Rheumatology · Hypermobility Spectrum Disorders

The Whole-Body Impact: Beyond Flexible Joints

At a Glance

Hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome can affect more than joints, with dizziness, fatigue, digestive symptoms, nerve pain, and headaches among the possible effects. Symptoms vary, so new or changing symptoms need medical evaluation.

While hypermobility is often first noticed because of flexible joints, it is increasingly understood as a multisystemic condition. Because connective tissue (the “glue” of the body) is found in almost every organ system, the effects of hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) can reach far beyond your joints ^[1]^[2].

It is important to remember that this condition is highly individual. You may experience many of these symptoms, or only a few. This page explains how these different systems interact and why you might feel symptoms in places that seem unrelated to your joints. Importantly, not every symptom is caused by hypermobility. A new or changing symptom still requires a routine medical evaluation to rule out other standard causes.

Joint Instability and the Mechanics of Pain

The most visible impact of hEDS/HSD is joint instability, where joints move beyond their intended range. This happens because the ligaments and tendons are too stretchy to hold the bones firmly in place ^[3].

Subluxations and Dislocations: You may experience joints that fully pop out (dislocations) or partially slide out and back in (subluxations) ^[4].
Proprioception: Many people with hypermobility have “poor proprioception,” which is your body’s ability to sense where your joints are without looking at them ^[4]. This can lead to a feeling of clumsiness and frequent “micro-injuries” that add up over time.
Muscular Fatigue: Because your ligaments aren’t doing their job of holding you together, your muscles have to work overtime to stabilize your skeleton. This often leads to deep, aching muscle fatigue and spasms ^[5].

The Autonomic Nervous System (Dysautonomia)

Many patients struggle with dysautonomia, a malfunction of the autonomic nervous system, which controls everything your body does automatically, like heart rate and digestion ^[6].

A commonly reported condition in hypermobile patients is Postural Orthostatic Tachycardia Syndrome (POTS) ^[7]. In POTS, when you stand up, your blood may pool in your lower body. Your heart then races to try and get blood back up to your brain ^[8]. POTS has several proposed physiological phenotypes and can occur without hEDS/HSD.

Symptoms: Dizziness, fainting (syncope), palpitations, shortness of breath, and “brain fog” ^[9].
Impact: This can cause profound fatigue that isn’t helped by sleep, but remember that fatigue and brain fog can have multiple causes and should be evaluated thoroughly rather than assumed to be solely from dysautonomia ^[10].

Gastrointestinal and Digestive Challenges

Digestive issues are frequently reported by people with hEDS/HSD in clinical surveys ^[11]. These symptoms are often classified as Disorders of Gut-Brain Interaction (DGBI), meaning the communication between your nervous system and your gut is disrupted ^[12].

Dysmotility: Your digestive tract may move too slowly (gastroparesis or constipation) or too quickly (diarrhea), leading to bloating, nausea, and reflux ^[13]. Gastroparesis requires objective evidence of delayed gastric emptying after obstruction is excluded.
Abdominal Compressions: Less commonly, some patients have structural issues where blood vessels compress parts of the digestive tract. Examples include Median Arcuate Ligament Syndrome (MALS) or Superior Mesenteric Artery Syndrome (SMAS), which can cause intense pain after eating and rapid weight loss ^[14]^[15]. These are uncommon, nonspecific, and not routine screening diagnoses; common gastrointestinal causes should always be evaluated first.

Neurological Symptoms and Altered Pain Processing

Hypermobility can also change how your brain and nerves process information.

Central Sensitization: Over time, the constant stream of pain signals from unstable joints can “wind up” your central nervous system. This is called central sensitization, an altered pain processing state where your brain becomes hyper-reactive, making even light touch or normal movement feel painful ^[16]^[17].
Small-Fiber Neuropathy (SFN): Some patients have damage to the tiny nerve endings in their skin ^[18]. This can cause burning, tingling, or “electric shock” sensations, and may also contribute to autonomic symptoms ^[19]. However, burning symptoms are nonspecific and require appropriate evaluation.
Headaches: Migraines are very common, but some patients also experience orthostatic headaches (headaches that get worse when standing), which might be related to POTS, neck instability, or changes in spinal fluid pressure ^[20]^[2]. Note that craniocervical instability and spontaneous CSF-leak diagnoses require specialist assessment with debated criteria, and alternative explanations should be considered.

