Hypermobility Playbook: Stabilize, Strengthen, Thrive

Hypermobility doesn’t have to mean fragility. With the right plan, you can build durable strength, steadier balance, and fewer flare-ups—without living at end range. 

Why this works:

In hypermobility (including hEDS/HSD), lax connective tissue allows joints to drift toward end range, stressing passive tissues and muddying joint position sense (proprioception). The antidote is stability first: better mid-range control, improved body awareness, slow strength, then carefully earned range. Layer in nervous-system regulation, ergonomic tweaks, and smart fueling, and the gains stick.

The Stability Stack (in order)

1. Calm & coordinate (2–5 min).
   • 4–6 slow breaths (longer exhale).
   • “Find neutral”: ribs over pelvis, shoulder blades down/wide, knees soft, feet tripod.
   • Micro-scans: when you feel end-range creep, come back to mid-range.

2. Proprioception before power (5–10 min).
   • Supported holds (30–45 s): wall push, quadruped rock-backs, mini-squat, split-stance shifts.
   • Single-leg balance with knee tracking over the 2nd toe; add slow head turns.
   • Consider light compression or kinesio-tape for extra feedback during practice.

3. Strength that sticks (10–20 min, 2–4×/week).
   • Isometrics → slow tempo → more range (end range last).
   • Isometrics (20–30 s, effort 3–5/10): wall-push, wall-row, wall-sit, bridge hold, calf raise hold.
   • Slow-tempo sets (3-0-3): mini-squat, hip-hinge to box, row, landmine/DB press, wall slide; 6–10 reps × 2–4 sets, leave 1–3 reps “in the tank.”
   • Bias the middle 70–80% of range until you’re symptom-stable for weeks—no bouncing or lock-outs.

4. Endurance & autonomic support (most days).
   Low-impact cardio (walk, bike, row) 15–30 minutes at “chat pace.” If you’re prone to dizziness/fatigue, use recumbent options, hydrate, and progress slowly; compression wear can help on longer days.

5. OT-style joint protection (all day).
   Short tasks, often; neutral wrists/knees/elbows; use handles and rests; sit-stand options; rotate tasks; cushioned footwear for long standing.

6. Flare rules (so you keep momentum).
   During: symptoms ≤3/10. After: back near baseline by the next day. If you overshoot, reduce load/range ~30% for 48–72 hours, keep isometrics and easy walking, then rebuild.

A simple weekly template

• Mon: proprioception + lower-body tempo strength (20–30 min)
• Tue: cardio (20–30 min) + isometrics (10 min)
• Wed: proprioception + upper-body tempo strength (20–30 min)
• Thu: cardio (20 min) + balance circuit (10 min)
• Fri: full-body strength (30–35 min)
• Weekend: one active recovery day, one full rest day

Fueling collagen & recovery

• Protein each meal to support tissue repair and training response.
• Vitamin C + collagen/gelatin pre-loading: preliminary work suggests ~15 g collagen/gelatin with vitamin C 45–60 minutes before tendon-loading may augment collagen synthesis when paired with exercise; individual results vary.
• Micronutrients: aim for a varied diet to cover vitamin C, copper, and zinc (co-factors for collagen cross-linking).
• Hydration, electrolytes, sleep: simple levers that move recovery and autonomic stability.

Mind–body skills

Brief mindfulness/breathing and CBT-style reframes reduce distress and improve follow-through. Choose the smallest meaningful action you can repeat tomorrow; consistency beats heroics.

Smart extras (selectively)

Compression garments for body awareness and balance; task-specific bracing/splints to enable good movement (not avoid it); hands-on care to reduce pain so you can train—remember, the training makes change durable.

Red flags

Rapidly worsening weakness or numbness, new bowel/bladder changes, unremitting night pain, or new/frequent dislocations—seek medical review.

Bottom line: you don’t need to be less hypermobile to be more capable. Stack stability, train the middle, strengthen slowly, fuel well, and protect your joints with smart habits. That’s how you go from bendy to resilient.

References:

1. Engelbert, R. H. H., Juul-Kristensen, B., Pacey, V., Simmonds, J., Rombaut, L., Smith, T. O., & Russek, L. (2017). The evidence-based rationale for physical therapy treatment of joint hypermobility syndrome/EDS-HT. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 158–167.

2. Malfait, F., Francomano, C., Byers, P., et al. (2017). The 2017 international classification of the Ehlers–Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 8–26.

3. Shaw, G., Lee-Barthel, A., Ross, M. L., Wang, B., & Baar, K. (2017). Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. American Journal of Clinical Nutrition, 105(1), 136–143.

4. Yew, K. S., & Kamps-Schmitt, K. A. (2021). Hypermobile Ehlers–Danlos syndrome and hypermobility spectrum disorders. American Family Physician, 103(8), 481–492.