What is Hypermobility Spectrum Disorder (HSD)?

Hypermobility Spectrum Disorder (HSD) is a term used when a person has symptomatic joint hypermobility (joints move beyond the typical range) and experiences related issues such as pain, instability, soft tissue injuries, or fatigue—but does not meet diagnostic criteria for a specific heritable connective tissue disorder (such as hypermobile Ehlers-Danlos syndrome).

HSD is a clinical diagnosis. Importantly, the focus of treatment is not the label—it’s your symptoms, functional goals, and what your body needs to handle daily life more safely and comfortably.

Common Symptoms and Functional Impacts

Symptoms vary widely. People with HSD may experience:

Joint and soft tissue symptoms

• Joint hypermobility (“double-jointedness”)

• Joint pain, aching, or flare-ups after activity

• Recurrent sprains/strains, tendon irritation, or soft tissue injuries

• Subluxations (partial joint slips) and/or dislocations (in some people)

• Feeling “unstable,” “wobbly,” or fearful of certain movements
  
  

Muscle and nervous system symptoms

• Muscle fatigue, weakness, or slow recovery

• Reduced proprioception (joint position sense) / clumsiness

• Poor balance or coordination

• Sensitivity to load (symptoms spike quickly with activity changes)
  
  

Day-to-day impacts

• Difficulty with prolonged standing, sitting, walking, or stairs

• Reduced tolerance for work, sport, or parenting demands

• Flare cycles (“boom–bust” pattern) and activity avoidance due to pain

• Sleep disruption and reduced quality of life

If symptoms are affecting your participation at home, work, sport, or community life, a tailored plan can help.

How Palms Can Help

How We Manage HSD at Palms

HSD management is most effective when it is progressive, consistent, and targeted to function—not just stretching or generic strengthening. Our approach typically includes:

• Stability and strength (especially around symptomatic joints)

• Movement control and technique (reducing end-range loading and “hanging” on joints)

• Load management and pacing (building capacity without triggering flares)

• Education and self-management (so you can confidently manage symptoms long-term)
  
  

Physiotherapy for HSD

Our physiotherapists focus on joint stability, movement quality, and pain-sensitive progression.

What Physiotherapy may include

• Joint stability training (control through range, not just strength)

• Strength and capacity building (glutes, core, scapular control—based on your needs)

• Proprioception and balance training (to improve joint awareness)

• Movement retraining (squats, stairs, lifting, gait—reducing end-range stress)

• Flare planning (how to modify safely without losing momentum)

• Manual therapy when appropriate for symptom relief as part of a broader plan

We aim to reduce reliance on passive treatment and build robust, self-manageable strategies.

Exercise Physiology for HSD

Exercise physiology can be a great fit for structured conditioning, especially when fatigue, deconditioning, or chronic pain patterns are present.

Exercise physiology may help with

• Graduated strength and endurance programming

• Safe, consistent conditioning without flare cycles

• Return-to-exercise planning (gym, Pilates-based strengthening, hydro, walking plans)

• Supporting long-term routines and adherence

Programs are tailored—often starting lower than you think and progressing steadily to build tolerance.

Occupational Therapy for HSD

Occupational Therapy supports function across daily activities, work, study, and home life, especially when symptoms affect participation.

OT may include

• Joint protection strategies for daily tasks (without over-restricting movement)

• Ergonomics and workstation set-up (reducing repetitive strain)

• Energy conservation and pacing strategies (managing fatigue and flares)

• Practical supports for handwriting, self-care, and household tasks (when needed)

• Recommendations for aids/equipment when clinically indicated (e.g., splints, braces—often in coordination with other providers)
  
  

Speech Pathology and HSD

Speech Pathology is not routinely required for HSD. However, it may be relevant in specific situations, such as:

• Swallowing concerns (where dysphagia symptoms exist and require assessment)

• Voice issues related to laryngeal irritation or high voice demands (where appropriate)

• Jaw/TMJ-related communication or feeding concerns (assessment-based)

If these issues are present, speech pathology can assess function and provide evidence-informed strategies and referral pathways as needed.

