Hypermobile EDS Treatment: Rule Out Low Tone First

How Is Hypermobile EDS Usually Treated?

Many people with hypermobility and dysautonomia reason that if loose joints are behind the autonomic problems, fixing the joints should fix the rest. We think that's sound logic, and in our experience that road often leads to injections or surgery. The clinic sees those options as relatively invasive and wants a less invasive path tried first.

A systematic review of conservative care in syndromic hypermobility found that controlled trial evidence for conservative management beating its comparators is weak, and that there is some evidence people improve over time (Palmer, 2021). In a retrospective study of patients with hEDS and hypermobility spectrum disorders, physical activity or exercise was among the treatments patients self-reported as helping their pain, though few reported improvement from any single treatment listed (Wilson, 2025).

Could It Be Hypotonia Instead of Hypermobility?

A hypermobile EDS diagnosis is made clinically, and a flexibility check called the Beighton score is one part of it. Genetic testing can identify other types of EDS, but no gene has been found for the hypermobile type. Our team's view is that one check often gets skipped: muscle tone. Hypotonia means muscle tone sits lower than it should, which gives a floppy, slumped-forward look. Low tone can let joints go past their usual limits, and our team finds that some people who seem hypermobile have low muscle tone instead.

People with cerebellar problems, which can show up as ataxia or dysmetria, are one example. In our experience, they tend to have low tone and weaker reflexes, and when they move, they drift toward the end range of their joints much like someone with EDS.

Why Would Low Muscle Tone Come With Dizziness or Autonomic Symptoms?

In our team's view, the reflexes that set muscle tone, which run largely through the cerebellum and brainstem, also control reflexes tied to the blood vessels, cardiac output and the body's anticipation of gravity when you're upright. That's why, as we see it, hypotonia generated by the cerebellum can come with autonomic problems, balance trouble, dizziness and problems with eye movements or tracking.

Studies point to autonomic involvement in some people with hEDS (Dell'Aversana, 2026). POTS and EDS: why they show up together covers the mechanisms researchers have proposed.

Loose tissue Low muscle tone

Replay

Where Do PRP, Prolotherapy, Stem Cells and Surgery Fit?

As the video at the top of this page describes them, PRP reinjects parts of your own blood into the injured area, prolotherapy injects a dextrose solution meant to set off a local immune response, and stem cell injections add cells that can turn into other tissue. Each one aims to start a healing response in the area, and fusion sits at the far end of the range. The video's view is that rehab stays the core and that these can be added to rehab. Our team's view, as with craniocervical instability, is that without outcome data in hEDS it's hard to make a definitive statement on what they do.

Where Do Exercise and Loading Fit?

The video at the top of this page names isometric loading as the main method. You contract the muscles and push against something without moving the joint, so the limb isn't taken through a range that could feel risky. The video also says many different joints can be involved and to start light. That's general education, so check with your own clinician first.

What If You Have hEDS and POTS?

A 2026 systematic review concluded that EDS and POTS frequently co-occur (Kwok, 2026), though co-occurrence alone doesn't show that one causes the other. Our team's part is testing the brain's regulation of heart rate, blood pressure and brain blood flow, and checking muscle tone along with it. POTS and EDS: why they show up together covers the overlap.

Hypermobile EDS Treatment: FAQ