Hypermobility & EDS Physical Therapy in Salt Lake City | Mindful Movement PT

Dr. Emily Warren, DPT treats hypermobility spectrum disorders and hypermobile EDS (hEDS) one-on-one at Mindful Movement Physical Therapies in Holladay and Salt Lake City. No referral needed in Utah. Dr. Warren understands the complexity of these conditions — you won’t be dismissed here.

📞 Call: (385) 332-4939
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Quick Answer

Hypermobility — being “double-jointed” or having joints that move beyond their normal range — sounds like a superpower. For many people with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD), it’s anything but. Pain, fatigue, recurrent joint injuries, and a healthcare system that has often dismissed their symptoms define their daily experience. Physical therapy — the right kind, from a PT who understands connective tissue disorders — is the single most evidence-supported intervention for managing hypermobility long-term. Dr. Emily Warren provides specialized hypermobility PT in Salt Lake City, Utah.

What Is Hypermobility — And Why Does It Hurt?

Joint hypermobility means your joints move beyond the range typically considered normal. For some people — gymnasts, dancers, yoga practitioners — this can be an asset. For people with heritable connective tissue disorders, the same extra range of motion comes with a cost: joints that are inadequately supported by ligaments and other passive stabilizers, leaving muscles to work overtime to compensate.

The result is a predictable cascade: muscles fatigue faster, joints sublux or partially dislocate more readily, proprioception (the body’s sense of joint position) is impaired, pain becomes widespread and difficult to localize, and activities that should be normal — sitting at a desk, standing in line, walking — become exhausting.

Hypermobile EDS (hEDS) and hypermobility spectrum disorder (HSD) are the two most common diagnoses in this space. They sit on a spectrum and share many features: generalized joint laxity, recurrent soft tissue injuries, musculoskeletal pain, and often a constellation of associated conditions including POTS, mast cell activation disorder (MCAS), proprioceptive deficits, and fatigue.

Why Standard Physical Therapy Often Fails Hypermobile Patients

Many hypermobile patients have had bad experiences with PT. They’ve been given standard protocols — stretching, generic core exercises, progressive resistance training — that either did nothing or made them worse. There’s a reason for this, and it’s not that PT doesn’t work. It’s that standard PT isn’t designed for hypermobility.

The core error is stretching. Stretching already-hypermobile tissue increases joint laxity further and destabilizes the very joints that need support. Many standard PT approaches also start with too-high loads, too much range of motion training, and not enough attention to proprioception and neuromuscular control — the domains where hypermobile patients actually need the work.

Effective hypermobility PT looks fundamentally different from standard orthopedic PT. It requires a PT who understands connective tissue disorders and adapts their approach accordingly.

What Evidence-Based Hypermobility PT Looks Like

Proprioception and Neuromuscular Retraining

People with hypermobility have measurably impaired joint position sense — their brains receive inaccurate information about where their joints are in space. This makes fine motor control, balance, and joint protection significantly harder. Proprioceptive retraining — exercises that challenge the body’s ability to sense and respond to joint position — is foundational to hypermobility rehab.

This isn’t just balance exercises. It includes slow, controlled movements within a “safe range” (not end-range), perturbation training, closed-chain exercises with proprioceptive feedback, and task-specific training for the activities that matter most to the patient.

Stability Before Mobility

The guiding principle of hypermobility PT is stability before mobility — the opposite of how most PT operates. Rather than increasing range of motion, the goal is to develop sufficient muscular control within the range the patient already has. This means exercises at mid-range, with an emphasis on the muscular co-contraction patterns that substitute for inadequate passive ligamentous support.

Isometric exercises (contraction without movement) are often the appropriate starting point — they build strength and neural recruitment without forcing joints through ranges that stress unstable structures. Over time, eccentric and then concentric loading is added as neuromuscular control improves.

Graded Loading and Pacing

Fatigue is a hallmark of hypermobility conditions. Many patients experience post-exertional malaise — an amplified crash after activity that exceeds their energy envelope. This isn’t deconditioning. It’s a physiological reality that must be built into any treatment program.

Effective hypermobility PT uses a pacing framework: establishing the patient’s current activity tolerance, working consistently at 70–80% of that level, and expanding the envelope incrementally. The “push through it” approach that works for athletes with standard injuries is counterproductive — and often harmful — for hypermobile patients.

Joint Protection Strategies and Activity Modification

Many daily activities stress hypermobile joints in ways the patient may not recognize. Prolonged standing with locked knees, sitting with extreme hip flexion, gripping objects in ways that hyperextend finger joints — these habits accumulate into chronic pain and micro-injury over time.

Dr. Warren teaches joint protection principles that reduce cumulative joint stress while preserving function: bracing recommendations (for patients who benefit from external support), ergonomic adjustments, movement pattern modification, and strategies for high-demand activities like exercise and work.

Addressing the Autonomic Nervous System

Many patients with hEDS and HSD have autonomic nervous system involvement — most commonly POTS (Postural Orthostatic Tachycardia Syndrome), which causes lightheadedness, rapid heart rate, and fatigue when standing. PT has an established role in POTS management: graduated recumbent exercise, compression strategies, and slow posture transition training. Dr. Warren integrates autonomic considerations into hypermobility treatment plans rather than treating the musculoskeletal and autonomic components in isolation.

