It's hypermobility all the way down

12 Feb 2026
💬 EN

Perhaps I should save this for a more personal blog, but I’ve got decent SEO on this one, and hopefully these notes about hypermobility can help someone else if I post them here. Devon Price recently posted about life at the extremely hypermobile end of the body spectrum. This one’s a little more about the “you don’t read ‘flexible’ to other people and wouldn’t even think you’re ‘hypermobile’ if you hadn’t been told by a professional that you slightly fit that category” end of the spectrum.

Scary new injury type

A few months, ago, multiple aspects of daily life that involved abducting my left leg away from my centerline suddenly started causing sharp intermittent pain:

• Sitting on the floor, without a significant bolster under my left knee
• Riding a bike (the seat & pedals placement pushed my leg off the centerline, and then I experienced pain as I approached the top of the left foot’s stroke)
• Sitting in a chair with my left ankle resting on my right knee, and my left knee unsupported
• Getting in or out of a car
• Something behind me catching my attention, or changing my mind about which direction it’d be handy to head in any given moment, and taking a rotational step with my right foot while bearing weight on my left foot (typically less pain going the other way).
  • Things got scary when, in a small bathroom, I started to reach to lift the lid on a toilet, changed my mind and realized I’d rather first put on the robe on the hook behind me for warmth, turned to my right to take the first step of turning around, and doubled over in excruciating pain so fast I nearly bashed my head through the glass shower door (just missed). At that point, the intermittent pain didn’t seem like a minor “tough it out” nuisance – it felt downright dangerous.

Things that didn’t cause the pain:

• Walking straight forward with my feet on a close “track” together
• Jogging straight forward with my feet on a close “track” together (in other words, impact itself was fine)
• Rowing machines, as long as the foot plates were close enough together
• Slow and careful squats (both loaded and unloaded), especially ones with my feet close together if going low to the floor

Frustrating diagnostics

I had three different providers – a physical therapist (“PT”) and two physician’s assistants (“PA”) – run me through a series of diagnostic tests, moving my leg around, having me resist pressure from their hand, etc. – that didn’t hurt, or that barely even started to threaten to hurt. They almost seemed … surprised and confused? … by this. And by me demonstrating what actually hurt.

I wrote in my diary of these experiences, “I feel disconnected from hope of healing, so far.” If they couldn’t see my pain, how would they ever make a care plan that would give me hope?

Scary diagnostics

I was fortunate enough to have health insurance and savings that covered adequate imaging, and yes, my imaging-visible structures are … lol, showing my age. I’m not going to go into too much detail because I value my health record privacy (I’m already feeling pretty vulnerable even writing in public that I have a body that at least one healing professional considers slightly into what they’d call “hypermobile” – helloooooooo being alive in America pre-ACA!), but basic stuff that the PA reviewing my imaging said is pretty normal in perhaps a majority of the population but doesn’t seem to cause most people pain but can seem to cause some people pain.

Point is, that also left me very “Now what??!!”.

Prescription for injection and PT

I left imaging review with a prescription from the second PA for a combination of:

1. One steroid shot, to reduce the inflammation and give me a lower-pain fighting chance to enjoy the magic of physical therapy.
2. Up to twelve sessions of physical therapy.

I was overwhelmed at the thought of picking a physical therapist. There are four well-reviewed clinics between one and eight miles from my home, but I’ve had a fair amount of PT in my life where the diagnostics have felt out of touch with my pain and the “solutions” haven’t helped relieve it.

Many years ago, a friend happened to do reception for a PT he considered brilliant. I’ve been to her, and she is. Every time I’ve gone to her, she’s fully understood and made complete sense of my constellation of symptoms into a cohesive cause and effect story. Her interventions have always helped. She’s also a long drive from home. And she’s always fully booked four months out (because she’s darned good at her job).

I curled up in a little ball and focused on getting the shot. The MD delivering it had been personally recommended by the PA, and had nothing but amazing reviews from former patients, and did a great job answering my general questions about steriod injections.

However, that night and the following morning, I had new joint pain near the injection site (not near the initial pain site!), and I melted down afraid everything was just going to be even more broken – forever.

(I’ve read some really useful books about disability lately 1, 2 that have helped me better cope with the prospect of loss of bodily function – ever more possible with each passing year – but that didn’t make it any less hard to be potentially staring a particular loss of function in the face.)

