Bendy But Not Broken
Supporting Pelvic Health in Patients with Hypermobility Syndromes
For many us, flexibility has always felt like an asset — a competitive edge in yoga class, dance, or athletics. But for a subset of our patients, that same flexibility is a clinical signal. If you can touch your toes with ease or your knees hyperextend past neutral, you may be living with Hypermobility Spectrum Disorder (HSD) or Ehlers-Danlos Syndrome (EDS). In these conditions, the connective tissue (collagen) that should stabilize your joints lacks normal tensile stiffness, leaving the joints inherently less stable — including the joints and connective structures of the pelvis.
Why Hypermobility Affects Pelvic Health
The pelvic floor is a muscular sling responsible for continence, organ support, and core stability. Under normal circumstances, these muscles share the structural load with the surrounding ligaments and fascia. In patients with lax connective tissue, however, that passive support system is compromised — forcing the pelvic floor muscles to compensate continuously. Over time, this chronic overactivity can lead to fatigue, pain, and dysfunction.
The clinical literature reflects a meaningful relationship between connective tissue laxity and pelvic floor disorders. A 2020 scoping review by Gilliam, Hoffman, and Yeh, published in Clinical Genetics, synthesized the existing research on urogenital and pelvic complications in patients with EDS and associated hypermobility spectrum disorders, finding that these complications are common but historically understudied. Separately, a 2019 study by Hastings and colleagues found that nearly a quarter of women presenting with chronic myofascial pelvic pain met criteria for generalized hypermobility spectrum disorder, a group that also showed significantly elevated rates of dyspareunia, low back pain, and stress urinary incontinence. Taken together, this research underscores what many of our patients already sense intuitively: hypermobility and pelvic floor dysfunction are clinically intertwined, and this connection warrants a deliberate, specialized approach to care.
Physical Therapy for Joint Stability in the Hypermobile Patient
This principle extends well beyond the pelvis. Across every joint system, patients with hypermobility syndromes benefit from an orthopedic approach that prioritizes neuromuscular control and stabilization over passive range of motion. Because these patients often already possess — and may over-rely on — excessive joint mobility, conventional strengthening protocols that emphasize end-range flexibility can inadvertently increase injury risk. Instead, our clinicians focus on building strength and proprioceptive awareness within a joint’s stable, mid-range zone, training the surrounding musculature to actively compensate for what the connective tissue cannot passively provide. This means graded, closed-chain strengthening, targeted motor control exercises, and progressive loading strategies designed to reinforce joint centration and reduce the likelihood of subluxation, sprain, or overuse injury. Whether we are addressing a shoulder, knee, or the pelvis itself, the underlying clinical philosophy is the same: durable joint stability is what allows a hypermobile patient to move — and perform — without compromising long-term tissue integrity.
Our Approach to Pelvic Floor Care
Because standard pelvic floor strengthening protocols can fall short — or even exacerbate symptoms — in hypermobile patients, our treatment philosophy centers on precision and control rather than raw strength or increased flexibility.
A Note to Our Patients
You understand, likely better than most, that sustainable high performance depends on well-calibrated systems — not brute effort alone. Hypermobility is not simply a flexible party trick; when unmanaged, it places ongoing, often invisible strain on your body’s supportive infrastructure. If you are experiencing pelvic pain, urinary symptoms, or a sense of instability, it may be time to work with a team that understands the specific biomechanics of connective tissue disorders.
Our physical therapists specialize in helping patients build a stable foundation — one that allows you to retain your natural flexibility without your body having to compensate for it every day.
References
- Gilliam, E., Hoffman, J. D., & Yeh, G. (2020). Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clinical Genetics, 97(1), 168–178.
- Hastings, J., Forster, J. E., & Witzeman, K. (2019). Joint hypermobility among female patients presenting with chronic myofascial pelvic pain. PM&R, 11(11), 1193–1199.
