Physical Therapy for Joint Hypermobility

Physical Therapy for Joint Hypermobility

Physical therapy for joint hypermobility uses strength, balance, and movement control exercises to help reduce pain and provide better support for the joints. Hypermobility means that the joints move farther than usual. It does not automatically require treatment: some people experience neither pain nor difficulty. If you’d like to learn more about this condition, its causes, and its symptoms, check out our comprehensive guide to joint hypermobility.

Exercise can help improve symptoms and daily activities. Results vary from person to person, and studies do not allow for a one-size-fits-all program. The physical therapist will tailor the exercises to your needs and your progress.

How does physical therapy help people with hypermobility?

Physical therapy helps people with hypermobility build strength, gain better control over their movements, and resume their activities. ¹Ligaments—bands of tissue that connect bones—contribute to stability. Muscles provide active support that can be trained. Treatment does not involve mechanically tightening all the ligaments.

Le programme travaille la force des muscles autour des articulations, la proprioception, c’est-à-dire la perception de leur position, et le Neuromuscular control, la coordination des muscles pendant un geste. Les exercices et l’entraînement des mouvements sont soutenus pour les personnes avec HSD ou syndrome d’Ehlers-Danlos hypermobile, appelé hEDS.² Les études restent variées et ne déterminent pas une dose idéale pour chacun.

Our physical therapists assess muscle and joint pain and then tailor exercises and advice to your specific challenges. The goal is to help you resume the activities that matter to you, taking into account your stability, fatigue, and other health issues.

Your physical therapist will conduct an evaluation to identify the factors contributing to your pain. Depending on your symptoms, this evaluation may include the following:

• The possible movements of your joint
• The sensitivity and response of nerves to movement
• Control and fluidity of your movements
• Your strength and your ability to control joint movement during activities

Based on the results of the evaluation, your physical therapist may:

• Use your hands to guide the movements of nearby joints that move less
• Suggest exercises to build strength and improve control of your joint
• Choose exercises to help you learn how to control your movements
• Work with you to adjust the duration, frequency, and intensity of your activities based on your symptoms and recovery
• Provide tips on how to vary your posture and adjust your movements.

The program aims to improve joint control and make activities easier. The exercises work on both muscle strength and movement awareness ³, and research on generalized disorders supports these exercises and the development of movement control ². The physical therapist selects the range and direction of movement based on the patient’s abilities, symptoms, and target activities.

What physical therapy exercises are recommended for hypermobility?

Exercises for hypermobility include muscle strengthening, balance exercises, and movement control exercises. They may include a modified chair rise, balance exercises near a support, and slow movements with resistance. The choice and difficulty level depend on which joints are painful and on your abilities.

Targeted muscle strengthening

Les exercices de renforcement sollicitent les muscles qui soutiennent les articulations. Une contraction excentrique fait travailler le muscle pendant qu’il s’allonge, par exemple quand vous ralentissez la descente vers une chaise. Des améliorations étaient rapportées avec l’exercice, sans preuve convaincante qu’un type précis soit meilleur qu’un autre.⁴ Les recherches plus récentes permettent de préciser certains choix, sans imposer un seul programme.

Depending on your needs, the physical therapist will work on the quadriceps at the front of the thighs and the hamstrings at the back, the abdominal and back muscles for core strength, or the rotator cuff—a group of four muscles that help support and rotate the shoulder. The therapist will adjust the resistance and number of repetitions based on your control and recovery.

After an initial traumatic shoulder dislocation caused by an injury, greater laxity—that is, more play in the joint—is associated with a higher rate of recurrent instability. ⁵ Follow-up care takes this risk into account without predicting whether another dislocation will occur.

Proprioceptive Exercises

Proprioception allows you to sense the position of a joint without looking at it. It may be less accurate in some people with hypermobility. Appropriate exercises can improve this perception and reduce pain. ^{6, 7} One example is standing on one leg near a stable counter, using your hand for support if needed. A less stable surface or closing your eyes should only be added if the exercise remains under control and a fall can be prevented.