In a fit of anger at the universe, I called the brilliant PT’s office and asked again about her schedule. There was an appointment open the next day – phew!

By 24 hours after the shot (perhaps assisted by completion of the slow gentle lower-body weightlifting class I was waiting to enter when I called Scheduling), the joint pain near the injection site finally started to fade, and I even started to feel better at the intended site. By the morning of my PT appointment, I was getting in and out of the car without pain, hadn’t hurt all morning turning around, and even had sat on the floor to put on shoes without thinking and maybe only felt a smidgin of a dull ache. Woah.

Actually the same old injury type

The brilliant, experienced PT didn’t examine me. We talked and I cried – first in fear, and later in relief. (I’d clarified when I went in that the biggest care plan I needed help with that particular day was figuring out where to start since it didn’t seem I could see her regularly any time soon.)

Her biggest contribution of the day was lowering the stakes around my current pain by explaining to me that I wasn’t experiencing a fundamentally new type of injury – I was just experiencing yet another symptomatic pain flareup from the same injury-prone condition I’ve had since the day I was born: a touch of hypermobility.

Sure, my old sudden-onset inexplicable sharp pains hadn’t previously crossed out of the gym and into daily life, but that didn’t make this one special. It was just yet another inconvenience in the life of a perfectly normal slightly-hypermobile human who got, perhaps, a smidge out of shape compared to what aging with hypermobility often demands if one wants to live (relatively) asymptomatically.

Chemical storms and chemical interventions

The PT pointed out that inflammation is a chemical storm that:

1. Hurts (duh)
2. Tends to happen and hurt more in some areas of the body than others (“pain-generating structures”)
   • Structures that, often, normally-mobile or hypomobile tense people can’t even accidentally smack their bones into in the first place, because their connective tissue such as tendons and ligaments are just too darned tight to end up there unless, like, a car crash shoves their body into a weird position with an inordinate amount of force. Whereas hypermobile people whose connective tissue doesn’t provide so much protection tend to end up with bones that dance all over the place and bump into all kinds of pain-sensitive structures that aren’t “meant to” be bumped into in the first place.
3. Tends to chemically interfere with nearby muscles.
   • Theoretically, this is evolutionarily a good thing and helps keep you from trying to walk on a broken body part that needs to rest.
   • Unfortuntely, since hypermobile people’s connective tissue is already inadequately keeping bones centered in sockets, they have to rely mostly on nearby muscle strength to keep bones centered in sockets – e.g. keep femurs from hitting pain-sensitive structures like labrums (which to boot are often a bit structurally rough around the edges, or postoperatively vulnerable – though again, ideally you shouldn’t be hitting them whether normal-shaped or roughed up) . Inflammation can cause a vicious cycle in hypermobile people, where the chemical loss in nearby muscle tone can make bones start dancing around all over the place, jostling up against pain-sensitive structures even more, causing more inflammation, causing less muscle tone, causing more impacts, causing more inflammation, causing less muscle tone, etc.
     • So with hypermobility, a steroid shot that reduces inflammation can not only reduce pain, but can also thereby help improve muscle engagement to keep the underlying cause (bumpin’ bones) from bringing the inflammation right back.
       • (Note: Lay a little low, perhaps especially on high-impact things, for maybe 48-72 hours after a shot; then get back to the gym as usual.)

Mechanical interventions

The PT said that, as an aging person on the hypermobile side of the spectrum, I basically don’t get to prioritize gaining above-average strength based on considerations like:

• Whether I would actually enjoy it as a hobby.

Squats, deadlifts, lunges, etc. aplenty are mandatory as my new bodyguard coterie, to protect me from the threat of sharp pain unexpectedly face-planting me into glass shower doors.

Exercising religiously is chore I was born into having to perform. One that youth gave me a hall pass from for a while, but it’s expired now. Especially as aging introduces lean muscle loss that can erode the youthful muscle that was keeping bones centered in sockets, hypermobile people simply have to maintain above-average strength, to compensate for their below-average connective tissue tension. Otherwise, bones go bumping into pain-sensitive structures, and hello shower door.

Attention span

I admitted I’d always tried my usual PT homework a handful of times and then gotten insanely bored with the self-paced repetitive micromovements. I was afraid I wouldn’t be able to comply with whatever it would take to keep me pain-free for life.

