Condition · 8 min read · 21 Jun 2021

Learn about Joint Hypermobility Pain and how to manage your pain.

Help make sense of what you can do to manage your Joint Hypermobility Pain.

By Dr Pavla Walsh, A/Prof Jane Munro and Ms Alysha Belcher

Joint hypermobility may be localised (fingers, shoulder etc), or generalised (many joints). Young people with generalised joint hypermobility may also show features of increased stretchiness of other soft tissues in the body, such as the skin. At the extreme end of the hypermobile spectrum, people may be described as having hypermobile Ehlers-Danlos Syndrome; this can have implications for general health and is best diagnosed by a doctor.

Joint hypermobility affects about 5% of the population. However, many young people with hypermobile joints never have any particular difficulty. We don’t yet know why some young people are affected more than others. Possible explanations include lifestyle differences, muscle fibre type, loss of muscle strength/ tone, genetic factors, or the presence of other life or environmental stressors.

The pain associated with joint hypermobility can vary; some people have chronic, low-grade pain in the legs, or in specific joints. Others can have pain throughout the body. Some people with hypermobile joints are susceptible to joint subluxation or dislocation (where the joint moves out of its normal position), although this is not necessarily painful.

Understanding how you are affected by this condition is very important, as this will guide your management. Young people who have hypermobile joints do better with a consistent routine to maintain their health, as well as a plan for managing acute pain flares or injuries. Having a team that you trust and can access is important, including a physiotherapist who has specialised knowledge about this condition.

Working with a supportive healthcare practitioner can help you to regain confidence, improve your quality of life, help to increase your functional capacity, and keep you engaged in the things you love to do.

Should I get a scan for my hypermobility?

Scans (xrays or imaging) are not recommended for most young people with joint hypermobility.

If there is a new problem, this should be assessed by your doctor and an appropriate investigation will be considered.

“Scans (xrays or imaging) are not recommended for most young people with joint hypermobility”.

How do I manage my Joint Hypermobility pain?

There is no single specific treatment for joint hypermobility currently available. This is because the underlying problem with joint hypermobility lies with systems of bodily defence that cannot be easily switched off. Management aims to help calm the cycles of pain and find helpful ways to manage it, even when pain is present.

The most recommended treatment is to do with managing lifestyle habits. This includes pacing movement, exercise and activities, cognitive (mind-body) therapies, improving sleep hygiene and a balanced diet.

It’s also important to know that it’s “ok to not be ok” and seek mental health support if you feel low.

A healthcare practitioner can help coach and support you to regain confidence, and improve your mobility and functional capacity, especially if you feel tense, fearful and unsure about what to do.

Ask your healthcare professional what the best evidence is for managing your pain (benefits and risks, costs and what happens if you do nothing). Check out our recommended care fact sheet which includes 5 important questions you need to ask your health professional about your care.

“Understanding that pain does not always mean damage to your body tissues is important”.

Understand the factors that are linked to pain

Understanding the factors (ie. physical and mental health, lifestyle or general wellbeing) linked to your pain is important as it helps you and your health team to target the best way to manage the pain.

Understanding joint hypermobility pain -- what causes it, the different triggers for you, and how stress, tiredness, anxiety and frustration can help you to better manage pain. Identifying other stressors (such as those related to school, study, friendships or family) and managing the feelings that come from these stresses and worries, is usually helpful too.

Moving and staying active helps your joint health and muscle system

Keeping your muscle system strong helps support your hypermobile joints. It’s good to let your coaches or gym instructors about your joint pain so they can help you work out a strengthening plan rather than focusing on stretching. Over-stretching can provoke more pain.

Moving and exercising using a paced way (that is taking the middle road and doing little bits often), and building up gradually over time, is often the best approach. Check out our getting back to what you want to do module.

Daily exercise

Daily exercise helps to boost your own inbuilt pain management systems. Exercise doesn’t mean you have to get hot and sweaty: walking, swimming and bike riding are low impact activities and safe to do. Strengthening exercises can be worked out with your physiotherapist.

Avoid prolonged bed rest (longer than 24 hours)!

Too much bed rest usually isn’t helpful and can lead to poorer general wellbeing and joint pain. If possible, staying at school and continuing to study and work is best, even if you require short-term changes that mean you can continue. Accommodating your needs might mean doing things differently and that’s ok. Keeping engaged in day-to-day activities and maintaining your social connectivity usually means better outcomes e.g. helping you to do the things that matter to you.

