27/12/2025
Joint hypermobility syndrome part 3
It’s been 18-months since I posted part-one and part-two of the joint hypermobility syndrome blogs, and 2025 has been a great, busy and flat-out year but here is the next part where we discuss more things that people with hEDS (Hypermobile Ehlers Danlos) and JHS (Joint hypermobility syndrome) experience. Remember we all experience these things on a spectrum, there are no two of us alike.
DOMS
While exercise is a great form of management for people with hypermobility, DOMS – delayed onset muscle soreness is something everyone has experienced at some point, and experience can range from just simple muscle tenderness to severe and debilitating pain for many of my hypermobile clients. Typically, most people experience it 24-48 hours post exercise.
People with hypermobility experience worse DOMS related pain and require more rest and recovery between exercise sessions. Some literature points to this being connective tissue damage (fascia) as well as micro-trauma of the muscle fibers. Pain is also not limited to the exercised area either which suggest that it involves connective tissue damage.
There have been several theories proposed as to why hypermobile populations experience greater pain and DOMS after exercise.
1) Lactic acid – it is a common misconception that lactic acid causes DOMS. This was debunked decades ago; it clears the system in 30-60 minutes.
2) Muscle spasm – while muscle spasms are a part of DOMS, they can be experienced more sharply and acutely in the hypermobile population. The muscle spasms can exacerbate the pain experienced.
3) Connective tissue damage – Hydroxyproline, an abundant protein in connective tissue, is shown to be very elevated in hypermobile populations, particularly 48-78hrs post-exercise. When Hydroxyproline metabolism is imbalanced, it leads to the accumulation of toxic byproducts and the degradation of essential collagen structures.
4) Muscle damage in the form of micro-trauma increases during exercise and raised levels of creatine kinase are an indicator of this tissue damage. However, these elevated levels do not cause pain.
5) Inflammation - Inflammation is triggered by microtrauma to the muscle and connective tissue from exercise. Inflammation is, as I often tell people, the conductor to the healing orchestra, and is necessary for the repair process to happen effectively, though the inflammation irritates nerve endings causing pain. Creatine Kinase markers peak between 24-84 hours after exercise.
6) Enzyme efflux – is a suggested theory whereby an accumulation of calcium builds up in damaged muscles following exercise. This calcium signals particular enzymes which cause muscle breakdown causing further damage the muscle.
Common deficiencies within hypermobile populations –
B12 - is essential for collagen production, nerve function and red blood cell production, and hypermobile populations suffer reduced B12 levels which are also linked to POTS (postural orthostatic tachycardia syndrome) and brain fog. Symptoms of low B12 include muscle weakness and pain, fatigue, pins & needles or numbness, involuntary muscle spasms and depression and/or anxiety and cognitive impairment.
Low iron (anemia) – Not only is iron required to transport oxygen via the blood cells and aid with energy production but it also helps us produce dopamine and serotonin in the brain. They are neurotransmitters; dopamine is linked to the reward, pleasure and motivation, while serotonin helps us feel calm and happy. Symptoms of iron deficiency include shortness of breath, extreme fatigue and dizziness.
D3 deficiency – I’ve written posts about the importance of D3 and its essential role within out immune system, bone health and muscle function. Low D3 can present as joint pain, fatigue and higher risk of fractures.
Folate deficiency - Folate is a B9 vitamin which helps us repair our DNA and helps our body produce collagen. Low folate can impair our body’s ability to synthesise collagen. It also elevates homocysteine levels and increased oxidative stress which can cause increased risk of health complications such as neurogenerative disorders and cardiovascular disease. Some papers recommend the most bio-available form of folate - methyl folate (5-MTHF).
Magnesium deficiency – Our bodies need magnesium for over 300 different processes but predominantly magnesium helps us regulate sleep, can help block pain receptors in the body, is instrumental in maintaining gastric function and helps our muscles relax. Magnesium also affects our nerves, so increased muscle cramps and restless legs are one of the symptoms of magnesium deficiency. Be aware though that magnesium can inhibit uptake of anti-biotics.
Its thought that gastrointestinal issues prevalent in hypermobile populations could cause malabsorption within the stomach and gastrointestinal system accounting for some of these deficiencies.
Coccyx pain – Coccydynia, pain in the coccyx region of the spine, is more common in women (5:1 ratio). In most cases, the tip of the coccyx can sublux (slightly move out of position) or be hypermobile. There may be a traumatic event to sick start a flare up of pain, it may also follow from childbirth, however there is not always a traumatic injury. Lower back pain is sometimes present in these cases. Obesity can be a factor in some cases because it decreases pelvic rotation during sitting.
Symptoms include pain on sitting, made worse by standing up. Relief of pain when sitting on their legs or sitting only on one buttock. A frequent need to open the bowels and pain during defecation.
Dysphagia – This is a medical term for difficulty when swallowing and can be painful and in some cases downright impossible. It can come from dysfunction of the oesophageal sphincter and its failure to relax. This can present as coughing or choking while eating, having the sensation of food being caught in your throat or food coming back up, possible through the nose.
TMJ issues – Temporomandibular joint (TMJ) dysfunction presents a facial pain on both palpation of the area and moving the joint when talking and eating. The (TMJ) consists of the temporal bone (part of the skull) and the head of the mandible (jaw bone). There is an interarticular disc which can become dislocated (anterior dislocations are more common in some people) and a lot of fibrocartilage that is resistant to sheer forces so quite good for this type of high-use joint. I treat a lot of people with dry needling for this and while it doesn't help in every single case, it works for the majority.
Tinnitus – Described as a buzzing or ringing in your ears. Sadly, very common with hEDS or JHS populations due to connective tissue issues affecting the stability of the bones in the middle ear, making them unstable. This can be further exacerbated by TMJ issues and instability of the cervical spine. Chronic fatigue and stress can affect symptoms as well as can menopause.
Scarring – Hypermobile populations are more likely to experience atrophic and even keloid scarring. As I like to say to my hypermobile clients, we have bronze standard collagen, not gold standard collagen so this leads to skin that is more fragile and paper-like tissue that can sink down. We also deal with delayed or poor healing as discussed previously. They will often widen and thin over time.
Small fibre neuropathy – This term refers to damage, dysfunction or impairment of the nerve fibres that carry pain signals to first the spinal cord, then to the brain. We call these nerve fibres nociceptors and there are two types; C fibres are slow transmitting and unmyelinated (uninsulated) fibres that transmit the slow deep burning and unremitting pain. In contrast, A-delta fibres carry sharp shooting pain because they have slightly better myelination (insulation) so transmit their signal faster to the spinal cord (and then brain). This condition can start at the feet with a burning sensation but can also manifest as decreased sensation and pain. It can stem from diabetes, but it can also stem from autoimmune disorders or develop for neither of those reasons.
It can affect temperature sensitivity and autonomic functions of the body like sweating, heart rate, and digestion. It can also develop into fatigue, sleep disturbances, cognitive function and headaches.
