hEDS and HSD Exercises: A Physiotherapist’s Guide to Getting Stronger Safely
Updated: 6 days ago
If you have hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD), exercise can feel confusing. You may have been told that strengthening is important, while also finding that certain exercises aggravate pain, fatigue or joint instability. The aim is not to avoid movement, but to find an appropriate starting point and progress gradually.
As a physiotherapist, I generally think about exercise for hypermobility in terms of control, strength, stability, proprioception and gradual progression. There is no single programme that is right for everyone with hEDS or HSD, so exercises should be adapted to your symptoms, current ability and any advice you have received from your own healthcare team.
Why strengthening can help with hEDS and HSD
When joints have more movement available, the muscles around them have an important role in providing active support and control. Strengthening therefore does not mean pushing into extreme ranges or repeatedly stretching already mobile joints. The focus is usually on building capacity and control through ranges that you can manage comfortably.
A useful programme may include lower-limb strengthening, upper-limb strengthening, trunk control, balance and proprioception work. The exact combination depends on which joints are affected and what you want to be able to do.
Start with control before making an exercise harder
With hypermobility, a harder exercise is not automatically a better exercise. Before adding resistance, repetitions or complexity, aim to perform the movement with good control. Avoid deliberately pushing a joint to the very end of its available range simply because you can.
If an exercise is difficult, it can often be modified by reducing the range, using support, lowering the resistance, performing fewer repetitions or choosing a more stable starting position. Progression can then happen gradually as your confidence and capacity improve.
Strengthening exercises for hypermobility
Examples of strengthening patterns that may be useful include sit-to-stand variations, supported squats, bridges, hip abduction work, calf raises, rowing movements and controlled shoulder stability exercises. These are examples rather than a prescription. The appropriate version and dosage will differ between individuals.
One reason I use exercise levels and progressions is that somebody may initially need a supported version of an exercise but later require more resistance or a more challenging variation. Having somewhere to progress to is important if the goal is to build strength rather than simply repeat the same easy exercise indefinitely.
Proprioception and balance
Proprioception is your awareness of where your body and joints are positioned. Balance and proprioceptive exercises can therefore form another part of rehabilitation for people with symptomatic hypermobility. These may begin with simple supported standing tasks and progress towards narrower bases of support, movement, reaching or more challenging balance activities where appropriate.
What if exercise causes a flare?
Some muscle tiredness after a new strengthening programme can be expected, but a significant or prolonged increase in your usual symptoms is a reason to reconsider the exercise, dosage or progression. Doing more is not always the answer. Sometimes the useful change is fewer repetitions, more recovery time, a smaller range or a different exercise targeting the same area.
Pacing is particularly relevant when fatigue or widespread symptoms are present. A programme that looks manageable on paper is not useful if it consistently leaves you unable to manage the rest of your day.
How often should you exercise?
There is not one frequency that suits everyone with hEDS or HSD. Frequency depends on the exercise, intensity, your starting level, symptoms and recovery. Consistency is usually more useful than repeatedly doing too much and then needing a long period away from exercise.
A structured hEDS and HSD exercise resource
I created the Tom Morgan Physio Solutions HSD/hEDS Physiotherapy Guide for people who want more structure than a short list of generic exercises. The digital guide contains 39 adaptable exercises across four pathways, alongside practical guidance on pacing and progression so that the movements are easier to follow at home.
It also brings together practical information around strengthening, stability, pacing, symptom management and adapting exercise. The aim is to give you a resource you can return to rather than expecting you to remember everything at once.
You can find the HSD/hEDS Physiotherapy Guide in the eGuide section of Tom Morgan Physio Solutions.
When to get individual advice
A general exercise resource cannot replace an individual assessment. Consider seeking personalised medical or physiotherapy advice if you have new or unexplained symptoms, recurrent significant joint injuries or dislocations, neurological symptoms, severe or rapidly worsening pain, or if you are unsure whether exercise is appropriate for you.
The key message is that being hypermobile does not mean you have to avoid strengthening. The useful starting point is an exercise level you can control and tolerate, followed by gradual progression based on how your body responds.
What does the paid guide add? This free article explains the principles. The £24.99 HSD/hEDS PDF brings 39 adaptable exercises across four pathways together with pacing and progression guidance in one resource you can save and revisit. View the sample in the product gallery before deciding whether its format suits you. It is a one-off digital purchase, not an individual assessment or a subscription.
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