Pain, Flare-Ups, and Self-Management

Many people with HSD experience fluctuating symptoms. We support you to:

• Identify triggers and early warning signs

• Build a flare plan (what to reduce, what to keep, and what to modify)

• Use pacing strategies to avoid “boom–bust” cycles

• Progress activity in a way that builds confidence and capacity

Where pain is persistent or complex, we use a biopsychosocial, evidence-based approach—without implying guarantees or one-size-fits-all outcomes.

Common Questions About HSD

What’s the difference between HSD and Ehlers-Danlos Syndrome (EDS)?

HSD is diagnosed when a person has symptomatic hypermobility but does not meet criteria for a specific heritable connective tissue disorder (such as hypermobile EDS). Both can involve pain and instability, but diagnostic frameworks differ. If connective tissue disorder is suspected, we can recommend appropriate referral pathways via your GP/specialists.

Can hypermobility be “cured”?

Hypermobility itself usually can’t be changed, but symptoms like pain, instability, fatigue, and recurrent injuries can often be improved with targeted stability training, load management, and practical strategies.

Why do I keep getting injuries?

Hypermobility can reduce joint stability and proprioception, meaning tissues may be exposed to higher strain—especially at end range. Therapy focuses on control, strength, and safer loading to reduce recurrence.

Do I need to stop exercising?

Usually, no. Most people do best with the right type of exercise, progressed safely. We help you find a level that is achievable now and build up without flare cycles.

Our Sensory Room and Kids Therapy Gym

Sensory Room

Our sensory room can be used (when clinically appropriate) to:

• Explore sensory preferences safely

• Support regulation strategies

• Practise functional participation skills (attention, transitions, tolerance of sensory input)
  
  

Kids Therapy Gym

Our kids gym allows therapists to work on:

• Gross motor skills (climbing, jumping, balance, coordination)

• Core strength and movement confidence

• Play-based therapy goals within an engaging environment
  
  

Early Intervention and Family-Centred Support

Early support can be helpful for building communication, play, regulation, daily living skills, and participation. That said, support is valuable at any age, and goals should be realistic, functional, and aligned with the child and family.

We prioritise:

• Practical strategies you can use at home

• Collaboration with educators and support teams (with consent)

• Consistent goal review and measurable progress tracking where appropriate
  
  

NDIS & Funding Support

We support self-managed and plan-managed NDIS participants (and private clients). Therapy recommendations aim to inform support needs and planning, noting that NDIS funding decisions are made by the NDIA.

External Resources for Hypotonicity in Australia

Down Syndrome Australia – Hypotonicity and Muscle Tone
https://www.downsyndrome.org.au
Resources and information on managing low muscle tone in individuals with Down syndrome.

Better Health Channel – Hypotonia (Low Muscle Tone)
https://www.betterhealth.vic.gov.au
Information on hypotonia, its causes, symptoms, and treatments for managing low muscle tone.

1. Cerebral Palsy Alliance – Hypotonicity in Cerebral Palsy
   https://cerebralpalsy.org.au
   Information on the management of low muscle tone in individuals with cerebral palsy.

2. NDIS (National Disability Insurance Scheme)
   https://www.ndis.gov.au
   Learn more about funding and therapy support for individuals with hypotonicity through the NDIS.

3. Spinal Muscular Atrophy Australia
   https://smaaustralia.org.au
   Support and resources for individuals with spinal muscular atrophy, a condition commonly associated with hypotonicity

Important disclaimer: This webpage contains general information only and is not intended to be relied upon as personal clinical advice. While we aim to keep information accurate and up to date, it may not reflect the most current research or your individual circumstances. Palms Physiotherapy & Allied Health does not accept liability for decisions made based on this information without an individualised assessment by an appropriately qualified health professional. If you have concerns, please contact us to book an assessment or speak with your GP/medical team.