Kara is a Physiotherapist at Nova Physiotherapy that has a special interest in and treats hypermobility. Being hypermobile herself, Kara is passionate about educating clients about this diagnosis, giving them self-management strategies and showing them the ways that physiotherapy can help.  


What is hypermobility?   

Joints can be considered hypermobile when they have an increased range of motion beyond what is expected. Joints are the area of the body where two bones meet. Hypermobility is a spectrum and no two people have the exact same symptoms.   

Signs you may be hypermobile:

  1. Your joints seem to move more than other peoples and you consider yourself “double-jointed”
  2. You feel tight most of the time regardless of how much you stretch
  3. You have dislocated your kneecap or shoulder more than once
  4. You can place your hands flat on the floor without bending your knees
  5. You can bend your thumb to touch your forearm

For some athletes, such as dancers or gymnasts this can be an advantage as they require a lot of flexibility in their sport. Hypermobility that does not cause pain or interrupt one’s life is called “asymptomatic joint hypermobility” and does not need to be treated.   

However, for some of you, joint hypermobility causes instability at the joint and this can be painful or impact your ability to do daily things. It can lead to joint subluxations, dislocations, sprains and other injuries. It may affect many joints in the body or just a few joints.  You may also experience other symptoms such as fatigue, dizziness, headaches, GI problems, and/or autonomic dysfunction.  

Other symptoms may include: 

  • Stretchy skin (hyperextensibility)
  • Delayed wound healing
  • Increased arm span to height ratio 
  • Long slender finger
  • Pain for > 3 months
  • Overload injuries (sprains/strains)
  • Subluxations
  • Recurrent fractures

It is important to know that having one symptom in isolation does not mean that you have hypermobility. Symptoms can vary greatly in the number and severity. Your team will look at your whole clinical picture. 


There are different connective tissue disorders that can cause joint hypermobility such as Ehlers-Danlos Syndrome (EDS), Hypermobility Spectrum Disorders (HSD), Marfan’s Syndrome and other Connective Tissue Disorders (CTDs).

There are some conditions that can be associated with EDS or HSD that include Dysautonomia, Mast Cell Activation Syndrome, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome, ADHD, GERD, Irritable Bowel Syndrome, Congenital Scoliosis and more.


When reading this list, don’t become anxious or worried if you don’t know anything about these conditions. Having hypermobility does not mean you will experience any or all of these things. Your health care team can help you make sense of any diagnoses you may have received.     

Often those with hypermobility benefit from the support of a multi-disciplinary team who are HSD/CTD-aware. Such a team may consist of a General Practitioner, Cardiologist, Rheumatologist, Gastroenterologist, Immunologist, Psychologist, Gynaecologist, Occupational Therapist, Physiotherapist, and Dietician.  

Don’t be overwhelmed by all this information, your physiotherapist and health care team can help you make sense of hypermobility and develop a plan specific for you!


Physiotherapy Assessment

Your first physiotherapy session is scheduled for 1 hour. This allows us time to discuss your concerns, past health history, assess you and begin a treatment plan. We use a series of assessment tools to help diagnose hypermobility and guide your treatment plan.   

The Beighton score is a common screening tool used to look for joint hypermobility. It is a series of movements that result in a score out of 9. A score greater than or equal to 6/9 in children before puberty, 5/9 in adults or 4/9 in adults over 50 is considered positive for hypermobility. You may also be asked a series of 5 screening questions, these are used in conjunction with the Beighton score to determine hypermobility.   

Kara will use a series of movement tests to help inform your treatment plan. 


Physiotherapy Treatment

A physiotherapy session with Kara may include the following:

  • Initial education on hypermobility and coping strategies/tips. Clients will be directed to relevant resources and referred on as necessary
  • Establishing baseline level of activities and setting achievable short- and long- term goals
  • Home exercises that builds gradually to improve cardiovascular fitness, strength, joint stability, proprioception/balance and mobility
  • Manual Therapy treatments to help manage pain and other symptoms
  • Taping for posture, joint protection, and/or movement facilitation

Kara will decide with you on when and how to book your follow-up appointments which can be 30 minutes to 1 hour in duration. Kara will continually monitor, educate and engage in discussions with you regarding your symptoms and care. Exercises will be progressed gradually based on how you are tolerating them. It is beneficial to work with a physiotherapist to manage any flare-ups as soon as possible.


Hypermobility truly is a spectrum and no two people are the same.

Therefore, it is essential to take an individualized approach to treatment planning.  


Here are some guidelines for management of hypermobile joints: 

1. Work with a team

You have likely seen a lot of different practitioners searching for pain relief and explanations. Working with Kara, a physiotherapist who understands hypermobility, means you can be confident your treatment plan is specific to you. With gentle joint mobilizations and soft tissue techniques as well as a progressive plan to improve strength, you can work towards managing your symptoms. 

Ask your other practitioners if they are familiar with hypermobility and ensure they know about all your symptoms or concerns.


2. Use caution with excessive stretching and joint manipulation

Joint manipulation (techniques that make your joint crack) should be used sparingly. While these techniques can provide quick, temporary relief they can sometimes contribute to increased dependency on practitioners and reduced ability to manage flare-ups yourself. 

Similarly, techniques that release your muscles, such as dry needling and massage techniques should be used very intentionally. Soft-tissue release techniques can be quite beneficial in helping to manage pain, but used alone will have the potential to contribute to flare-ups.

When your goals of a treatment session are to find relief from pain and tension, it can be highly beneficial to incorporate stability exercises pre- or post-treatment to ensure you are working to increase the stability of the joints. 


3. Strength training needs to be a part of your lifestyle

There is no “cure” for hypermobile joints but with the right treatment plan you can successfully manage symptoms.

Unquestionably, the number one thing you can do for the management of hypermobile joints is to get stronger so that your muscles will better provide you with the stability and stiffness that your joints lack.

Kara can help develop an exercise program for you based on your assessment findings or work closely with your personal trainer or strength coach.   


The above information just touches the surface of hypermobility and the things you may be experiencing. Kara would be happy to assess you in the clinic and discuss more of the above. You can book an initial assessment with Kara HERE


More information can be found on The Ehlers Danlos Society website can be found here

Kara Montieth

Kara Montieth

Founding Partner & Physical Therapist

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