Hypermobility & Pilates: How to Strengthen, Stabilize & Move Safely

Hypermobility is a term that gets thrown around a lot in the Pilates and physiotherapy world, but it’s often misunderstood, mismanaged, or even dismissed. If you’re a hypermobility warrior yourself or a Pilates instructor working with hypermobile clients, this blog is for you.

As a physiotherapist and clinical Pilates instructor, I’ve seen firsthand how intelligent, well-structured movement can be life-changing for hypermobile individuals—reducing pain, preventing injury, and building true strength and control. But without the right approach, Pilates (and exercise in general) can just reinforce poor movement habits, increase joint instability, and leave people frustrated and in pain.Let’s break it all down—what hypermobility is, common issues it causes, and how to approach Pilates safely and effectively.

What Is Hypermobility? A Quick Science Lesson

Hypermobility refers to excessive joint movement beyond the normal range of motion, often due to increased ligament laxity and altered connective tissue properties.While some people have generalized hypermobility (affecting multiple joints), others may have localized hypermobility (affecting just a few specific joints, like the shoulders, spine, or hips).Hypermobility Spectrum Disorders (HSD) & Hypermobility Syndrome. Hypermobility exists on a spectrum, ranging from mild joint laxity to more complex connective tissue disorders like Ehlers-Danlos Syndrome - Hypermobile Type (hEDS).

Benign Joint Hypermobility Syndrome (BJHS) – Excessive joint flexibility that can lead to pain, instability, and injury, but without a broader systemic condition.

Hypermobile Ehlers-Danlos Syndrome (hEDS) – A genetic connective tissue disorder causing hypermobility, joint instability, chronic pain, easy bruising, fatigue, and sometimes autonomic dysfunction (e.g., POTS).

Hypermobility Spectrum Disorder (HSD) – Similar to hEDS but without meeting full diagnostic criteria.

Test for Hypermobility

The Beighton Score is commonly used to assess hypermobility. It scores out of 9 points based on joint flexibility in areas like the knees, elbows, thumbs, and spine. A score of 5/9 or higher suggests hypermobility. But here’s the key takeaway: Hypermobility isn’t just about being extra bendy—it’s about how your body handles movement, stability, and load.

Common Injuries & Issues in Hypermobile Clients

Hypermobility doesn’t automatically mean pain or injury, but it does increase the risk of certain issues.

Chronic Joint Pain & Instability

Without adequate muscle control, hypermobile joints rely on ligaments, tendons, and passive structures for stability—which they aren’t designed to do. This leads to joint subluxations, microtrauma, and chronic inflammation.

Common hypermobile "problem joints"

Knees (hyperextended, patellar instability)Hips (excessive external rotation, labral tears)Shoulders (subluxations, impingement)Lumbar spine (excessive lordosis, SIJ instability)

Increased Risk of Tendinopathies & Muscle Strains

Hypermobility overloads tendons and muscles, leading to chronic tightness, tendinopathy, and poor force distribution. Common issues:Achilles tendinopathyIT band syndromeHamstring strainsRotator cuff irritation

Fatigue & Proprioceptive Deficits

People with hypermobility often have poor proprioception (awareness of body position) and motor control, leading to excessive muscle activation (tightness) and rapid fatigue.

Nervous System Dysregulation (hEDS & HSD)

Many hypermobile individuals experience dysautonomia (e.g., POTS), poor temperature regulation, and fatigue, which affects energy levels, recovery, and exercise tolerance.Why Pilates is a Game-Changer for HypermobilityPilates, when done correctly, is one of the best training tools for hypermobile individuals. The focus on alignment, core control, stability, and precision makes it an ideal method for enhancing joint integrity and reducing injury risk.But not all Pilates exercises are created equal for hypermobile clients. Without the right focus and cues, Pilates can reinforce the very patterns that contribute to pain and instability.

Top Considerations for Teaching Hypermobility Clients in Pilates

Prioritize Strength & Stability Over Stretching

Hypermobile clients often feel tight—but that doesn’t mean they need more stretching. The tightness is often a protective mechanism due to instability. Tip: Limit end-range movements. Instead of deep hamstring stretches, focus on eccentric control (slow lengthening contractions) and isometric holds to build resilience. Great stability-building exercises:Quadruped Hover (Hands & Knees Hover Hold) – Activates deep stabilizers without overloading joints.Glute Bridges with Slow Eccentrics – Strengthens hamstrings, glutes, and core while improving control.Reformer Footwork with Resistance Variations – Helps train controlled range of motion with appropriate feedback.

Control Hyperextension in Joints

Many hypermobile clients lock into their joints (hyperextending knees, elbows, or lower back). Pilates should train active control, not passive resting into ligaments.Tip:Use tactile cues to help clients engage supporting muscles instead of relying on passive structures.Slight micro-bends in the knees and elbows prevent hyperextension and improve joint awareness.

Focus on Core & Proprioception

Hypermobility isn’t just about flexibility—it’s about how well the body senses movement and reacts to it. A strong core, glutes, and scapular stabilizers are essential for control.

Best Pilates exercises for proprioception & strength:Reformer Stability Work (e.g., Feet-in-Straps, Short Spine with Control)Side-Lying Glute Work (e.g., Clamshells, Side-Lying Leg Press)Dead Bug & Bird-Dog Variations

Teach Functional Strength for Daily Life The goal isn’t just to get stronger in Pilates, but to carry that strength into everyday movements. For example: A single-leg squat on the Reformer should translate into better stair climbing mechanics. Seated posture exercises should improve desk work positioning and reduce pain from prolonged sitting.

Final Thoughts: Movement is Medicine— But Smart movement is key for hypermobile clients, Pilates can be life-changing, but only when done with intention, control, and proper muscle activation. More isn’t always better—precision is everything. If you’re a hypermobile client → Work on strength, stability, and endurance before flexibility. If you’re a Pilates instructor → Watch for compensations, limit extreme ranges, and prioritize controlled movement. Pilates should feel empowering, not exhausting. With the right approach, it can help stabilize joints, reduce pain, and enhance movement for life.

References & Further ReadingChopra, P. et al. (2017). "Pain management in hypermobility syndromes." Rheumatology International.Rombaut, L. et al. (2011). "Muscle Strength, Coordination, and Proprioception in Hypermobility Syndrome." American Journal of Medical Genetics.Engelbert, R. et al. (2017). "The Use of Exercise Therapy in Hypermobility Spectrum Disorders." Journal of Physiotherapy.