Beyond Growing Pains: Managing Hypermobility Joint Syndrome

By Blanche Leung, Physiotherapist

When I meet people with hypermobility joint syndrome (HJS), many tell me their symptoms first started when they were young and were brushed off as “growing pains.” Over time, it often becomes clear that it’s much more than that. Hypermobility isn’t just about flexible joints. It’s a complex connective tissue condition that can affect the whole body and have a real impact on daily life.

Hypermobility means that the joints move beyond the normal range of motion. Some people are naturally flexible without any issues, but for others, that extra movement can lead to pain, fatigue, and instability. I often describe joint hypermobility as just the tip of the iceberg. Beneath that surface, there are many symptoms that people might not realise are connected, including:

• Chronic pain and fatigue
• Frequent sprains, subluxations, or dislocations
• Digestive issues like reflux, constipation, or bloating
• Autonomic symptoms such as dizziness or heart palpitations (often linked with Postural Orthostatic Tachycardia Syndrome, or POTS)
• Anxiety, brain fog, and sleep disturbances

Because these symptoms can seem unrelated, it’s not uncommon for people to go years without a clear diagnosis or explanation for what’s happening.

To assess flexibility, I often use the Beighton score, which measures how far certain joints move beyond their normal range—like bending your thumb to your forearm or touching your palms flat to the floor. You don’t need a perfect score to be considered hypermobile, and not everyone who’s flexible has symptoms. Some people may also meet the criteria for Ehlers-Danlos Syndrome (EDS), a group of connective tissue disorders. Around 80–90% of EDS cases are hypermobile EDS, but the tricky part is that there’s no specific genetic test for this type yet. That can make diagnosis challenging and sometimes frustrating for patients and clinicians alike.

Source: ehlers-danlos.com

Many children I see with hypermobility have had symptoms since primary school. They might have frequent “growing pains,” struggle with endurance in sports, or complain of headaches, fatigue, or tummy pain. Some find handwriting or sitting still at school difficult because of low muscle tone and joint laxity. Recognising these signs early can make a big difference. Helping children build strength, balance, and coordination through play-based activities can reduce pain and improve confidence over time.

One of the biggest challenges people describe to me isn’t just chronic pain, it’s the constant cycle of injuries and recovery. Research has shown that people with hypermobility value approaches that address both physical and mental wellbeing. Some strategies I often recommend include:

• Gentle daily movement and structured physiotherapy to build strength and stability
• Balance or water-based exercise to reduce strain
• Psychological support to help manage anxiety, fatigue, or trauma from repeated injuries
• Connecting with support groups to share experiences and feel less isolated

I’ve found that support and understanding are just as important as the exercise program itself.

Because the joints and connective tissues can be more fragile, small adjustments can make a big difference. Some of my patients find it helpful to use:

• Adaptive tools like wide-grip cutlery, jar openers, or modified scissors
• Splints or compression gloves for finger and wrist support
• Custom orthotics for lower limb pain
• Weighted blankets to help with sensory regulation and sleep

These tools don’t replace exercise, but they can make daily activities easier while the body gets stronger.

Many people with hypermobility also experience Postural Orthostatic Tachycardia Syndrome (POTS), which happens when the body struggles to regulate blood flow and heart rate upon standing. This can cause dizziness, fatigue, and palpitations. When I support people with POTS, I usually start with horizontal or seated exercises, gradually progressing to upright movements. Strengthening the core and leg muscles together helps improve blood flow and reduce symptoms. Other helpful strategies include:

• Staying well hydrated and increasing salt intake (if safe to do so)
• Using compression garments that cover the calves, thighs, and abdomen
• Incorporating rest and pacing throughout the day

It’s all about going slow and steady to build tolerance safely.

It used to be thought that people with hypermobility should avoid moving into their flexible ranges, but newer research shows that it can be safe, and even beneficial, when done under supervision. The goal is to move with control and confidence, not avoidance. I work closely with other professionals: rheumatologists, podiatrists, exercise physiologists, psychologists, and hand therapists. Because a multidisciplinary approach gives people the best chance to improve their strength, function, and quality of life.

Managing hypermobility joint syndrome can be complex, but progress is absolutely possible. The key is to prioritise, stay patient, and take small steps. My advice to anyone living with this condition: “Start low, go slow. Focus on control and stability before pushing for strength. Stay in touch with your healthcare team, and seek out communities who understand what you’re going through.” With the right guidance, understanding, and support, people with hypermobility can move more freely, manage their symptoms, and live well beyond the “growing pains.”