Neuromuscular control

Neuromuscular control exercises help improve muscle coordination during a movement. The physical therapist may have you practice climbing a step or performing a slow arm movement, and then adjust the speed or resistance. The goal is to improve your control over the movements needed for your daily activities, including their range of motion when appropriate. ³

Progression begins with movements you can control. The load, duration, or difficulty is then increased based on your tolerance. It is not necessary to achieve perfect control or to permanently avoid any extension beyond the straight position. New pain, increased instability, or worsening symptoms require a reassessment of the exercise.

How long does physiotherapy treatment last?

Le traitement initial de l’hypermobilité s’étend souvent sur plusieurs semaines ou mois, puis le suivi s’ajuste aux besoins. Les programmes décrits durent de 4 à 8 semaines.⁸ Pour l’épaule, un programme de 16 semaines est décrit plus bas. Ces durées ne prédisent pas votre délai de récupération.

Des conseils seuls ont été comparés à des conseils avec six séances sur quatre mois.⁹ Cette comparaison ne permet pas encore de conclure. Pour l’épaule, chez des adultes ayant des symptômes depuis au moins trois mois, le programme de 16 semaines avec charges élevées et davantage de supervision a davantage amélioré les résultats d’un questionnaire sur les symptômes et les activités liés à l’épaule que celui à faibles charges.¹⁰ La différence moyenne était toutefois inférieure au seuil choisi pour une amélioration jugée importante, et les courbatures et maux de tête étaient plus fréquents.

À un an de suivi¹¹, l’avantage sur le score global n’était plus clair. Certains résultats sur les émotions liées à l’épaule restaient favorables aux charges élevées. Ces résultats soutiennent une progression encadrée, pas le passage automatique à des poids lourds.

Après les premières séances, les exercices peuvent se poursuivre à domicile avec des réévaluations au besoin. La mobilité peut changer avec l’âge, les blessures et l’entraînement; toute hypermobilité n’est donc pas une amplitude figée pour la vie. Certaines prédispositions familiales et certains symptômes peuvent toutefois durer.¹² Cette variabilité est aussi décrite pour le hEDS.¹³ La fréquence des rencontres dépend de vos besoins, par exemple après une blessure ou un changement des symptômes.

A specific issue, such as instability between the skull and the upper neck, may require a medical evaluation and specially tailored exercises. ¹⁴

The duration of treatment depends on the affected joints, pain, fatigue, other health issues, and your goals. The physical therapist also takes into account any barriers to exercise, such as a lack of energy or daily life constraints. Slow progress does not necessarily mean you are not trying hard enough.

Physical therapy aims to help you become more independent in choosing your activities and managing your symptoms. Some people need reassessments at various times; this does not mean that regular sessions will be necessary for the rest of your life.

How can you prevent injuries caused by hypermobility?

Injury prevention aims to improve strength, gradually prepare for activities, and adjust movements that cause discomfort. These habits can help you better control your joints; they do not guarantee that you will not get injured.

Adjust positions that become uncomfortable

A position at the end of the range of motion, near the limit of movement, can be adjusted if it becomes uncomfortable. You can then keep your knee slightly bent, adjust the position of your elbow, or switch to a “W” sitting position, with your legs folded to either side. ¹⁵ These are temporary options, not a general prohibition against stretching the joints. The position alone does not prove that a ligament is damaged.

Chez des jeunes de 7 à 16 ans avec douleur du genou, la douleur a diminué avec des exercices jusqu’à la position droite comme avec des exercices allant dans leur extension plus grande.¹⁶ Certains résultats de qualité de vie favorisaient une approche ou l’autre. Ces résultats ne permettent pas de recommander une même amplitude à tous, surtout après une blessure ou une luxation.

