Understanding HSD & EDS:
Symptoms, Treatment & Physical Therapy

HSD manual therapy at Invincible Physical Therapy

At Invincible Physical Therapy, we see many people who experience excessive mobility in their joints. While we cannot formally diagnose Hypermobility Spectrum Disorder (HSD), Ehlers-Danlos Syndrome (EDS), or other hypermobility-related conditions, we can screen for signs of excessive mobility and provide education and individualized physical therapy to support people in living well with this challenge.

We are always learning and becoming more knowledgeable about the unique experience these individuals have in their bodies. This understanding highlights the need for a more nuanced and multifaceted approach to care.

What Is HSD & EDS?

Hypermobility Spectrum Disorder (HSD) is the medical term for this condition. Ehlers-Danlos Syndrome (EDS) is a known syndrome within the HSD spectrum. One can have HSD without being diagnosed with EDS. Many subtypes of HSD exist, which affect different body systems in different ways.

Folks who have more “bendy” or hyperflexible joints often experience co-existing issues because these hyperflexible and more fragile tissues are not only contained in the joints, but are found throughout many other areas of the body.

The basic building block of joints is connective tissue and, more specifically, collagen. There are many types of collagen and many ways these presentations can manifest in an individual with HSD/EDS. Please refer to this link from The Ehlers-Danlos Society to see helpful visuals that explain why each person’s presentation is unique and requires different supportive structures.

Beyond Joint Hypermobility: Systems and conditions associated with HSD/EDS

Beyond the musculoskeletal system (bones, muscles, and joints), other affected body systems may include:

Neurological
Vascular
Gastrointestinal

Immune
Reproductive

As a result, we often see other conditions co-exist with HSD/EDS, such as:

Postural Orthostatic Tachycardia Syndrome (POTS)
Dysautonomia
Craniocervical Instability (CCI)
Chiari Malformation and Cerebellar Tonsillar Ectopia (CTE)
Mast Cell Activation Syndrome (MCAS)

Abdominal Compression Syndromes, including Nutcracker Syndrome and May-Thurner Syndrome
Pelvic Venous Disorders (PeVD)
Structural and Functional Gastrointestinal Disorders
And many others

The Role of Collagen and the Extracellular Matrix

More recent research also confirms relationships between how collagen and the surrounding fluids called the Extracellular Matrix (ECM) that the collagen “swims” in and supports works.

One important function of this combination of collagen support and the ECM is supposed to act as a filter for the body’s trash. With HSD/EDS, this filtration system is often impaired. As a result, it cannot take out the trash efficiently, leaving many body tissues in an excessively inflammatory state.

This excess inflammation can look like mold toxicity issues that won’t resolve, reactivated viral or bacterial infections, or disease Lyme co-infections that seem to persist, for example.

How Physical Therapy Can Help

As an HSD/EDS-informed practice, we know from our HSD/EDS colleagues that visceral, neural, and vascular manipulation — which is the core focus of our work at Invincible — is a helpful strategy for supporting patients managing this condition.

Visceral Manipulation helps create balance in the tensions and pressures of the body. We use a very precise and gentle anatomical approach, with the nuance that is often required by these patients.

As Doctors of Physical Therapy, we couple this gentle and effective manual therapy with:

Restoring optimal posture
Adding mindful strengthening practice at the right time
Supporting and educating patients on regulating the nervous system as it relates to nervous system overwhelm and persistent pain
Supporting patients in connecting with specialists in various disciplines when needed to address particular issues that an individual patient may be experiencing

HSD physical therapy at Invincible Physical Therapy

Recommended Resources for HSD and EDS

If you’d like to learn more about HSD/EDS, a few of our favorite resources include:

Taming the Zebra, Volume 1 — By Patricia Stott, DPT, MS, ATC, CHT and Heather Purdin, MS, PT, CMPT.

This is a definitive text for providers as well as patients to optimally understand and serve as a starting point to address not only joint hypermobility, but the many additional conditions that may accompany it. Dr. Missy and Dr. Beth Anne reference this text on a regular basis to support our patients at Invincible.
Dare to Dazzle: A Patient, Parent, and Provider’s Medical Research Memoir on HSD/EDS — By Patricia Stott

Our friend and colleague shares her personal experience of living in an HSD/EDS body in a way that is validating, empowering, and encouraging to anyone on this journey. Her own vulnerability in sharing her memoir is helpful for patients and providers alike to truly understand the wide array of experiences that folks endure in an effort, in the end, to live their best lives with this condition. She also shares specific scientific information that may be helpful for readers’ own journeys.
The Ehlers-Danlos Society

The Ehlers-Danlos Society website contains loads of information for anyone just learning about their condition to those with a seasoned understanding, and everywhere in between. It’s an excellent resource for providers as well to increase their education in this condition and care for these patients with excellence and the most updated information to provide optimal care.

If you live in Lakewood, Colorado and have been diagnosed with HSD or EDS — or are experiencing symptoms associated with excessive joint mobility — contact Invincible to learn more about our HSD/EDS-informed physical therapy approach.