A Note on System Interaction

It can be overwhelming to see all these symptoms listed together. However, understanding that they are connected can be empowering. For example, treating your POTS may improve your brain fog, and stabilizing your joints through physical therapy may reduce the “volume” of your pain signals ^[21]^[22]. Your care team should look at you as a whole person, rather than treating each symptom as an isolated problem.

Common questions in this guide

Can hypermobility cause symptoms outside the joints?

Yes. Hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders may be associated with joint instability, muscle fatigue, dizziness, digestive symptoms, nerve sensations, headaches, and changes in pain processing. Symptoms vary from person to person, and new or changing symptoms still need a routine medical evaluation.

Why do I feel dizzy or get a racing heart when I stand up?

In postural orthostatic tachycardia syndrome, or POTS, blood can pool in the lower body after standing and the heart rate rises to help maintain blood flow to the brain. POTS can occur with or without hEDS or HSD, and a clinician may use an active standing assessment such as a NASA Lean Test or a tilt-table test.

What digestive problems can be related to hypermobility?

People with hEDS or HSD may report bloating, nausea, reflux, constipation, diarrhea, or feeling full quickly because of altered gut movement or gut-brain interaction. Gastroparesis should be diagnosed only when testing shows delayed stomach emptying after an obstruction has been excluded, and uncommon compression syndromes should not be assumed before common causes are evaluated.

Could burning or tingling mean I have small-fiber neuropathy?

Small-fiber neuropathy can cause burning, tingling, or electric-shock sensations and may contribute to autonomic symptoms. These sensations have many possible causes, so a clinician should decide whether evaluation such as a skin biopsy is appropriate.

Why do my muscles hurt or tire easily with hypermobility?

When ligaments are too stretchy, muscles may work harder to stabilize the joints, leading to aching fatigue and spasms. Repeated pain signals can also make the nervous system more sensitive, so physical therapy focused on stability may help some people; treatment should be individualized.

What might explain headaches that worsen when I stand?

Migraines are common, but headaches that worsen when you are upright may be related to POTS, neck stability, or changes in spinal fluid pressure. These possibilities require specialist assessment, and other common causes should also be considered.

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Curated prompts to bring to your next appointment.

1.Based on my symptoms, should we screen for POTS using a 'NASA Lean Test' or a formal tilt-table test?
2.How much of my pain do you believe is caused by physical joint instability versus central sensitization?
3.I have significant digestive issues; should we screen for abdominal compression syndromes or a disorder of gut-brain interaction (DGBI)?
4.Could my burning/tingling pain be a sign of small-fiber neuropathy, and is a skin biopsy appropriate for me?
5.Do my headaches have features of migraine, or could they be related to my neck stability or intracranial pressure?

Key takeaways

Hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders can affect multiple body systems because connective tissue is found throughout the body.
Joint instability, poor proprioception, and muscle overuse can contribute to subluxations, dislocations, pain, fatigue, and spasms.
Dysautonomia, including POTS, can cause standing-related dizziness, palpitations, fainting, brain fog, and fatigue, and POTS can occur without hEDS or HSD.
Digestive symptoms may include bloating, nausea, reflux, constipation, or diarrhea, while uncommon abdominal compression syndromes require careful evaluation after common causes are considered.
Burning or tingling, altered pain sensitivity, and headaches have multiple possible causes and should be assessed rather than automatically attributed to hypermobility.

References (22)

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This page explains how hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome may affect multiple body systems for informational purposes only and does not constitute medical advice. New or changing symptoms should be evaluated by a healthcare professional.

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