As a chiropractor, I frequently encounter patients with varying degrees of joint hypermobility. For some, it’s an incidental finding—a quirky ability to bend their thumbs to their wrists or execute yoga poses with enviable ease. Sometimes even these folks have some chronic pain that can greatly affect their daily activities. For others, however, hypermobility is a defining feature of their overall health, accompanied by chronic pain, instability or systemic symptoms. Two conditions that often come up in these conversations are Benign Joint Hypermobility Syndrome (BJHS) and Ehlers-Danlos Syndrome, hypermobility type (EDS-HT). While these conditions may appear similar at first glance, they are distinct entities with unique diagnostic criteria, implications, and management strategies. Let’s break it down.
What is Benign Joint Hypermobility Syndrome (BJHS)?
BJHS is exactly what its name suggests: a condition where joints move beyond the normal range without underlying systemic disease or structural tissue abnormality. The term "benign" implies that it is not associated with life-threatening complications or progressive tissue damage, though it can cause significant discomfort for some.
Key Features of BJHS:
Joint Hypermobility: Often measured using the Beighton score, BJHS is diagnosed when joint mobility exceeds the typical range for an individual’s age and sex.
Musculoskeletal Symptoms: Pain is the most common complaint, particularly after physical activity. Joint instability can also lead to sprains or subluxations. Most people don’t know that joint instability can cause so much pain.
No Systemic Involvement: Unlike syndromic conditions, BJHS doesn’t involve skin fragility, vascular complications, or organ dysfunction.
It is often said that BJHS often improves with age as natural joint flexibility decreases, this may be true for some, but for others the pain of instability can last a lifetime if untreated. Targeted physical therapy and lifestyle modifications can help manage symptoms and reduce the risk of injury.
What is Ehlers-Danlos Syndrome, Hypermobility Type (EDS-HT)?
EDS-HT, now classified as Hypermobile Ehlers-Danlos Syndrome (hEDS) under updated criteria, is a heritable connective tissue disorder. It is part of a broader group of EDS subtypes, each characterized by abnormalities in collagen—the protein that provides strength and elasticity to skin, ligaments, and other connective tissues.
Key Features of EDS-HT/hEDS:
Joint Hypermobility: Like BJHS, joint hypermobility is a hallmark feature. However, in hEDS, it’s often more severe and associated with other systemic symptoms.
Chronic Pain and Instability: Patients frequently experience widespread pain, frequent joint dislocations, and difficulty with proprioception (the sense of joint position).
Systemic Manifestations: hEDS goes beyond the joints, affecting the skin (e.g., soft or velvety texture, easy bruising), gastrointestinal system (e.g., IBS-like symptoms), cardiovascular system (e.g., dysautonomia or mitral valve prolapse), and more.
Genetic Basis: While the exact gene responsible for hEDS remains unidentified, a family history of the condition is often present.
Management of hEDS requires a multidisciplinary approach, as the condition impacts multiple organ systems. Chiropractors, physicians, physical therapists, pain specialists, and genetic and mental health counselors may all play a role in care.
Diagnostic Challenges
One of the biggest challenges for patients and clinicians alike is distinguishing BJHS from hEDS. Both conditions share hypermobility as a core feature, and there’s ongoing debate within the medical community about whether BJHS might represent a milder spectrum of hEDS. However, the current consensus is that they are separate conditions—though they exist on the same continuum of connective tissue variability.
A thorough history and physical exam are critical. In addition to evaluating joint hypermobility, I pay close attention to family history, skin characteristics, and systemic symptoms. When in doubt, collaboration with a geneticist or rheumatologist can provide clarity.
How Chiropractic Care Can Help
Whether a patient has BJHS or hEDS, chiropractic care can play a valuable role in symptom management:
Joint Stability: Gentle adjustments and targeted stabilization exercises can help reduce joint instability and prevent injuries.
Pain Management: Soft tissue techniques, low-force mobilizations, and modalities like ultrasound or cold laser therapy can address chronic pain.
Postural Support: Many hypermobile patients struggle with poor posture, which exacerbates joint strain. Postural retraining can help.
Lifestyle Education: Teaching patients how to modify daily activities to protect their joints is key, especially for those with hEDS.
It’s important to note that hypermobile patients often have heightened sensitivity to pain and physical manipulation. For this reason, I use the gentlest techniques possible and always work within the patient’s comfort zone.
The Bigger Picture
BJHS and hEDS are conditions that challenge conventional understanding of joint and connective tissue health. They remind us that flexibility—while often celebrated—can sometimes be a double-edged sword. Whether you’re an athlete with hypermobile joints or someone struggling with chronic symptoms, understanding the nature of your hypermobility is the first step toward living a more comfortable, balanced life.
If you have concerns about joint hypermobility or suspect you may have BJHS or hEDS, don’t hesitate to reach out. As a chiropractor, I’m here to help you navigate your symptoms, optimize your joint health, and get you moving with confidence again.
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