Exercise is one of the most important tools in managing hEDS and HSD, but it needs to be carefully selected and progressed. When appropriately designed, exercise can improve joint stability, proprioception, strength, and overall function. It can also reduce pain over time by improving muscular support around unstable joints and supporting nervous system regulation.
However, not all exercise is beneficial for hypermobility. Activities that emphasize end-range stretching, high-impact loading, or rapid uncontrolled movements can increase joint instability and contribute to micro-injury. In some cases, this can worsen pain, fatigue, or subluxation frequency.
A key concept is that the goal of exercise in hypermobility is control, not flexibility. Many people with hEDS or HSD are already naturally flexible, so additional stretching often does not improve function and may increase risk. Instead, effective programs prioritize slow, controlled strengthening, mid-range joint stability, and neuromuscular coordination.
Another important consideration is symptom variability. People with hypermobility conditions often experience fluctuations in energy, pain, and autonomic symptoms. Exercise programs usually need to be adjusted based on daily capacity, rather than following a rigid progression model.
A well-designed approach typically includes gradual strengthening, frequent rest periods, and careful attention to post-exertional symptom flares. When done correctly, exercise can be highly beneficial, but when done without adaptation to connective tissue differences, it can contribute to symptom worsening rather than improvement.