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PubMed This is a summary of 27 peer-reviewed journal articles Updated
Physical Therapy · Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder

Why Do Joints Sublux or Dislocate with hEDS or HSD?

At a Glance

In hEDS and HSD, joints may sublux or dislocate with little force because loose ligaments and joint capsules provide less restraint, joint-position sensing may be altered, muscles can fatigue while compensating, and joint-specific anatomy may add instability.

In this answer

6 sections

01

The Role of Connective Tissue (Ligamentous Laxity)

02

Proprioception and Movement Control

03

Muscle Overuse, Fatigue, and Guarding

04

Joint-Specific Anatomy

05

What to Do During an Episode and When to Seek Urgent Care

06

Documenting Your Symptoms

In hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD), recurrent joint subluxations (where a joint partially slips out of position) and full dislocations can happen with very little force, often during ordinary daily activities [1][2]. Recurrent slipping can be painful and frightening, but it is not your fault. While being generally flexible plays a role, instability is thought to be caused by a complex combination of looser connective tissues, altered sensory feedback, muscle compensation, and sometimes the unique shape of specific joints [3][4][5].

The Role of Connective Tissue (Ligamentous Laxity)

Your ligaments and joint capsules act as the passive structural supports—the “seatbelts”—that hold your bones together. In hEDS, differences in the extracellular matrix (the structural network surrounding your cells) are thought to make these tissues stretchier and less capable of providing firm passive restraint [3][6]. In HSD, the exact biological contributors can vary, but the result is similar: because the primary structural supports of the joint are loose (known as ligamentous laxity), the bones can slide further than they should, even without trauma [4].

Proprioception and Movement Control

Joint stability also relies on proprioception—your nervous system’s ability to sense exactly where your joints are in space. Research shows that proprioception and joint-position sense can be reduced in some people with hEDS and HSD [4][7]. This sensory feedback is variable, but when it is altered, your body might not react quickly enough to prevent a joint from moving past its safe range of motion [5].

Muscle Overuse, Fatigue, and Guarding

To compensate for loose ligaments and altered sensory feedback, your muscles have to work overtime as active stabilizers. People with hypermobility often demonstrate increased muscle activation and antagonist co-contraction (where opposing muscles tighten at the same time) just to maintain stability during simple tasks like walking [8].

  • Fatigue: This constant overworking requires more energy, which can lead to muscle fatigue and pain [8][9].
  • Guarding: Muscles may spasm or “guard” the joint tightly in response to pain or instability. While this is a protective response, it does not always prevent a joint from slipping.
  • Coordination and Strength: Despite overworking, specific muscle groups may lack the coordinated control or endurance needed to fully stabilize the joint during movement [10][11].

Joint-Specific Anatomy

Instability isn’t identical across the body; the regional anatomy of a specific joint also plays a role [12]. For example:

  • Shoulders: Altered scapular (shoulder blade) movement patterns can contribute to multidirectional shoulder instability [13].
  • Knees: Changes in bone shape, such as trochlear dysplasia (a shallow groove for the kneecap), are more common in people with hypermobility and can be a coexisting structural risk factor for kneecap dislocation [14].
  • Ankles and Feet: Laxity in ankle ligaments and hypermobility across the many small joints of the foot can alter the way forces are distributed when you walk [15][12].

What to Do During an Episode and When to Seek Urgent Care

If a joint slips or dislocates, never forcefully manipulate it or ask an untrained person to pop it back in (a process called reduction) [16]. Forcing it can cause severe damage to bones, nerves, or blood vessels [17][18]. Instead, stop the activity, support the limb in the position you found it, and avoid testing its range of motion.

Work with your healthcare team to create a specific, written plan for when a familiar, minor subluxation can be observed at home. However, you should seek urgent emergency medical evaluation if you experience:

  • Persistent deformity or severe pain: If a joint stays visibly out of place, will not reduce, or if pain/swelling is rapidly worsening, this could indicate a fracture, an irreducible joint (one that is physically blocked from going back into place), or soft tissue trapped in the joint space [16][17].
  • New nerve symptoms: Numbness, tingling, or weakness that is new or rapidly changing requires urgent assessment for nerve compression or injury [19][20].
  • Vascular signs: Coolness, a change in skin color (pale or blue), or an absent pulse in the limb are medical emergencies. Note that having a normal pulse does not completely rule out a blood vessel injury [18][21].
  • Concerning mechanical symptoms: While harmless grinding (crepitus) is common, true locking, painful catching, or a sudden loss of function can indicate secondary damage, such as tears to the cartilage, meniscus, or labrum (a rim of cartilage that deepens some joints) [22]. Imaging is not automatically required for every familiar slip but is selected based on these clinical concerns and the specific joint [23][24].

