Skip to content
Inciteful Med
Resources About us Ask a Question

What is HSD vs hEDS? Understanding the Difference

Published: | Updated:

Hypermobility Spectrum Disorder (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) have identical symptom severity, chronic pain, and joint instability. Patients diagnosed with HSD under the strict 2017 criteria require the exact same medical management and physical therapy as those with hEDS.

Key Takeaways

  • • The 2017 diagnostic criteria made hEDS much stricter, leading many highly symptomatic patients to be diagnosed with HSD instead.
  • • Symptom severity, including chronic pain, joint instability, and fatigue, is identical between HSD and hEDS.
  • • HSD and hEDS require the exact same symptom-based, multidisciplinary medical care and targeted physical therapy.
  • • Both conditions share a high rate of multi-systemic comorbidities, such as POTS, MCAS, and gastrointestinal dysfunction.

If you are living with chronic pain, joint instability, and extreme fatigue, being told you “only” have Hypermobility Spectrum Disorder (HSD) instead of hypermobile Ehlers-Danlos Syndrome (hEDS) can feel incredibly invalidating. You might wonder if your doctors believe your pain or if you will be denied the care you need because you missed a few checkboxes on a diagnostic form. The most important thing to know is this: HSD is an equally valid, painful, and complex condition, and it requires the exact same treatment, physical therapy, and multidisciplinary care as hEDS [1][2].

The 2017 Criteria: Why the Labels Changed

Before 2017, many people with symptomatic joint hypermobility were diagnosed with Joint Hypermobility Syndrome (JHS) or Ehlers-Danlos syndrome-hypermobility type (EDS-HT) [1]. To improve research and establish clearer guidelines, an international consortium introduced stricter diagnostic criteria for hEDS [3][4].

Under the 2017 criteria, an hEDS diagnosis requires passing a very strict checklist [5]. Patients must have generalized joint hypermobility, measured by the Beighton score (a 9-point test of joint range of motion exceeding normal limits) [6]. They must also have a combination of systemic manifestations (like specific skin textures, recurrent hernias, or organ prolapses) or a family history of hEDS, and other connective tissue disorders must be ruled out [7][6].

If you have highly symptomatic, painful joint hypermobility but do not meet every single strict requirement for hEDS, your diagnosis under the 2017 criteria is HSD [8]. Because the new hEDS criteria are so strict, many highly symptomatic patients are classified as having HSD simply because their joints have stiffened with age or past injuries, lowering their Beighton score over time, or because they lack specific skin features [9][10].

Your Symptoms Are Real and Identical

It is common for patients with HSD to feel dismissed, but research clearly shows that the severity of your symptoms is not lesser than someone with hEDS. Studies have proven that pain severity, physical functioning, muscle strength, and the overall symptom burden are largely indistinguishable between patients with hEDS and HSD [2][11].

Like hEDS, HSD is associated with a massive burden of multi-systemic symptoms, including:

  • Gastrointestinal dysfunction [12]
  • Chronic fatigue and poor sleep [13]
  • POTS (Postural Orthostatic Tachycardia Syndrome, which causes a rapid heart rate upon standing) [14]
  • MCAS (Mast Cell Activation Syndrome, involving frequent allergic-type reactions and inflammation) [15]

In fact, recent research analyzing cellular tissue has found shared molecular signatures between hEDS and HSD. This leads many experts to believe they might actually exist on a continuum or represent the exact same underlying disorder [16][4].

Treatment and Management Are Exactly the Same

A different label does not mean a different standard of care. The 2017 international classification guidelines do not mandate different management pathways for hEDS and HSD [1][17]. Whether your chart says HSD or hEDS, accommodations for work, school, or physical therapy should be based on your disabling symptoms, not the specific diagnostic label.

Hypermobility Spectrum Disorder (HSD) Hypermobile Ehlers-Danlos Syndrome (hEDS)
Symptom Severity High (Pain, fatigue, instability) High (Pain, fatigue, instability)
Associated Conditions POTS, MCAS, GI issues POTS, MCAS, GI issues
Physical Therapy Targeted, hypermobility-aware PT Targeted, hypermobility-aware PT
Medical Management Symptom-led, multidisciplinary care Symptom-led, multidisciplinary care

Your care team should use the identical management strategies [2][18]. This includes:

  • Targeted Physical Therapy: To strengthen the muscles around unstable joints and improve proprioception (your body’s awareness of where it is in space).
  • Symptom-Led Care: Management focuses on your specific symptoms, such as medications or diet changes for GI issues, and hydration or heart rate-regulating prescription medications for POTS [19][11].
  • Multidisciplinary Approach: You may still need to see a team of specialists, including rheumatologists, cardiologists, gastroenterologists, and pain management experts [20][17].

