What Are the Beighton Score Age Cutoffs for hEDS?

The Beighton score is the standard tool doctors use to evaluate generalized joint hypermobility (joints that move beyond the typical range of motion) when diagnosing hypermobile Ehlers-Danlos syndrome (hEDS). Because it is completely normal for joints to become stiffer as we age, the 2017 international hEDS diagnostic criteria include age-adjusted cutoffs. This means the older you are, the lower your score needs to be to meet the hypermobility requirement for an hEDS diagnosis ^[1][2]. Furthermore, if you fall just short of these cutoffs due to aging, arthritis, or past injuries, doctors use a 5-point historical questionnaire to capture how flexible you used to be ^[3].

Beighton Score Cutoffs by Age

The Beighton score is measured on a 9-point scale. A doctor will typically use a tool called a goniometer to measure the exact angles of your joints. You receive one point for each of the following that you can perform ^[4]:

• Bending your pinky finger backward past 90 degrees (1 point for each hand)
• Pulling your thumb back to touch your forearm (1 point for each arm)
• Hyperextending your elbow backward more than 10 degrees (1 point for each arm)
• Hyperextending your knee backward more than 10 degrees (1 point for each leg)
• Placing your palms flat on the floor while keeping your knees straight (1 point)

To account for the natural decline in joint flexibility over a person’s lifespan, the threshold for a “positive” hypermobility score decreases as you age ^[2].

The current cutoff scores required for an hEDS diagnosis are:

• Pre-pubertal children: A score of 6 or higher (out of 9) ^[4][2].
• Pubertal adolescents and adults up to age 50: A score of 5 or higher ^[4][2].
• Adults aged 50 and older: A score of 4 or higher ^[4][2].

Using these age-specific cutoffs helps ensure that older adults are not given a false-negative result simply because of the normal stiffening of joints that happens over time ^[1].

What if I used to be flexible, but I am stiff now?

Many adults with hEDS worry they have “aged out” of a diagnosis because decades of joint instability, micro-injuries, surgeries, or early-onset osteoarthritis have left them stiff. The diagnostic criteria recognize this issue ^[3].

If your current Beighton score falls exactly one point below the age cutoff (for example, a 4 in a 30-year-old, or a 3 in a 55-year-old), the doctor will use the Five-Point Questionnaire (5PQ) to assess your historical hypermobility (providing evidence that you used to be flexible all over) ^[3]. Unlike the Beighton score, which is physically measured by your doctor today, this questionnaire relies entirely on your personal history.

If you can answer “yes” to at least two of the following five questions, it is considered a positive indicator of historical generalized joint hypermobility, and you can still meet the hypermobility requirement for hEDS ^[3]:

1. Can you now (or could you ever) place your hands flat on the floor without bending your knees?
2. Can you now (or could you ever) bend your thumb to touch your forearm?
3. As a child, did you amuse your friends by contorting your body into strange shapes or could you do the splits?
4. As a child or teenager, did your shoulder or kneecap dislocate on more than one occasion?
5. Do you consider yourself “double-jointed”?

This two-step process—first checking your current Beighton score against age cutoffs, and then asking about your past flexibility if you fall one point short—ensures that your lifelong experience with hypermobility is accurately captured during the diagnostic process ^[3].

What if I fall further below the cutoffs?

If your score is significantly below the cutoffs or you cannot answer “yes” to at least two questions on the 5PQ, you may not meet the strict, formal criteria for an hEDS diagnosis. However, this does not invalidate your lived experience or symptoms. Many patients in this situation are diagnosed with Hypermobility Spectrum Disorder (HSD), a closely related condition that carries the exact same symptom management, physical therapy approaches, and need for specialized medical care ^[2][5].