Physical Therapy Treatment for Hypermobile joints

by Dr. Erin Carr, June 21, 2016

Physical therapy treatment for hypermobile joints is effective for various joints in our bodies. Have you sprained an ankle? Dislocated your shoulder? Experienced whiplash? You may have joint hypermobility. Although ankle sprains, whiplash, and shoulder dislocations sound like very different injuries, they have a lot in common.  Repetitive re-injury to these parts of your body, may develop into pain or muscle stiffness due to unstable or hypermobile joints.  Hypermobility or instability are terms used by physical therapists and other healthcare professionals describing what happens to a joint when it is not supported properly by the ligaments, cartilage muscles and tendons in and around it.


Joint pain can be caused by a variety of reasons, but when caused by joint instability or hypermobility it can be commonly misunderstood, misdiagnosed and mistreated. Why? Because hypermobile joints can actually be masked by joint stiffness, muscle spasms and limited range of motion. Physical therapy treatment for hypermobile joints can be extremely beneficial in regards to patient education and treatment. Depending on which part of the body is affected, I ask patients a variety of questions to help determine if their joint pain may be caused by  hypermobile joints.


Do you experience more pain at rest than with activity? Do you have a hard time falling asleep or staying asleep? Do you experience catching in your joint(s) with certain movements? Do you feel better when you move or walk versus stay in one place like sitting or standing? If so, you may experience something called hypermobility or instability in your joints. Physical therapy treatment for hypermobile joints focuses on strength, stability and proprioception.


Most people think an injury only gets exacerbated with physical activity, where as, someone with instability or hypermobility may actually have less pain with activity and more pain at rest or static positions. Meaning, when sitting, standing or sleeping, such static postures can actually increase pain where walking or moderate exercise relieves it. When there is an unstable joint in the body, our body innately understands that it needs to protect this area by using the larger muscle groups to tighten, spasm, ache or limit range of motion. Our brain is essentially tells our body to tighten, spasm, ache or cause pain so that we eventually move and change positions so our muscles and ligaments activate and stabilize the area.


Physical therapy treatment for hypermobile joints can address a variety of injuries. The most commonly seein include ankle sprains, shoulder subluxations or dislocations and whiplash. Such diagnosis’ can be related to stretched ligaments that are no longer providing support to a joint from overuse (i.e. repetitive ankle sprains or repetitive shoulder dislocations or subluxations where the joint can come out of the socket or trauma from a car accident for instance). It can also be related to genetics, spinal deformities or degeneration causing changes to the bone structure.


If you think you experience such symptoms, physical therapy treatment for hypermobile joints incorporates strength and endurance. Keep in mind, it is essential to strengthen the smaller, postural muscles that surround such joints to give support. For example, shoulder injuries, especially unstable shoulders need strength and endurance of the rotator cuff as well as muscles between the shoulder blades (i.e. middle trapezius and serratus anterior) to support the shoulder girdle. Having strong biceps, pecs and deltoids, is good, and are the common muscles strengthened in the gym, but they are often overworked and cannot provide true stability to the shoulder joint itself. If your joints are not supported by the necessary muscle groups you are at risk for re-injury.


On the other end of the spectrum, repetitive ankle sprains are also very common. The ankle joint is supported by several ligaments. When these ligaments are overstretched from repetitive trauma or re-injury, the more stretched the ligaments get the less support they are. Strengthening is also essential for the foot and ankle, as are balance exercises. Balance exercises such as standing on one foot or tandem walking can help with proprioception, which is knowing where your body is in space. Proprioceptors are found in ligaments throughout the body. They have receptors that communicate with the brain. The brain can then send the proper signals back to the body to help with timing and coordination of movement between large and small muscle groups.

When one experiences hypermobility in the cervical spine from a whiplash injury, these individuals complain of pain while sleeping, sitting at the computer or looking up for an extended period of time. Physical therapy treatment for hyperomobility in the neck incorporates strength and endurance exercises for the deep neck flexors (the abdominals for the neck). These are essential along with coordinating eye movements with head movements for added proprioception to stabilize the deep postural muscles supporting the spine itself.

Physical therapy treatment for hypermobile joints focus on building awareness through the use of small postural muscles, strengthening on stable surfaces and moving toward more challenging activities to build connections between the brain and body for better coordination and long term injury recovery and prevention.


When it comes to hypermobile joints, do be careful with stretching as this can aggravate your symptoms. Although many experience tightness or stiffness, it is your body’s way of asking you to simply move, not necessarily stretch as this tightness is a protective mechanism Our body’s are smart, listen to what is saying. As you strengthen, become more stable and have less pain, the stiffness will slowly diminish as joints are supported and more stable.


If you are not sure if you are experiencing instability, contact your local physical therapist in regards to treatment for hypermobile joints. In addition to physical therapy, PRP, prolotherapy and/or stem cell regenerative medicine can also be extremely helpful in healing unstable joints from ligament or tendon injury. Physical therapy after PRP injections will continue to help stabilize, strengthen and balance the area of injury providing long term pain relief while improving overall function. Turn pain and weakness into strength and vitality.


Dr. Erin Carr is owner and head practitioner of Dr. Carr Integrative Physical Therapy. She has been featured in Malibu Times Magazine as a “Local Specialist”. Dr. Carr Integrative Physical Therapy’s therapists offer in office visits from our clinic in Santa Monica. As well as off site home physical therapy for patients throughout many areas of Los Angeles, CA.



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