Movement for People With Hypermobility and Ehlers-Danlos Syndromes

Why this matters for yoga

Yoga classes often reward flexibility, and people with very mobile joints may find deep positions easy. That is not the same as safe. This page covers what hypermobility and the Ehlers-Danlos syndromes (EDS) are, what research says about exercise, and how to approach yoga or similar movement carefully. It is information only and not a diagnosis or treatment plan. For the yoga-specific cautions, read yoga and hypermobility: joint instability cautions.

Hypermobility, HSD and EDS in brief

The Ehlers-Danlos Society explains that joint hypermobility means joints have a greater range of motion than expected, and that it continues into adulthood for some, up to about 20% of people. [1] Being "flexible" or "double-jointed" is not usually a problem. [1] The trouble arises when joints are also unstable, meaning the bones are not held in place securely, which can lead to subluxations, dislocations, sprains and other injuries. [1]

The NHS describes hypermobile EDS (hEDS) as the most common type. [2] People with hypermobility spectrum disorder (HSD) have problems from hypermobility without one of the specific EDS conditions, and the NHS says HSD is treated in the same way as hEDS. [2] Vascular EDS is a rare type that affects the blood vessels and internal organs, which can split open and cause life-threatening bleeding. [2] If you or a family member has been told you have a rarer EDS type, ask your specialist what movement is appropriate before any class.

What exercise advice says

• The NHS says there is no specific treatment for EDS but many symptoms can be managed with support, and a physiotherapist can teach exercises to strengthen joints, avoid injuries and manage pain. [2]
• It says to be careful about activities that strain your joints, but not to be overprotective. [2]
• Advice depends on the type of EDS. Some people may be advised to avoid heavy lifting and contact sports, and lower-risk activities such as swimming or pilates may be recommended. [2]
• For hypermobility more generally, the NHS says the main treatment is improving muscle strength and fitness so joints are better protected, and advises not overextending joints just because you can. [3]
• It recommends gentle, low-impact exercise to start and pacing, with regular breaks instead of repetitive activity. [3]

What research shows

1. Exercise and rehabilitation in EDS

   promising but limited

   A systematic review of 10 studies (330 people, 5 randomized trials) found all showed some physical or psychological improvement, with one nonserious possible adverse event. [4] Only 2 of the 5 trials were rated high quality. [4]

2. Home exercise for shoulder instability in hEDS/HSD

   promising but limited

   In 21 people, two home programs over 6 months both improved shoulder function, with no difference between them. [5]

3. Online modified Pilates for symptomatic hypermobility

   promising but limited

   In 420 people, an 8-week program improved self-reported function, body awareness and fear of movement compared with a waitlist. [6] Changes were modest, and limits included high drop-out and no way to monitor performance. [6]

4. Yoga in hEDS/HSD

   Proper evidence not found

   See below.

Proper evidence not found: I did not find a controlled trial of yoga in people with HSD or EDS. I searched PubMed for yoga with hypermobility and with Ehlers-Danlos syndrome, and read NHS and Ehlers-Danlos Society pages. A survey of 353 adults with HSD or EDS found that 58% had used yoga, but that describes use, not effect or safety. [7]

The movement trials above are not blinded, and several used waitlist or self-reported outcomes, so expectation can shape results. They also test specific programs designed for this group, which is different from a general class.

Practical points for choosing movement

• Talk with your own clinician or a physiotherapist who knows hypermobility before starting. In the UK, the NHS says a GP or consultant can refer you to physiotherapy and occupational therapy. [2]
• Tell any teacher about your diagnosis. Ask whether they will let you stay well short of your full range and offer strengthening alternatives. See questions to ask a yoga teacher.
• Pace yourself with regular breaks instead of repetitive activity. [3]
• Compare options such as Pilates and adapted yoga and movement, and see over-stretching and movement safety.

This site does not list or recommend teachers or clinics. See physical therapists, yoga teachers and trainers for who does what.