Advocating For Your Care

Because HSD is a relatively newer term, some medical professionals may incorrectly assume it just means being “double-jointed” without pain. If a provider dismisses your diagnosis or denies a referral because you “only” have HSD, firmly advocate for yourself. You can say: “I understand my diagnosis is HSD, but the 2017 international guidelines mandate that HSD and hEDS require the exact same symptom-based multidisciplinary care. Can we focus on treating my specific symptoms today?”

Do not let the label of HSD make you feel that your struggles are “less than.” Your pain is real, your joint instability is real, and you deserve comprehensive, compassionate care to help you manage your symptoms and improve your quality of life [13][21].

Frequently Asked Questions

Is Hypermobility Spectrum Disorder less severe than hEDS?
No. Research shows that pain severity, physical functioning, and overall symptom burden are largely identical between patients with HSD and hEDS. Both conditions can be highly disabling and require the same level of comprehensive care.
Why did my doctor diagnose me with HSD instead of hEDS?
In 2017, the diagnostic criteria for hEDS became much stricter. If you have highly symptomatic joint hypermobility but do not meet every requirement on the new checklist—such as specific skin features or a high Beighton score—you are diagnosed with HSD.
Are the treatments for HSD and hEDS different?
Treatment and management are exactly the same for both conditions. International guidelines mandate identical symptom-based, multidisciplinary care, including targeted physical therapy and management of associated conditions.
What related conditions should I be screened for if I have HSD?
Patients with HSD often experience multi-systemic symptoms. It is common to be screened for associated comorbidities like Postural Orthostatic Tachycardia Syndrome (POTS), Mast Cell Activation Syndrome (MCAS), and gastrointestinal dysfunction.

Questions for Your Doctor

  • • Given my HSD diagnosis, can we review the 2017 international management guidelines together to ensure we are taking a multidisciplinary approach?
  • • Which of my specific symptoms, such as joint instability or autonomic issues, should we prioritize treating first?
  • • Can you refer me to a physical therapist who has specific experience treating hypermobility and connective tissue disorders?
  • • Do you recommend screening for common hypermobility comorbidities, such as POTS or dysautonomia, based on my current symptoms?

Questions for You

  • • What are the most disabling symptoms I am experiencing right now that I need my doctor to focus on, regardless of my specific diagnostic label?
  • • Are there specific times of day, activities, or environmental factors that make my joint pain, fatigue, or dizziness worse?
  • • Have I previously had a doctor dismiss my symptoms because of my HSD diagnosis, and how can I prepare myself to firmly advocate for symptom-based care in my next appointment?

Want personalized information?

Type your question below to get evidence-based answers tailored to your situation.

References

  1. 1

    Recognizing and Effectively Managing Hypermobility-Related Conditions.

    Russek LN, Stott P, Simmonds J

    Physical therapy 2019; (99(9)):1189-1200 doi:10.1093/ptj/pzz078.

    PMID: 31158283
  2. 2

    Muscle Strength, Muscle Mass and Physical Impairment in Women with hypermobile Ehlers-Danlos syndrome and Hypermobility Spectrum Disorder.

    Coussens M, Lapauw B, Banica T, et al.

    Journal of musculoskeletal & neuronal interactions 2022; (22(1)):5-14.

    PMID: 35234154
  3. 3

    The 2017 international classification of the Ehlers-Danlos syndromes.

    Malfait F, Francomano C, Byers P, et al.

    American journal of medical genetics. Part C, Seminars in medical genetics 2017; (175(1)):8-26 doi:10.1002/ajmg.c.31552.

    PMID: 28306229
  4. 4

    Looking back and beyond the 2017 diagnostic criteria for hypermobile Ehlers-Danlos syndrome: A retrospective cross-sectional study from an Italian reference center.

    Ritelli M, Chiarelli N, Cinquina V, et al.

    American journal of medical genetics. Part A 2024; (194(2)):174-194 doi:10.1002/ajmg.a.63426.

    PMID: 37774134
  5. 5

    Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care.

    Atwell K, Michael W, Dubey J, et al.

    Journal of the American Board of Family Medicine : JABFM 2021; (34(4)):838-848 doi:10.3122/jabfm.2021.04.200374.

    PMID: 34312277
  6. 6

    Hypermobile Ehlers-Danlos Syndrome: Diagnostic Challenges and the Role of Genetic Testing.

    Forghani I, See J, McGonigle WC

    Genes 2025; (16(5)) doi:10.3390/genes16050530.