Luckily, the PT said that since my usual gym classes tend to involve a lot of strength work (helpfully shouted over a loudspeaker by a teacher to keep me engaged!), PT wouldn’t necessarily have to involve a lot of that kind of homework. It could probably look a lot more like just making sure I can actually get to, and make the most of, the gym at least 3 times a week. (e.g. “Hey, this hurts lately but we do it a lot in class” -> “Here’s an adapted version you can do, so that you still get the benefits of the movement 3+x/week, until the normal way feels better again.”)

Trust impingement

She said “impingement” pain is nice because it doesn’t, say, last 5 days once activated – instead, it hurts when you’re impinging the pain-sensitive structure, and it doesn’t hurt when you’re not.

She said to let that be a guide about how to adjust exercises while in the gym. If it hurts to squat low with wide feet, don’t – adjust your stance or your depth until it doesn’t hurt, and keep banging out those squats.

(And use checkins with PT to make sure you’re not missing out on anything, and if so, to figure out what you can do pain-free to train the muscles that doing the exercise as instructed at the gym was meant to target. But in any given week of your life, just … keep exercising, and don’t exercise in ways that hurt. Simple as that; don’t overthink it, just keep getting to the gym regularly, even if you have to drop certain exercises during certain flareups.)

Joints need use to stay healthy, so instead of thinking of “wear & tear,” think “wear & repair.” Stay at the gym.

Propioception and mindfulness

Another intent about getting to the gym regularly is that hopefully all that intense concentration on form while doing deadlifts will eventually help wire the brain to be more generally mindful of form outside the gym, too, even while distractedly sitting / moving through daily tasks.

Everyday glute activation

It’s normal for muscles – even strong well-trained ones that hit the gym a lot – when sitting or standing, to want to clock out and offload “resisting gravity” posture duties to connective tissues and bone. However, since hypermobile connective tissues aren’t going adequately to keep the bones from drifting into weird pain-sensitive places under pressure, hypermobile people tend to have to keep their muscles “on the clock” more often than other people. Various “Wake up, glutes!” exercises can help.

While sitting

If I must sit for longer periods, wake up my glutes every so often with an exercise like a few rounds of flexing abs, glutes, and leg adductors (with a bit of resistance from the adductors) cumulatively in sequence; release all 3 together. Repeat until the glutes start to feel a smidge of burn / activation.

Obviously, get up and walk around, too.

Before walking

Each time I get up from sitting, try doing a few squats before actually walking anywhere, to fully reactivate my glutes.

Put the hypermobility first

The PT wasn’t surprised that other providers had seemed surprised by my symptoms. She said she’s often disappointed how little education there seems to be around hypermobility.

She’s been making peace with that – trusting that her hypermobile patients are strongwilled and smart enough to advocate for themselves and ask their other providers to research how hypermobility might impact X, Y, or Z, even if she wishes they didn’t have to.

She said that hypermobile people can get the care they need from just about any provider, but that they might have to gently introduce some things they’ve learned from hypermobility specialists, wait patiently to get answers at a followup appointment so their provider can have time to catch up on relevant research, etc.

The less a given provider knows about hypermobility, the more labor a hypermobile patient will likely have to do to help guide treatment sessions.

If treatment isn’t working / feeling right, always question whether looking at the problem from a hypermobility lens would help.

• (This makes so much sense! And might explain why all I said was “abductive motion, e.g. cycling” and then the brilliant PT with decades of hypermobility expertise read my mind and asked based on other patient stories if it also hurt to sit on the floor and rest my left ankle on my right hip, if the cycling pain was a the top of the stroke, if rowing machines probably felt fine except maybe sometimes on the recoil, if impact such as running felt just fine as long as my legs were close together, etc. Hypermobility does not impact the majority of the population. I went into other providers describing the black and white stripes of my pain while they looked for horses; a hypermobility specialist hears that and can say “yup, classic zebra.”)

Sadly, she didn’t know any hypermobility-specialist PTs closer to my home, but she was able to refer me to two others at her clinic with better availability than her. So I’m going to get the care I need, without a huge research project on my part, at the minor cost of a longer commute for treatment.

Paradox of buffness

I find it rather amusing that hypermobile people can struggle in “classic” “ultra-strong” endeavors like Crossfit, and … also … hypermobile people have to be above-average strong just to safely get a bathrobe off a hook. 🤪

I’ll figure out how to strike the right balance, some way or another!

(Even if quite that much time at the gym per week wouldn’t have been my dream hobby.)

💪