What Causes Hypermobile Joints? Genes, Shape and Training

What causes hypermobile joints is rarely one thing. For most people it is a mix of inherited connective tissue, the shape of the joints, muscle tone, age, sex and hormones, and sometimes years of training. If your thumb folds back to your wrist or your knees bend past straight, you may have wondered why your body works this way when others do not. This page walks through each cause in plain words. It also explains why the useful answer for a hypermobile body is usually more steadiness, not more flexibility, which is the ground the Feldenkrais Method® works on.

What causes hypermobile joints: the short list

A joint has more range than usual when the things that hold it together allow it. Those things are the ligaments and joint capsule, the shape of the bones where they meet, and the muscles that cross the joint. Anything that changes one of these can change how far a joint travels.

Here are the main hypermobile joints causes, in rough order of how often they matter:

• Connective tissue with more give, which is often inherited
• Joint shape, such as a shallow socket
• Muscle tone, how firmly muscles hold at rest
• Age, sex and hormones
• Training, especially dance, gymnastics and some yoga
• Less often, a medical condition that a clinician needs to identify

Most hypermobile people have several of these at once.

Connective tissue with more give, often inherited

Ligaments are strong bands that connect bone to bone and limit how far a joint can move. Their strength comes mostly from collagen, a protein found all through the body. In some people, collagen is built a little differently and has more give. The ligaments then let the joint travel further.

This tends to run in families. If you are bendy, there is a good chance a parent, brother or sister is too. In a study of nearly 1,000 pairs of female twins, researchers estimated that about 70% of the differences in joint hypermobility between people came down to genes (Hakim et al., Arthritis and Rheumatism, 2004). That is a strong family pattern. It does not mean genes decide everything, and the study relied on people describing their own joints.

For most people, inherited joint hypermobility is simply a trait, like height or eye color. Our page on hypermobility without EDS explains why bendy joints on their own are common and often cause no trouble.

Joint shape

Bones meet in different ways from person to person. A hip socket can be deeper or shallower. The end of an elbow bone can be shaped so the arm goes a little past straight. A shallow socket gives less built in support, so the ligaments and muscles do more of the holding.

Joint shape usually explains hypermobility in one or two joints rather than all over. It is one reason someone can have very bendy elbows and quite ordinary hips.

Muscle tone

Even at rest, muscles hold a little tension. This is called muscle tone, and it varies between people. Lower resting tone means the muscles around a joint offer less background support, so the joint can drift further, especially when you stand still or lean.

This is one place where movement practice can help. You cannot change your collagen, but you can learn to sense and use the muscles around a joint with more skill. Our Feldypedia article on hypermobility and joint instability looks at why this kind of sensing matters so much for a bendy body.

Age, sex and hormones

Age. Children are usually more flexible than adults, and connective tissue tends to stiffen slowly over the years. Many hypermobile people lose some range with age, though symptoms can follow their own course. Our page on whether hypermobility gets worse with age explains this in more detail.

Sex. Joint hypermobility is more common in women and girls than in men and boys.

Hormones. Some people notice their joints feel looser at certain points in their menstrual cycle, or during other times of hormone change. The research here is still mixed, but it matches what many hypermobile women describe.

Training: dancers, gymnasts and yoga

Years of dance, gymnastics, martial arts or some styles of yoga can increase range in the joints that are trained most. A dancer may have very mobile hips and spine, for example. This is usually more about muscles that lengthen easily and practiced range than about the connective tissue itself, and it tends to show up in specific joints, not everywhere.

Many people who are already hypermobile are drawn to these activities, because bendiness makes them feel easy at first. So training and an inherited trait often appear together. If you are unsure which describes you, our guide to hypermobile vs flexible sets out the differences.

When the cause is a condition: HSD, hEDS and others

For most people, hypermobile joints are a trait, not a disease. Sometimes, though, hypermobility comes with ongoing symptoms such as joint pain, frequent sprains or dislocations, or marked fatigue. Then a clinician may look for a named condition.

Hypermobility spectrum disorder (HSD) is the diagnosis when hypermobility comes with real symptoms but does not meet the criteria for hEDS. It is not a milder label. It simply describes a different pattern.

Hypermobile Ehlers Danlos syndrome (hEDS) is diagnosed with a formal checklist, set out in 2017, that looks beyond the joints to skin, family history and other features. For most people with hEDS, no single gene has been found yet, so there is no blood test for it.