    PMID: 40428350
  7. 7

    Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome.

    Miller AJ, Stiles LE, Sheehan T, et al.

    Autonomic neuroscience : basic & clinical 2020; (224()):102637 doi:10.1016/j.autneu.2020.102637.

    PMID: 31954224
  8. 8

    Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.

    Yew KS, Kamps-Schmitt KA, Borge R

    American family physician 2021; (103(8)):481-492.

    PMID: 33856167
  9. 9

    Utilization of the 2017 diagnostic criteria for hEDS by the Toronto GoodHope Ehlers-Danlos syndrome clinic: A retrospective review.

    McGillis L, Mittal N, Santa Mina D, et al.

    American journal of medical genetics. Part A 2020; (182(3)):484-492 doi:10.1002/ajmg.a.61459.

    PMID: 31840928
  10. 10

    Pediatric joint hypermobility: a diagnostic framework and narrative review.

    Tofts LJ, Simmonds J, Schwartz SB, et al.

    Orphanet journal of rare diseases 2023; (18(1)):104 doi:10.1186/s13023-023-02717-2.

    PMID: 37143135
  11. 11

    Subtle differences in autonomic symptoms in people diagnosed with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.

    Martinez KL, Mauss C, Andrews J, et al.

    American journal of medical genetics. Part A 2021; (185(7)):2012-2025 doi:10.1002/ajmg.a.62197.

    PMID: 33826221
  12. 12

    A machine learning approach to stratify patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders according to disorders of gut brain interaction, comorbidities and quality of life.

    Choudhary A, Fikree A, Ruffle JK, et al.

    Neurogastroenterology and motility 2025; (37(1)):e14957 doi:10.1111/nmo.14957.

    PMID: 39543811
  13. 13

    Fear avoidance, fear of falling, and pain disability in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.

    Chuchin JD, Ornstein TJ

    Disability and rehabilitation 2024; (46(18)):4234-4245 doi:10.1080/09638288.2023.2268520.

    PMID: 37843031
  14. 14

    AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review.

    Aziz Q, Harris LA, Goodman BP, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2025; (23(8)):1291-1302 doi:10.1016/j.cgh.2025.02.015.

    PMID: 40387691
  15. 15

    Hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders in older women: A feasibility study.

    Anderson LK, Lane KR

    Musculoskeletal care 2023; (21(3)):741-748 doi:10.1002/msc.1747.

    PMID: 36864687
  16. 16

    Bridging the Diagnostic Gap for Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: Evidence of a Common Extracellular Matrix Fragmentation Pattern in Patient Plasma as a Potential Biomarker.

    Ritelli M, Chiarelli N, Cinquina V, et al.

    American journal of medical genetics. Part A 2025; (197(1)):e63857 doi:10.1002/ajmg.a.63857.

    PMID: 39225014
  17. 17

    Hypermobile Ehlers Danlos for the Primary Care Provider.

    White L, Procknow SS

    Missouri medicine 2024; (121(4)):289-296.

    PMID: 39575079
  18. 18

    Does Muscle Strength Change Over Time in Patients With Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder? An Eight-Year Follow-Up Study.

    Coussens M, Calders P, Lapauw B, et al.

    Arthritis care & research 2021; (73(7)):1041-1048 doi:10.1002/acr.24220.

    PMID: 32293111
  19. 19

    Severity classes in adults with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders: a pilot study of 105 Italian patients.

    Copetti M, Morlino S, Colombi M, et al.

    Rheumatology (Oxford, England) 2019; (58(10)):1722-1730 doi:10.1093/rheumatology/kez029.

    PMID: 30783660
  20. 20

    Developing a self-management intervention to manage hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS): an analysis informed by behaviour change theory.

    Bennett SE, Walsh N, Moss T, Palmer S

    Disability and rehabilitation 2022; (44(18)):5231-5240 doi:10.1080/09638288.2021.1933618.

    PMID: 34101520
  21. 21

    Comorbidity, misdiagnoses, and the diagnostic odyssey in patients with hypermobile Ehlers-Danlos syndrome.

    Halverson CME, Cao S, Perkins SM, Francomano CA

    Genetics in medicine open 2023; (1(1)):100812 doi:10.1016/j.gimo.2023.100812.

    PMID: 39669244

This page explains the differences between HSD and hEDS for educational purposes only. Always consult a healthcare provider for an accurate diagnosis and a personalized symptom management plan.

Stay up to date

Get notified when new research about Hypermobile Ehlers-Danlos Syndrome (hEDS) is published.

No spam. Unsubscribe anytime.