Ehler’s Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD)

What is EDS/HSD?

Many people are naturally flexible. However, for some individuals, joint hypermobility is associated with chronic pain, joint instability, fatigue, headaches, dizziness, and other complex symptoms that can significantly affect daily life.

Two common conditions associated with symptomatic hypermobility are Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS).

At Foundations Physiatry, we evaluate the full picture of hypermobility-related symptoms and develop individualized treatment plans focused on improving stability, function, and quality of life.

  • Patients with HSD or hEDS may experience:

    • Chronic joint or muscle pain

    • Joint instability, sprains, or subluxations

    • Neck pain or back pain

    • Headaches or migraines

    • Fatigue and brain fog

    • Dizziness or autonomic symptoms

    • Poor body awareness or clumsiness

    • Difficulty tolerating exercise or recovering after activity

  • Diagnosis begins with a detailed medical history and physical examination. At Foundations Physiatry, we evaluate joint hypermobility using the Beighton score as outlined in the 2017 diagnostic criteria, while also considering other joints that may demonstrate hypermobility and contribute to symptoms or functional limitations.

    Our evaluation also includes assessment of associated symptoms and overlapping conditions that may influence how hypermobility affects daily function.

    When appropriate, evaluation may also include screening for and management of related comorbidities, such as Postural Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS), which are sometimes seen in individuals with symptomatic hypermobility.

  • Treatment is individualized and focuses on improving stability, function, and symptom management.

    Treatment strategies may include:

    • Joint stabilization strategies

    • Rehabilitation recommendations, which may include physical therapy and occupational therapy

    • Activity pacing and symptom management

    • Treatment of related pain, headaches, dizziness, and functional and mobility concerns

    • Guidance for long-term stability, including helping patients develop practical strategies and tools to better manage symptom flares over time

Common Conditions Associated with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD)

People with hypermobility conditions may experience symptoms affecting multiple body systems. Some individuals have only joint symptoms, while others develop additional conditions that can contribute to fatigue, pain, or other health concerns.

  • Joint instability and repeated micro-injury can lead to chronic muscle and joint pain. Some patients develop pain patterns similar to fibromyalgia or chronic myofascial pain.

  • The autonomic nervous system regulates heart rate, blood pressure, and circulation. Dysautonomia can cause symptoms such as dizziness when standing, rapid heart rate, fatigue, temperature intolerance, and exercise intolerance.

  • Migraine and chronic headaches are common in hypermobile individuals and may be related to autonomic dysfunction, cervical instability, or altered pain processing.

  • Connective tissue differences can affect the digestive tract, contributing to symptoms such as reflux, constipation, abdominal pain, bloating, irritable bowel syndrome, or delayed stomach emptying.

  • Some patients experience symptoms related to mast cell activation, including flushing, itching, hives, food sensitivities, allergic-type reactions, and gastrointestinal symptoms.

  • Persistent fatigue is common and may be related to dysautonomia, sleep disturbance, chronic pain, or the body’s increased energy demands from joint instability.

  • Individuals with hypermobility may experience insomnia, restless sleep, circadian rhythm disruption, or sleep-disordered breathing.

  • Damage to small nerve fibers can cause burning pain, tingling, numbness, or temperature sensitivity and may also contribute to autonomic symptoms.

  • Pelvic floor dysfunction, bladder pain syndromes, or pelvic organ prolapse may occur due to connective tissue laxity.

  • Some individuals develop structural conditions affecting the spine or the junction between the skull and upper neck. These may include craniocervical instability, Chiari malformation, tethered cord syndrome, or cerebrospinal fluid (CSF) leaks. In some cases, these conditions can contribute to symptoms such as severe headaches, neck pain, neurologic symptoms, or worsening dizziness.

Treatment for EDS/HSD

At Foundations Physiatry, care begins with a comprehensive evaluation focused on understanding the symptoms that are most bothersome and most functionally limiting for each patient. Rather than focusing only on the diagnosis, we prioritize what matters most to you and how your symptoms affect your daily life.

Treatment is developed using an individualized, holistic approach that may include:

  • Targeted rehabilitation plan to improve joint stability and movement patterns

  • Activity modification, pacing, and joint protection strategies

  • Management of musculoskeletal pain, headaches, and dizziness

  • Medication management when appropriate to help control symptoms and improve function

  • Lifestyle medicine and counseling strategies

  • Nutrition guidance to support healing and overall health

  • Sleep optimization and fatigue management

  • Consideration of genetic variations that may influence nutrient processing and detoxification pathways (such as MTHFR and COMT)

  • Procedures such as trigger point injections, joint injections, electrodiagnostic studies (EMG/NCS), and osteopathic manipulative treatment (OMT)

  • Collaboration with a multidisciplinary team of rehabilitation experts and trusted physician specialists in the community

Our goal is to create a comprehensive and practical plan that reduces symptom burden, improves stability and resilience, and helps patients return to meaningful daily activities while supporting long-term health.