What the Research Shows

• Exercise reduces pain and improves function: A systematic review in Rheumatology International (2017) found that exercise-based physical therapy significantly reduces pain and disability in hypermobility spectrum disorders, with proprioceptive training showing the strongest effect sizes.
• Proprioceptive deficits are real and modifiable: Studies using force platform testing consistently demonstrate that patients with hEDS have measurably impaired joint position sense compared to controls — and that targeted proprioceptive training improves this deficit (Rombaut et al., 2010).
• Stability-focused PT outperforms general exercise: A 2021 RCT in Physical Therapy found that patients with hypermobility who received a stability-focused PT program had significantly better outcomes at 6 months compared to general exercise — including lower pain scores, better balance, and higher quality of life.
• Aquatic therapy as an adjunct: For patients with severe fatigue or pain that limits land-based exercise, aquatic therapy provides buoyancy that reduces joint loading while allowing meaningful muscular work. Multiple studies support its use in hypermobility and connective tissue disorders.

Common Conditions Associated With Hypermobility

Dr. Warren treats the full spectrum of hypermobility-related conditions:

• Recurrent ankle sprains — chronic lateral ankle instability is extremely common in hypermobility; proprioceptive retraining is highly effective
• Patellofemoral pain and patellar subluxation — the knee cap tracks poorly without adequate dynamic stabilization; VMO strengthening and hip control work is the cornerstone of treatment
• Shoulder instability — multidirectional instability (MDI) is common in hEDS; rotator cuff and periscapular strengthening in stable ranges is the evidence-based approach
• SI joint dysfunction and pelvic girdle pain — ligamentous laxity in the pelvis causes pain and instability, particularly postpartum; core and hip stabilization is central to treatment
• Chronic widespread pain — the central sensitization component of hypermobility is real; treatment integrates pain neuroscience education with graded exercise
• Cervical instability — upper cervical laxity can contribute to headache, dizziness, and neck pain; requires careful assessment before manual therapy

What to Expect at Your First Visit

Dr. Warren begins with a comprehensive assessment that includes:

• Beighton Score — the validated clinical measure of generalized hypermobility (9-point scale)
• Joint-by-joint hypermobility assessment — identifying which joints are hypermobile vs. hypomobile (yes, hypermobile patients often have stiff joints alongside lax ones)
• Proprioception testing — joint position sense, single-leg balance, and dynamic balance under perturbation
• Movement quality assessment — how you move is often more informative than how far you can move
• Fatigue and symptom diary review — understanding your energy envelope and symptom pattern
• Pain map and sensitization screening — central sensitization is common in hypermobility and shapes the treatment approach

From this assessment, Dr. Warren builds a program that is genuinely individualized — not “here’s the standard hypermobility protocol.” The program will evolve as your capacity changes.

Common Questions

I’ve been told I just need to strengthen more. Why hasn’t it helped?

Strengthening is necessary but not sufficient. The issue in hypermobility isn’t just muscle weakness — it’s impaired neuromuscular control, meaning the muscles aren’t being recruited in the right sequence, at the right time, with the right coordination. Piling more resistance onto a poorly controlled movement pattern doesn’t fix the control problem; it can actually reinforce it. Effective hypermobility PT rebuilds the movement pattern first, then layers in load.

Will I always need to do these exercises, or will I eventually not need them?

Because the underlying connective tissue won’t become “normal,” ongoing exercise is important for long-term management. However, the goal is to transition from a structured PT program to a sustainable independent routine — not lifelong PT visits. Most patients reach a maintenance phase where they can manage independently with periodic check-ins during flare-ups or when they want to progress their program.

I was told I have “just hypermobility” and not hEDS. Does it matter for PT?

Not much. The 2017 EDS nosology distinguishes hEDS (meets specific diagnostic criteria) from hypermobility spectrum disorder (HSD, hypermobility causing symptoms but not meeting full hEDS criteria). From a PT standpoint, the treatment approach is essentially the same — the principles of proprioceptive retraining, stability-first loading, and pacing apply regardless of whether the official label is hEDS or HSD.

I’m extremely fatigued — can I even exercise?

Yes, but the starting point needs to match your actual capacity. For patients with severe fatigue, “exercise” might initially mean short bouts of gentle isometric work in bed or chair, with strict pacing protocols to avoid post-exertional worsening. Dr. Warren will meet you where you are, not where a standard protocol assumes you should be. Progress can be very gradual — and that’s appropriate.

Does my hypermobility explain my chronic widespread pain?

It’s likely a significant contributor. Widespread musculoskeletal pain is one of the diagnostic criteria for hEDS, and central sensitization — amplified pain processing in the nervous system — develops in many hypermobile patients over time as a consequence of years of chronic low-level pain and injury. Dr. Warren incorporates pain neuroscience education into treatment for patients with central sensitization, which helps break the cycle of pain-avoidance-deconditioning that perpetuates symptoms.

Hypermobility PT in Salt Lake City

If you have hypermobility spectrum disorder or hEDS — or suspect you might — you deserve care from a physical therapist who understands the nuances of these conditions. Not dismissal, not cookie-cutter protocols, and definitely not instructions to stretch more.

Dr. Emily Warren sees hypermobility patients one-on-one at Mindful Movement Physical Therapies in Holladay and Salt Lake City. No referral needed in Utah.

📞 Call: (385) 332-4939
📅 Book Your Evaluation →

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Dr. Emily Warren, DPT is a McKenzie-certified physical therapist with over 14 years of clinical experience in Salt Lake City, specializing in complex musculoskeletal and connective tissue conditions. She treats patients one-on-one at Mindful Movement Physical Therapies in Holladay, Utah.