joint or muscle pain
• Have difficulty maintaining a comfortable position for long periods

The goal of rehabilitation is generally not to make a hypermobile person less flexible. Instead, the focus is on improving strength, control, proprioception and the ability to manage everyday and sporting activities.

Joint instability and subluxations

Some people with significant hypermobility experience recurrent episodes where a joint feels unstable or partially moves out of its usual position. These symptoms should be assessed individually.

Joint instability can affect activities such as:

• Walking
• Running
• Squatting
• Lifting
• Reaching overhead
• Playing sport
• Sitting or standing for prolonged periods

If you regularly experience a joint giving way, repeated sprains or suspected dislocations, a healthcare professional can assess the problem and determine whether further investigation or referral is appropriate.

Exercise and physiotherapy for hypermobility

For people experiencing symptomatic hypermobility, physiotherapy can focus on improving strength, movement control and joint stability. A rehabilitation programme may include:

1. Strength and stability

Progressive strengthening can help improve the muscles' ability to support and control hypermobile joints. Depending on your symptoms, this may include exercises for the core, hips, knees, ankles, shoulders and upper back.

2. Proprioception and movement control

Proprioception is your body's ability to sense where a joint is positioned. Exercises can help improve awareness and control, particularly for people who frequently roll their ankles, feel their knees giving way or struggle to control their joints during exercise.

3. Avoiding excessive end-range loading

People with hypermobility may naturally move into positions such as excessive elbow, knee or spinal extension. Learning to perform exercises with controlled joint positioning can help reduce unnecessary loading and improve movement efficiency.

4. Gradual return to sport

If you play football, netball, run, do gymnastics, dance or another sport, rehabilitation can be tailored to your specific requirements. The goal is to help you build the strength and control needed for your sport rather than simply telling you to stop being active — see our sports rehabilitation approach.

5. Pacing and activity management

Some people with hypermobility experience increased symptoms after doing too much activity at once. Learning how to gradually increase activity while allowing adequate recovery can help make exercise and daily activities more manageable.

6. Taping and support

Depending on the individual, physiotherapy may include advice around taping, bracing or other forms of external support. These strategies should complement, rather than replace, appropriate strengthening and movement rehabilitation.

Hypermobility and everyday life in Auckland

Living with hypermobility can present challenges during everyday activities. Auckland's environment can involve plenty of walking, stairs, hills, commuting, standing and recreational activities. For someone with joint instability, activities that repeatedly load the knees, hips or ankles may sometimes aggravate symptoms.

This does not mean you need to avoid activity. Instead, learning how to manage your joints and gradually build strength and control can help you participate in the activities that are important to you.

What about EDS and hEDS?

If you have significant hypermobility together with ongoing joint instability, pain or other symptoms, you may wonder whether you have EDS or hEDS. It is important not to self-diagnose based solely on flexibility or a Beighton score.

A physiotherapist can identify concerning patterns and help you understand your movement and functional issues. Where appropriate, your physiotherapist can also recommend discussing further assessment with your GP or another appropriate healthcare professional.

You don't have to stop being active

Having hypermobile joints does not automatically mean that you need to stop exercising or participating in sport. In many cases, the focus should be on finding the right balance between:

Movement + Strength + Control + Recovery

With an appropriate rehabilitation programme, people with symptomatic hypermobility can work towards improving their strength, confidence and ability to participate in everyday activities and sport.

How AZ Physiotherapy can help

At AZ Physiotherapy, we provide assessment and rehabilitation for hypermobility and EDS. Our physiotherapy approach may include:

• Joint and movement assessment
• Strength and stability exercises
• Proprioception and movement-control training
• Exercise programmes
• Manual therapy and soft tissue techniques where appropriate
• Taping and support strategies
• Sports rehabilitation
• Advice on activity modification and gradual return to sport

If you experience frequent joint pain, instability, recurrent ankle rolling, excessive joint movement or difficulty controlling your joints during exercise, an assessment can help identify areas that may benefit from targeted rehabilitation.

Book a hypermobility assessment in Auckland

If you are in East Auckland, near our clinic in Pakuranga, or in the surrounding areas, book an assessment to discuss your joint hypermobility or symptoms. No GP referral is needed.

You don't have to give up the activities you enjoy. The right rehabilitation approach can help you move with greater strength, control and confidence.

Sources

• Healthify (NZ): Ehlers-Danlos syndrome (EDS)
• Ehlers-Danlos Syndromes Aotearoa NZ: NZ Hypermobility and EDS Guideline 2019