How to Exercise With hEDS: Strength, Pacing and Progression
Updated: Oct 8
Exercise with hypermobile Ehlers-Danlos syndrome can be difficult to navigate. Advice to simply exercise more can be unhelpful when pain, fatigue, joint instability or other symptoms affect how much activity you can tolerate. A more useful approach is to find an appropriate starting level and build from there.
There is no single hEDS workout
People with hEDS vary enormously in symptoms and physical ability. Exercise therefore needs to reflect the individual rather than a diagnosis alone. Strengthening, stability, balance, proprioception and cardiovascular activity may all have a place, but not necessarily at the same starting level for everyone.
Start with a level you can control
Choose variations that allow you to control the movement without repeatedly pushing joints to their end range. If an exercise is too difficult, modifying the range, resistance, position or number of repetitions is still exercise. It gives you somewhere sensible to progress from.
Strength is part of joint management
Strengthening can improve the active support around joints. Current evidence in symptomatic hypermobility is limited but generally supports therapeutic exercise as part of conservative management, with reported improvements in outcomes including pain, function or proprioception in several studies.
Pacing matters
Doing a large session on a good day and then being unable to exercise for a prolonged period can make progression difficult. A smaller repeatable dose may be a better starting point. Pay attention to how you feel later that day and afterwards, not only while you are exercising.
Progress one thing at a time
Progression might mean more repetitions, slightly more resistance, less external support or a harder exercise variation. You do not need to increase every part of the programme simultaneously. Gradual changes make it easier to understand what your body is tolerating.
39 adaptable exercises across four pathways
The Tom Morgan Physio Solutions HSD/hEDS Physiotherapy Guide contains 39 adaptable exercises across four pathways, with guidance on strengthening, stability, pacing and progression. It also covers practical considerations around managing exercise and symptoms, giving you a resource to return to as your ability changes.
General exercise information cannot replace an individual assessment. Seek appropriate healthcare advice for significant new symptoms, recurrent serious instability, acute injury or if you are unsure whether a particular type of exercise is suitable for you.
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