Hypermobility Isn’t Just “Being Double-Jointed” — Here’s What Every Woman Should Know

Being able to bend a thumb back to the forearm or drop into the splits without warming up often gets treated as a party trick — the “double-jointed” family member, the naturally gifted gymnast. For many people, that flexibility really is just how their body is built.

But for others, that same bendiness comes bundled with years of joint pain, recurrent sprains, unexplained fatigue, and a sense that something more is going on. As physiotherapist Stephen O’Rourke has written, people can spend years collecting injuries and symptoms before anyone connects the dots back to hypermobility.

As a physiotherapist who has spent two decades assessing joints, movement patterns and pain presentations, I want to go a layer deeper — because for women specifically, hypermobility rarely travels alone. It shows up alongside ADHD, endometriosis, and a diagnostic journey that’s often longer and harder than it should be.

What Hypermobility Actually Is

Three terms get used, and it’s worth knowing the difference:

• Generalised Joint Hypermobility (GJH) — joints that move beyond the typical range, which on its own may cause no other symptoms at all.
• Hypermobility Spectrum Disorder (HSD) — hypermobility accompanied by pain, fatigue, joint instability, or frequent injuries that interfere with daily life.
• Hypermobile Ehlers-Danlos Syndrome (hEDS) — a more complex, inherited connective tissue disorder where hypermobility sits alongside effects on the skin, digestive system, and cardiovascular system.

GJH is thought to affect somewhere between 10–20% of the general population, though the figure shifts depending on age, sex, ethnicity, and how it’s measured. What’s consistent across the research is that hypermobility and hEDS show up more often in women than men — a pattern with real implications for how we screen, diagnose, and support patients.

Getting a Diagnosis Isn’t Simple

There’s no single blood test or scan that confirms a hypermobility disorder. Diagnosis relies on a detailed clinical assessment, often alongside ruling out other conditions with overlapping symptoms — inflammatory and autoimmune diseases like rheumatoid arthritis and lupus, thyroid disorders, and other inherited connective tissue conditions. A GP can arrange bloodwork covering inflammatory markers and thyroid function; a rheumatologist may get involved to exclude inflammatory conditions or arrange genetic testing for specific EDS subtypes.

Physiotherapists and GPs commonly use the Beighton Score — a simple nine-point physical assessment of joint flexibility across the fingers, thumbs, elbows, knees and spine — as one piece of that picture, alongside symptoms, age, and medical history. If you would like to book an assessment Click Here

The diagnostic gap in Ireland is significant. Research has found that patients in Northern Ireland wait an average of 21 years for a diagnosis — one of the longest delays recorded in the NHS — with close to 40% needing to travel outside the region for it. Within Ireland, specialist bimonthly clinics led by Dr Anand Saggar at the Beacon Hospital have improved access, but the waitlist still runs to around 18 months. Estimates suggest roughly 2,000 people in Ireland have a diagnosed EDS and 650 an HSD diagnosis — against a projected population of at least 6,250 living with one of these conditions, meaning a substantial number remain undiagnosed.

It’s Not Just Joints — The Gut Is Connective Tissue Too

One of the least expected parts of this picture is the digestive system. Connective tissue isn’t confined to joints and skin — it runs through the walls of the gut as well, and when it’s more lax or less able to contract efficiently, digestion can be affected from mouth to bowel.

According to Ehlers-Danlos Support UK, a meaningful proportion of people with hEDS experience some form of gastrointestinal symptom, and both the upper digestive tract (oesophagus, stomach, duodenum) and lower tract (small intestine, colon, rectum) can be involved — often in isolation, which is part of why the connection to hypermobility gets missed. A national cohort study of EDS patients in France similarly found digestive symptoms to be common and to meaningfully affect quality of life, with the hypermobile subtype most frequently represented.

The symptoms reported are broad: reflux and heartburn, bloating, early satiety, nausea, delayed stomach emptying (gastroparesis), and constipation or irritable bowel syndrome (IBS)-type symptoms. Autonomic dysfunction — the same dysautonomia that overlaps with ADHD and hypermobility — appears to compound the problem further, since the nervous system’s control over gut motility can be affected alongside the connective tissue itself.

The practical implication is one clinicians increasingly stress: gut symptoms in someone with joint hypermobility are worth mentioning to a GP or gastroenterologist as part of the same picture, rather than being investigated as an entirely separate, unexplained issue.

The ADHD Connection

One of the most striking overlaps in recent research is between hypermobility and neurodivergence — particularly ADHD.

A 2022 study by Csecs and colleagues found that around half of individuals with neurodevelopmental conditions, including ADHD and autism, also show joint hypermobility. Looking at it from the other direction, people with Ehlers-Danlos Syndrome have been found to be five to six times more likely to have an ADHD diagnosis than the general population.

A Swedish case-control study led by Glans and colleagues (2021) examined adult ADHD specifically and confirmed a meaningful association between generalised joint hypermobility and ADHD in adults — not just children, where much of the early research was concentrated.

More recent work has started to explain why. A 2025 paper by Kustow, presented through the UK Adult ADHD Network, describes a cluster of hypermobility, immune dysfunction, and dysautonomia that appears disproportionately in people with ADHD — with roughly half of individuals with ADHD showing signs of hypermobility. This isn’t simple joint laxity; it often comes bundled with autonomic nervous system symptoms like postural orthostatic tachycardia syndrome (POTS), mast cell-related symptoms, and autoimmune conditions.

