One of the more fascinating patterns I’ve noticed in recent years is the number of people walking into the clinic saying, “I was completely fine until I got COVID.”
They’re not describing lingering coughs or loss of taste. Instead, they’re talking about aching joints, overwhelming fatigue, dizziness when standing, shoulders that suddenly feel unstable, knees that no longer trust them on stairs, or a body that simply doesn’t seem to recover from exercise anymore.
As a physiotherapist, I naturally look for injured tissues. Which tendon? Which muscle? Which joint?
But with these patients, the answer is often more complex.
Not everyone who is hypermobile develops pain. In fact, around 10–20% of the population has generalised joint hypermobility, yet only a proportion will ever develop symptoms. Many people have lived their entire lives with more compliant connective tissue, relying on strong muscles, efficient movement patterns and good cardiovascular fitness to provide stability. Their body has learnt to compensate.
Then COVID comes along.
COVID doesn’t suddenly make ligaments stretchier. Instead, it appears capable of disrupting many of the systems that have quietly been compensating for years.
One of the biggest changes we see is deconditioning. Research has consistently shown that muscle strength, aerobic capacity and physical function can remain reduced for months following COVID-19, even after relatively mild infections. For someone with hypermobility, this matters enormously. Muscles don’t simply create movement—they are the primary source of dynamic joint stability. When muscular endurance declines, joints become more difficult to control, tissues experience greater mechanical load, and movements that once felt effortless begin to require significantly more effort.
Over the past few years, studies have demonstrated a growing association between Long COVID and autonomic dysfunction, particularly Postural Orthostatic Tachycardia Syndrome (POTS). Interestingly, autonomic dysfunction has long been recognised as being disproportionately common in people with hypermobility and hypermobile Ehlers-Danlos syndrome. Researchers are now exploring whether underlying connective tissue differences may partly explain why some individuals develop persistent post-viral symptoms after COVID-19.
From a physiotherapy perspective, this creates the perfect storm.
Fatigue reduces activity. Reduced activity weakens muscles. Weaker muscles provide less joint stability. Less stability increases pain. Pain discourages movement, and the cycle continues.
Patients often tell me, “I feel like I’ve aged twenty years overnight.”
The challenge is that traditional advice doesn’t always work. Rest alone rarely restores the physical capacity that has been lost, yet pushing through symptoms often leads to crashes in fatigue or symptom flare-ups. Rehabilitation becomes less about returning to sport immediately and more about rebuilding the body’s capacity from the foundation up.
Emerging evidence also suggests that people with hypermobility may be over-represented within Long COVID clinics. A 2024 study by Miller and colleagues found that joint hypermobility was significantly more common in individuals with Long COVID than expected in the general population, supporting what many clinicians have been observing anecdotally. While this doesn’t prove that hypermobility causes Long COVID, it does suggest that underlying connective tissue differences may increase vulnerability to persistent symptoms following viral illness.
This aligns closely with what many physiotherapists see in practice.
Patients frequently report that they were always “double-jointed” but never considered it medically relevant until after COVID. In hindsight, they realise they had subtle clues throughout life—frequent ankle sprains, being unusually flexible, sitting in the “W” position as a child, or always being the person who could do the splits without training. Their hypermobility wasn’t new. Their symptoms were.
COVID may simply have been the event that tipped an already finely balanced system beyond its capacity to compensate.
Importantly, COVID is not unique in this respect. Pregnancy, surgery, significant injury, glandular fever and other major physiological stressors have long been recognised as potential triggers for the onset of symptomatic hypermobility. COVID appears to have joined that list.
The encouraging news is that the systems affected are remarkably adaptable.
Unlike ligaments, muscles respond to training. Cardiovascular fitness can improve. Balance can be retrained. Proprioception becomes more accurate. The nervous system becomes more efficient at coordinating movement again. None of this happens overnight, but with appropriately graded rehabilitation, many people regain confidence in their bodies and return to activities they had feared were no longer possible.
Perhaps the greatest lesson COVID has taught us is that connective tissue doesn’t exist in isolation. Hypermobility is rarely just about flexible joints. It is an interaction between connective tissue, muscles, the autonomic nervous system and physical capacity. When one of those systems is disrupted, the entire body can feel different.
If you’ve noticed that your body hasn’t quite felt the same since COVID, you don’t have to simply accept that as your “new normal.” Persistent fatigue, dizziness, pain, reduced exercise tolerance or joint instability are worth discussing with your specialist, GP and healthcare team.
If hypermobility may be part of the picture, a physiotherapist can help you understand what has changed and, importantly, where to start rebuilding. Rehabilitation isn’t about pushing through symptoms or “just getting fitter”, it’s about finding the right starting point and gradually rebuilding strength, stability and physical capacity at a pace your body can tolerate.
Sometimes, the goal isn’t to get your old body back. It’s to help you trust your body again.
References
Miller AJ, et al. Generalised joint hypermobility among adults with Long COVID: a cross-sectional study. BMJ Open. 2024.
Rowe PC, et al. Myalgic encephalomyelitis/chronic fatigue syndrome diagnosis and management in the context of connective tissue disorders and orthostatic intolerance. Frontiers in Pediatrics. 2021.
Mathias CJ, et al. Postural tachycardia syndrome: current experience and concepts. Nature Reviews Neurology. 2011.
Malek N, et al. The relationship between hypermobile Ehlers-Danlos syndrome, hypermobility spectrum disorders and dysautonomia. American Journal of Medical Genetics Part C. 2021.
World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus. 2021.
|
If you'd like personalised support with rebuilding physical capacity and movement after changes in your symptoms, Physiotherapist Blanche Leung consults at BJC Health. Book an appointment here |