Hypermobility Spectrum Disorder (HSD)
What is Hypermobility Spectrum Disorder (HSD)?
Hypermobility spectrum disorder (HSD) is a connective tissue disorder that causes joint hypermobility, instability, injury, and pain. Other problems such as fatigue, headaches, GI problems, and autonomic dysfunction are often seen as part of HSD.
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What is hypermobility?
Joint hypermobility means that a person’s joints have a greater range of motion than is expected or typical.
Most babies and children are naturally very flexible. Many people become less flexible as they grow, but hypermobility continues into adulthood for some, up to about 20% of people. Being “flexible,” “bendy,” or “double-jointed” is not usually a problem, and for some, like dancers or gymnasts, it is an advantage. Hypermobility that does not cause pain or other symptoms is referred to as “asymptomatic joint hypermobility” and does not need to be treated.
The problem occurs when joints are not just hypermobile but are also unstable. Joint instability occurs when the bones of a joint aren’t held in place securely. This can lead to joint subluxations, dislocations, sprains, and other injuries. Joint instability can cause both acute and chronic pain and interfere with daily life.
Joint hypermobility and/or instability may be a person’s only problem. It can also occur as part of a known syndrome, such as types of Ehlers-Danlos syndromes (EDS), Marfan syndrome, or Down syndrome. Hypermobility spectrum disorder occurs when a person has symptomatic joint hypermobility that cannot be explained by other conditions. A person with HSD may have joint instability as their only concern or may have other medical issues as well.
People with hypermobility often experience chronic pain for several reasons:
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Muscles must work harder to stabilize loose joints
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Repeated micro-injuries can occur from joint instability
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The nervous system may become more sensitive over time
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Fatigue and overuse patterns develop
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What is a spectrum disorder?
A spectrum disorder refers to a condition that has wide variation in both the type and severity of symptoms people experience. For example, people with HSD may have mild or severe joint involvement. They may also experience one, two, or many other symptoms such as fatigue, dizziness, constipation, or headaches, and any of these problems may be mild or severe.
HSD is often co-occuring with other conditions. Two people with HSD may have different comorbidities so HSD is not the same for everyone.
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What is Hypermobility Spectrum Disorder (HSD)?
Hypermobility spectrum disorder (HSD) is a connective tissue disorder that causes joint hypermobility, instability, injury, and pain. Other problems such as fatigue, headaches, GI problems, and autonomic dysfunction are often seen as part of HSD.
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What are the types of HSD?
Four types of HSD are described, based on the type of joint hypermobility present.
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Generalized HSD (G-HSD): HSD in which joint hypermobility occurs throughout the body
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Peripheral HSD (P-HSD): HSD in which joint hypermobility is limited to the hands and feet
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Localized HSD (L-HSD): HSD in which joint hypermobility occurs in a single joint or group of joints in the same area
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Historical HSD (H-HSD): HSD in which there is history of generalized joint hypermobility, but without current evidence of generalized joint hypermobility on exam.
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How is HSD identified?
Many people can recognize that their joints are able to move more than other people’s. A doctor or physical therapist can evaluate a person’s joints to determine if they are hypermobile. For some joints, a tool called a goniometer is used to measure how far the joint can extend. An experienced clinician can determine whether other joints move more than the normal range of motion.
One way to assess generalized joint hypermobility is with the Beighton Score, which measures joint hypermobility on a 9-point scale. One point is given for each of the following joints that show hypermobility on exam:
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Base of the right 5th (pinky) finger
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Base of the left 5th (pinky) finger
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Base of the right thumb
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Base of the left thumb
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Right elbow
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Left elbow
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Right knee
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Left knee
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Lower spine
A positive Beighton score is any score greater than or equal to 5/9 points in adults, 6/9 points in children (before puberty), and 4/9 points in adults over age 50.
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Can HSD cause chronic pain?
Yes. When joints move beyond their optimal range, muscles often work harder to stabilize them. Over time this can lead to fatigue, recurring muscle tension, joint irritation, and chronic pain.
Should people with HSD stretch?
Excessive stretching is not recommended because hypermobile joints already move beyond the normal range. Instead, treatment often focuses on improving joint stability, muscle control, and load tolerance.
What type of exercise is best for HSD?
Exercises that build stability, coordination, and gradual strength are often most helpful. This may include controlled strengthening, proprioception training, and movements that improve joint control rather than extreme range of motion.
Can physical therapy help HSD?
Yes. Physical therapy can help improve joint stability, muscle coordination, and movement confidence. Treatment is typically individualized to focus on strengthening, nervous system regulation, and gradual increases in activity.
Do you treat HSD in Waco, TX?
Yes. Our clinic specializes in working with individuals experiencing hypermobility-related pain, joint instability, and chronic symptoms. Treatment focuses on improving stability, building load tolerance, and helping patients move with greater confidence.
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How is HSD different than hEDS?
Since there is not yet a definitive diagnostic test for HSD or for hEDS, there is no way to absolutely differentiate between the two conditions. Some experts believe that HSD and hEDS are in essence the same condition along a spectrum, some are not sure, and others think that HSD and hEDS are separate, distinct conditions.
It is possible that hEDS and HSD have different underlying causes and that they are truly distinct from each other and from other disorders. It is also possible that hEDS and HSD have a common underlying cause and are not truly separate conditions.
While it is frustrating to not have all the answers yet, this is not unusual. The history of medicine is full of examples of developments in diagnostic criteria and separation of conditions within the same family of disorders as knowledge grows. The hEDS/HSD Working Group of the International Consortium on EDS and HSD is continuing to research and gain better understanding of these conditions.
At present, the principles and types of management are the same for both HSD and hEDS. Both conditions need awareness, recognition, validation, and care. It is fundamentally important that clinicians worldwide know that there are management strategies for both HSD and EDS that can improve the lives of people living with these conditions.
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