What Exercises Are Safe for Hypermobile EDS and HSD?

Exercise with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) can be confusing. Patients often receive conflicting advice, ranging from complete bed rest to aggressively pushing through extreme stretching. However, there is no single universally banned activity for hEDS/HSD ^[1]. Current evidence favors individualized, controlled strengthening and low-impact aerobic exercise tailored to your specific joints ^[1][2]. While you do not necessarily need to avoid yoga, stretching, or weight lifting, you will likely need to modify these activities. The focus should be on active stabilization (using your muscles to control and support your joints) and improving everyday function, rather than trying to increase your flexibility ^[2]. Because inappropriate exercises can cause pain or injury, working with a physical therapist who understands hypermobility is highly recommended ^[3][4]. (Note: This guidance is specific to hEDS and HSD; people with other subtypes, like vascular EDS, may have different restrictions and should consult their specialist).

The Goal of Exercise in hEDS and HSD

Research indicates that some people with hEDS and HSD have lower muscle strength and endurance compared to the general population ^[5]. When ligaments are loose, muscles must work harder to stabilize the joints. A well-designed exercise program aims to improve proprioception (your body’s awareness of its position in space) and build muscle strength to support unstable joints ^[4][6]. Studies show that exercise-based rehabilitation can improve functional capacity, balance, fatigue, and quality of life for many people with hEDS and HSD, though results vary from person to person ^[7][8].

Flexibility, Yoga, and Stretching

You do not have to completely avoid yoga or stretching, but your approach should shift from increasing flexibility to building stability. In hypermobile joints, aggressive or repeated stretching into an already excessive range of motion can provoke joint instability or subluxations (partial dislocations) ^[9][10].

However, some muscles may be genuinely tight from working overtime to stabilize your joints. A gentle, targeted stretch prescribed by a physical therapist can be helpful for those specific areas. If you participate in yoga, dance, or gymnastics:

• Focus on strength and control: Use yoga to build balance, breathing, and muscle control, not to achieve extreme poses.
• Avoid uncontrolled hyperextension: Do not forcefully lock your joints into an overextended position. For many, keeping a slight, soft bend in the elbows and knees helps maintain muscular control, though safe ranges are specific to you and the exercise ^[11].
• Modify passive stretching: Avoid “hanging” in a stretch where your loose ligaments are doing all the work; keep your muscles actively engaged to support the joint ^[2].

Resistance and Weight Training

Resistance training can be highly beneficial for building the strength and endurance needed to support hypermobile joints ^[12][5]. However, uncontrolled lifting or poor technique can cause injury.

• Start with light resistance, focusing entirely on mastering the technique and maintaining a safe, aligned joint position.
• Work within a controlled range of motion so that you do not push the joint into an unstable hypermobile position ^[11].
• Use symptom-responsive load management—meaning you adjust the weight and repetitions based on how your body feels that day, rather than following a rigid schedule ^[13].
• Physical supports, such as taping or braces, can be used as adjuncts if recommended by a clinician, but they should supplement—not replace—your own muscle control ^[14].

Aerobic Exercise and POTS Precautions

Aerobic exercise is important, but joint pain, fatigue, and co-occurring conditions like dysautonomia (dysfunction of the autonomic nervous system) or Postural Orthostatic Tachycardia Syndrome (POTS) can make it challenging ^[3][15]. POTS can cause rapid heart rate, lightheadedness, and exercise intolerance when upright ^[15][16].

• Consider recumbent or water exercises: Swimming, water aerobics, or using a seated stationary bike remove the strain of gravity and can be better tolerated if you have POTS or lower-body instability ^[15][17].
• Water safety: If you are prone to fainting, never swim or exercise in water alone. Be aware that hot water or quickly getting out of a pool can worsen lightheadedness.
• Shoulder stability: Certain swimming strokes can aggravate unstable shoulders, so choose movements that feel controlled.

Monitoring Symptoms, Pacing, and PEM

Fatigue is a major barrier to exercise in hEDS/HSD, and walking or movement often requires more energy than it does for others ^[18][13]. Many patients also experience post-exertional malaise (PEM)—a severe, delayed symptom flare that happens hours or days after physical activity.

• Pace yourself: Break activities into smaller, manageable chunks rather than pushing to exhaustion ^[19].
• Progression is not mandatory: You do not have to increase your exercise load on a strict timetable. If you experience a delayed crash, it means you need to scale back your activity level and discuss it with your clinician.
• Reframe your view of pain: While some mild, temporary muscle soreness is normal after exercise, new sharp joint pain, swelling, acute instability, or loss of function are signs of overload ^[3]. Do not “push through” concerning pain.

When to Stop and Seek Medical Help

Exercise should not cause medical emergencies. Stop exercising and seek immediate medical evaluation if you experience:

• A suspected joint dislocation that does not promptly go back into place, or an acute joint deformity.
• Inability to bear weight on a limb.
• Fainting (syncope), chest pain, or unusual shortness of breath.
• New neurologic symptoms, such as sudden weakness, numbness, severe headache, or loss of coordination.