Regular preventive maintenance

A routine of strength and balance exercises helps maintain the abilities needed for daily activities. The muscle groups targeted and the frequency of exercise should be tailored to your needs; there is no need to treat asymptomatic hypermobility as if it were an injury. However, the risk may increase in certain situations, particularly in the knee during contact sports. ¹⁷

Appropriate warm-up and cool-down

Un échauffement progressif prépare les gestes de l’activité, par exemple marcher avant d’augmenter la vitesse ou commencer avec une résistance faible. Un muscle raide peut parfois bénéficier d’un étirement doux¹⁸. Le physiothérapeute aide à étirer ce qui est raide sans pousser davantage une articulation déjà très mobile. Il n’est pas utile de chercher toujours plus de souplesse.

Paying attention to body language

Your symptoms and your control over the movement guide any adjustments. If the joint feels like it’s giving way, reduce the difficulty or modify the movement. Take breaks when fatigue makes it harder to control the movement. If pain increases, moves to a different area, or further limits your activities, you should reassess the program rather than push through it.

Joint hypermobility and physical activity: Are they compatible?

Physical activity is compatible with hypermobility as long as the exercises are tailored to your abilities and take into account the precautions associated with your diagnosis. We’ll work with you to choose the right activities; the presence of an unstable joint or another medical condition may require adjustments.

La natation, l’aquaforme, le vélo et les exercices de force peuvent convenir selon vos symptômes. L’eau soutient une partie du poids du corps; le vélo se règle pour permettre un pédalage confortable. Le Pilates et le yoga peuvent aussi être adaptés avec un professionnel informé de votre état. Le but est de contrôler les gestes, pas de pousser toujours plus loin la souplesse. Huit semaines d’exercices à domicile ont amélioré douleur, équilibre et perception de la position du genou.¹⁹ Ce résultat reste à confirmer. Cela ne prouve pas que toutes ces activités donnent le même résultat.

Les sauts répétés, les sports de Contact, la gymnastique et les gestes rapides peuvent demander davantage de préparation ou être déconseillés si l’articulation reste instable. Ces activités demandent une décision individuelle. Les personnes atteintes d’un autre type, comme le syndrome d’Ehlers-Danlos vasculaire qui fragilise les vaisseaux sanguins, ont des précautions particulières et doivent suivre les conseils de leur équipe médicale.

To make progress, choose an activity you can tolerate, gradually increase its duration or difficulty, and allow time for recovery. Combine endurance, strength, and balance exercises as needed. If your symptoms worsen or you lose control, return to a level you can tolerate better and seek advice.

Some hypermobile people participate in intense or competitive sports. Their training takes into account previous injuries, their stability, their recovery, and other health issues. The choice of sport and intensity is discussed on an individual basis; flexibility alone does not determine everything.

What can you do at home for joint hypermobility?

Lorsque l’hypermobilité entraîne des douleurs, la physiothérapie pour l’hypermobilité articulaire aide à stabiliser les articulations concernées. Les soins à la maison combinent des activités adaptées, des pauses et une reprise graduelle des mouvements tolérés. Réduisez temporairement les mouvements qui font trop mal, puis reprenez-les graduellement. Conservez les activités qui restent tolérables. Une attelle, un soutien qui limite certains mouvements, ou un taping, une bande adhésive appliquée sur la peau, peut parfois compléter les soins²⁰. Le taping peut apporter un soulagement temporaire. Chez des personnes ayant un syndrome d’Ehlers-Danlos de type hypermobile et une douleur à l’épaule, deux techniques ont été suivies d’une amélioration de la douleur et des activités à 48 heures. La part d’amélioration attribuable à la bande elle-même reste incertaine²¹. Le professionnel vérifie avec vous si l’aide choisie améliore réellement votre confort et vos activités.

Avoid forcing a painful joint to make it crack or to show how far it can move.

If you don't see any improvement despite these adjustments, consult a physical therapist.

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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.