Staying positive and protecting your mental health

We know that it can be really hard to stay positive when you have pain and an ongoing health condition. Experiencing low mood, anxiety, fear and many other emotions is very common: when you have pain, this is a normal response.

If you feel low in mood or are looking for ways to manage pain and your mental wellbeing, check out approaching pain. If you feel distressed and can’t cope with the pain, seeking help can be tough. Remember it takes courage to seek help and your team is there for you. Don’t be afraid to ask for help.

Good quality sleep

Sleep is a powerful natural pain ‘medicine’. Getting more than 6-7 hours of sleep a night boosts immune function, lifts mood and reduces tissue sensitivity. Regular sleep times, reducing screen time and avoiding alcohol/caffeine before bed can also improve sleep quality. Relaxation techniques and regular exercise, meditation and relaxation may also help improve sleep: check out the sleep module.

Healthy diet

Extra weight on hypermobile lower limb joints can cause extra pressure and increase pain. Managing weight loss can be hard, but is possible with the right support. Consider seeking help from a dietitian or nutritionist with expertise in this area if you feel this is an issue.

What is safe and best to do when Joint Hypermobility pain persists?

The key to effectively managing persistent pain takes time. Be kind to yourself and seek support from your health team to work out a good care plan. Small gains build in the long term to better health.

A good plan should include:

Understanding the factors that are relevant to your joint pain.
Learning to relax your body particularly when you experience pain.
Building confidence to move and function normally without over-protecting the affected joints.
Gradually getting back to doing the things in life you value.
Making a plan to engage in regular physical activity that you enjoy, to get back to school/work/study and social engagement.
Developing healthy sleep and lifestyle habits.
Learning to manage your stress, worries and mood.
Working out a plan for when pain flares happen.

“The best person to be in control of your pain is you, with good support from your health team”.

What about using medicines?

While medicines may be helpful, they are not for everyone and do come with risks, and should be carefully considered when recommended for young people.

Some young people get pain relief with anti-inflammatory medications. Paracetamol can also be helpful. Generally, stronger medicines are not recommended due to the significant side effects, risks and low level of evidence for benefits. On occasions, using a low dose anti-depressant may help you to regulate your sleep: discuss this with your doctor. For each young person based on their condition, care must be taken to assess benefit against risk.

Getting helpful advice without judgement is important. Remember, your health team is there to support any questions you might have about medicine use.

Helpful summary of tips to manage Joint Hypermobility pain

Pain can mean we become over-protective, stopping valued life activities. If pain is getting in the way of your valued activities, try checking out our making sense of pain module.

Look back at your small gains, so you can see you are making progress.

Be reassured that it is normal to experience pain as you move. Muscle stiffness pain is usually adaptive and eases as you progress your activity, movement and exercise.

Listening to your body and taking things gently and gradually increasing is the key.

“Sustaining your efforts brings rewards”.

The following outline specific approaches to help you manage your pain and joint health:

Set yourself little tasks you can achieve TODAY.
A regular sleep routine is very important – a dark room, same time, and some quiet music may help. Check out our sleep and pain
Pace your activities: this means doing small bits often or taking the middle road, rather than overdoing or underdoing. This also helps to conserve energy. See our getting back to what you want to do module
Exercise a little every day. Doing exercise you like, means that you are more likely to do it, even if this is only a short walk.
Exercise is good for your general well-being, your mood, heart and lungs, joints and muscles, your balance and your bone health. Check out the movement with pain.
Gentle stretching and relaxation are often useful options. Try changing positions frequently rather than staying in one position for extended periods.
Planning your school, work, and social activities ahead helps you think about ways you can better manage challenging situations or pain flares. Possibly only going for part of the function rather than all will help manage your energy levels and pain levels.
Asking your family or friends to help where possible, may not only help you but also help them to understand your condition.
Keeping socially engaged as well as staying at school or work if possible will help you recover better and sooner
Low mood, anxiety and fear are common when you have pain and can be helped with the right support and care. Check out our approaching pain module for help

Want more information?

For more information visit Cochrane Plain Language Summaries and download the consumer’s guide to managing hypermobility.

Hypermobility recommended care (PDF)

Download a summary of quick tips and information to help you understand and manage Joint Hypermobility.

Arthritis Australia - Hypermobility syndrome

A range of audio guides to help you be more in control over how you feel by Stanford University.

Ehlers Danlos