Documenting Your Symptoms

Because instability can be frequent, keeping a precise log can help your medical team tailor your care. Instead of trying to diagnose whether an event was a “subluxation” or a “dislocation,” focus on recording what you observe and feel:

  • The Location: Which specific joints are affected, and on which side of the body [25].
  • What Happened: Was there visible deformity? What did it feel like (e.g., a slipping sensation, a loud pop)?
  • The Trigger: What position, force, or activity caused it?
  • The Aftermath: Did it return to normal on its own, how long did it take, and what was the impact on your ability to use the limb?
  • Monitoring: Standardized questionnaires and functional assessments can track how these events impact your balance, mobility, and daily life over time [26][27].

Common questions in this guide

Why can my joints slip or dislocate with very little force in hEDS or HSD?
In hEDS and HSD, ligaments and joint capsules may provide less firm support, allowing bones to move farther than intended. Changes in joint-position sensing, muscle fatigue, and the shape or movement of a particular joint can add to the instability.
What should I do when a joint partially or completely slips out?
Stop the activity, support the limb in the position you found it, and avoid testing its range of motion. Do not force the joint back into place or ask an untrained person to do so; follow a written plan from your healthcare team only for a familiar, minor episode.
When should I go to the emergency room after a joint slips or dislocates?
Seek urgent evaluation if the joint remains visibly out of place, pain or swelling is severe or worsening, or the joint will not return to position. New numbness, tingling, weakness, cool or pale or blue skin, an absent pulse, true locking, or sudden loss of function also require urgent assessment.
Can the shape of a joint make instability worse in hEDS or HSD?
Yes. Shoulder-blade movement can contribute to multidirectional shoulder instability, and a shallow groove for the kneecap can increase the risk of kneecap dislocation. Loose ankle ligaments and highly mobile foot joints can also change how walking forces are distributed.
Can physical therapy help reduce recurrent joint slipping?
A tailored physical therapy program may work on proprioception, movement coordination, strength, and muscle endurance. These strategies can help the muscles stabilize a joint more effectively, although they should be selected for your symptoms and the specific joint involved.
What details should I record when a joint slips?
Record the joint and side, what activity or position triggered the event, whether there was a visible deformity or popping sensation, and whether it returned to normal on its own. Also note how long it lasted, any numbness or color change, and how it affected your ability to use the limb.

Related questions

What Kind of Doctor Diagnoses hEDS or HSD? How to Prepare Can Older Adults Be Diagnosed With hEDS If Less Flexible? Can You Have hEDS or HSD With a Borderline Beighton Score? Do hEDS and HSD Get Worse Over Time? Long-Term Outlook How Are hEDS and HSD Diagnosed in Children and Adolescents?
Show more
How Do I Get an hEDS or HSD Evaluation From a Doctor? How Common Are hEDS and Hypermobility Spectrum Disorder? Is Hypermobile EDS Hereditary? Family and Child Evaluation Is Joint Hypermobility Just Flexibility—or HSD or hEDS? Is Treatment Different for HSD vs. Hypermobile EDS? Can I Safely Do Beighton Score Tests for hEDS at Home? What Tests Rule Out Other Causes of Joint Hypermobility? What Causes hEDS and HSD If There Is No Genetic Test? What Exercises Are Safe for Hypermobile EDS and HSD? What Is the 5PQ for hEDS and How Is It Scored in Practice? How Do hEDS, Classical EDS, vEDS, Marfan, and LDS Differ? What Should You Do for a Dislocated or Subluxing Joint? When Is Genetic Testing Recommended for Suspected EDS? Why Does Exercise Worsen hEDS or HSD Symptoms and Flares?

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References

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This page is for informational purposes only and does not constitute medical advice about hEDS, HSD, or a joint injury. Follow your healthcare professional’s individualized plan, and seek urgent care for persistent deformity, severe pain, new nerve symptoms, or circulation changes.