The leading theory isn’t that one condition causes the other. Instead, both may share underlying variation in connective tissue and nervous system development — meaning the same biological differences that affect joint structure may also influence attention, sensory processing, and autonomic regulation.

For women, this matters enormously. ADHD in women is already significantly under-diagnosed, often masked by better compensation strategies or misattributed to anxiety. Layering in an unrecognised connective tissue component adds another reason women’s symptoms get dismissed, delayed, or misdiagnosed for years.

The Endometriosis Overlap

The second thread — and one that’s had far less airtime — is the relationship between hypermobility and endometriosis.

There’s emerging evidence of meaningful overlap between endometriosis and hypermobility-related connective tissue conditions, though researchers are careful to note the relationship is still being mapped and one doesn’t straightforwardly “cause” the other. What’s becoming clearer is that when both are present, symptoms can compound each other — pelvic pain from endometriosis interacting with joint instability, pelvic floor dysfunction, and nerve sensitivity driven by an underlying connective tissue difference.

This is an area GP and women’s health advocate Dr Ceri Cashell has been actively drawing attention to, alongside her broader work highlighting gaps in the medical education and research base for women’s hormonal health. She’s also flagged newly updated international guidelines recommending ultrasound and MRI as first-line, less invasive tools for diagnosing endometriosis — a shift that could meaningfully shorten the diagnostic delay many women currently face, and one that also opens the door for physiotherapy and psychology input to be built into pelvic pain care pathways from the outset, rather than added on as an afterthought.

Cashell has also pointed to a lesser-known crossover: women with hypermobility and EDS report notably higher rates of local anaesthetic failure — including at the dentist — a pattern also seen in women with PMDD (premenstrual dysphoric disorder). It’s a small clinical detail, but it illustrates something bigger: connective tissue differences don’t stay in one lane. They show up in pain sensitivity, hormonal symptom severity, and even how your body responds to routine medical procedures.

Why Women, Specifically?

There are a few threads worth pulling on here, none of which are fully resolved in the research yet, but which are worth naming:

• Hormonal influence on connective tissue. Oestrogen and relaxin both affect collagen and ligament laxity, which may partly explain why hypermobility-related symptoms can fluctuate across the menstrual cycle, worsen in pregnancy, and shift again around perimenopause.
• Diagnostic delay. Women with chronic pain conditions — endometriosis very much included — routinely wait years longer than average for diagnosis. Add joint hypermobility or ADHD into that picture and the path to being taken seriously gets even longer.
• Symptom fragmentation. A woman might see a physiotherapist for joint pain, a GP for fatigue, a gynaecologist for pelvic pain, and a psychiatrist for attention difficulties — with no one clinician holding the full picture of an underlying connective tissue and nervous system difference running through all of it.

Managing It: Why Strength Beats Stretching

Care for hypermobility conditions works best as a multidisciplinary effort — GPs, rheumatologists, occupational therapists, pain specialists and physiotherapists, depending on which symptoms are most disruptive.

Within that team, physiotherapy has a well-evidenced central role, and the approach often surprises people: strength training, not stretching, is the priority. The goal isn’t to become less flexible — that’s rarely realistic or necessary — it’s to build the muscular stability and control around lax joints that reduces recurrent sprains, subluxations, and pain. For anyone new to resistance work, that usually starts light, with bodyweight movements, and builds gradually towards bands and loaded strength training as capacity improves.

Alongside strength work, pacing and symptom management are just as important for daily quality of life — particularly where fatigue is a major feature.

If you would like to book an assessment Click Here

What This Means Practically

You don’t need a formal diagnosis to start paying attention to your own patterns. Some questions worth reflecting on:

• Do you have a history of joint pain, sprains, or “giving way” joints that started young?
• Do you bruise easily, or recover slowly from minor injuries?
• Do you experience unexplained fatigue, digestive symptoms — reflux, bloating, IBS-type patterns — or dizziness on standing?
• Is there a personal or family history of ADHD, autism, anxiety, or endometriosis alongside joint symptoms?

None of these confirm anything on their own. But if several resonate, it’s worth raising with a physiotherapist or GP who can assess joint mobility (often using the Beighton Score) and consider whether a broader referral pathway makes sense — rather than treating each symptom in isolation.

This is exactly where physiotherapy has a role to play: not just in managing joint pain and building stability around lax joints, but in recognising the wider pattern and making sure it doesn’t get missed. If you would like to book an assessment Click Here

For further reading, the Ehlers-Danlos Society and the Irish EDS website both offer evidence-based information, support groups, and signposting to specialist services.

This article is for general education and does not replace individualised clinical assessment. If any of this resonates with your own experience, speak with your physiotherapist or GP.

References

• O’Rourke, S. (2026). Hypermobility isn’t just being double-jointed. TheJournal.ie, “The Physio is In.”
• Ehlers-Danlos Support UK. Gastrointestinal problems in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.
• Fikree, A., et al. (2014). Functional digestive symptoms and quality of life in patients with Ehlers-Danlos syndromes: results of a national cohort study.
• Csecs, J.L.L., et al. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain.
• Glans, M., Bejerot, S., Humble, M., Elwin, M., & Thelin, N. (2021). Association between adult ADHD and generalised joint hypermobility, with and without systemic manifestations: A case-control study. European Psychiatry.
• Kustow, J. (2025). Hypermobility, immune dysfunction and dysautonomia cluster in ADHD. European Psychiatry.
• Cashell, C. Healthy Hormones — commentary on RANZCOG endometriosis guidelines and hypermobility/PMDD overlap in anaesthetic response.