Other inherited conditions, such as Marfan syndrome and other types of Ehlers Danlos syndrome, can also include hypermobile joints. These need a specialist to identify.

A score on the Beighton scale is often part of the picture, but it cannot give a diagnosis on its own. Our guide to the hypermobility Beighton scale explains what it measures. Please do not try to diagnose yourself from any page, including this one. A GP is the right first step, and can refer you to a rheumatologist or clinical geneticist.

What the cause means for how you move

Whatever lies behind your hypermobile joints, the practical answer is similar. Ligaments with more give do not tighten up with exercise or stretching. What can change is how you sense and support your joints.

Many hypermobile people hang on their joints without noticing: knees locked back when standing, weight sunk into one hip, elbows pushed straight when leaning on a table. More stretching rarely helps here, because range was never the missing piece. What helps is learning to feel where the middle of your range is, and to rest there with a little muscle support.

This is where awareness based movement fits. In a Feldenkrais® lesson you move slowly and in small ranges, and pay attention to how each part of you takes part. Many hypermobile people find they begin to notice the moment a joint drifts to its end, and can choose to come back. When you want something concrete, our exercises for hypermobility offer a gentle sequence built on this idea. Feldy, the online program I created from my years of teaching, offers short audio lessons in the same spirit, and you can read more on our hypermobility page.

Find where to start

Several movement methods can help a hypermobile body feel steadier, and they suit different people. Some prefer building strength around the center, some prefer a slow standing form, and some prefer to learn by sensing small movements.

Not sure which movement method fits you? Take the 60 second Movement Match quiz. Tell it how your joints feel on an ordinary day, and it points you to one method that favors control over range.

Common Questions about what causes hypermobile joints (FAQ)

What causes hypermobile joints most often?

Most often it is the connective tissue itself. Collagen, the protein that gives ligaments their strength, can have a little more give in some people, and this tends to run in families. The shape of the joint, muscle tone, age, sex and hormones add to it. Training such as dance or gymnastics can add range in the joints that are used most.

Is hypermobility genetic?

Often, yes. Hypermobility tends to run in families, and a large study of female twins estimated that genes explain most of the difference between people. That does not mean every family member will have it, or have symptoms. Hypermobile Ehlers Danlos syndrome also runs in families, though for most people no single gene has been found yet.

Do hypermobile joints mean I have EDS?

No. Most people with hypermobile joints do not have Ehlers Danlos syndrome. Many simply have a common trait with no symptoms. When hypermobility comes with ongoing pain, instability or other symptoms, a clinician may consider hypermobility spectrum disorder or hEDS, using formal criteria. Only a clinician can make that call.

What is the best exercise for hypermobile joints?

The best exercise is slow, controlled work in the comfortable middle of your range, where you learn to feel and hold your joints instead of hanging on them. Light strength work, Pilates style control, and awareness methods such as the Feldenkrais Method all work this ground in different ways. More flexibility is rarely the goal.

What should I avoid with hypermobile joints?

Avoid pushing joints to the end of their range, locking knees or elbows when you stand or lean, and showing off bendy positions as party tricks. Avoid training that rewards extreme range, and avoid ignoring a joint that keeps slipping. These habits put more load on ligaments that already have extra give.

How often should I practice stability work with hypermobile joints?

Short sessions on most days usually work better than one long session a week. Ten to fifteen minutes of slow, attentive movement is a realistic start. Rest when joints feel tired or sore, and build up slowly. Consistency matters more than effort.

How long until hypermobile joints feel steadier?

Some people feel a little more settled after a few sessions, because they notice where they were hanging on their joints. Changes in strength and control usually take several weeks to a few months of regular practice. Your connective tissue itself will not change, but how you use and support your joints can.

How are hypermobile joints different from being flexible?

Flexibility usually comes from muscles that lengthen easily, often after training, and it tends to show up in the joints you practice. Hypermobility comes mainly from the connective tissue around joints, is often inherited, and tends to appear in many joints at once. A flexible person mostly needs range; a hypermobile person mostly needs control.

When should I see a doctor about hypermobile joints?

See a doctor if joints dislocate or keep giving way, if pain or fatigue does not settle, if you feel dizzy or faint when you stand, or if your skin bruises, scars or splits easily. Also mention a family history of connective tissue conditions. A GP can assess you and refer you to a rheumatologist or clinical geneticist when needed.