J Orthop Sports Phys Ther. 2026 Aug;56(8):478-481. doi: 10.2519/jospt.2026.13979.
ABSTRACT
SYNOPSIS:Patients with hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) frequently present to outpatient musculoskeletal practice. Yet many physical therapists feel uncertain about how best to manage these complex conditions. Individuals often report years of recurrent sprains, joint subluxations, widespread pain, and fatigue, accompanied by normal imaging and inconsistent clinical explanations. As a result, care may become fragmented, overly passive, or prematurely discontinued when pain persists. Although high-quality randomized trials remain limited, international classification updates and emerging consensus provide sufficient direction to guide practice. This editorial argues that a preparation gap exists in musculoskeletal physical therapy and outlines five principles for best-practice care: recognizing hypermobility as a multisystem condition, prioritizing education and validation, emphasizing active stabilization over passive strategies, accounting for altered pain processing and fatigue, and collaborating within a broader interdisciplinary framework. Applying these principles shifts the focus from eliminating pain to restoring function, participation, and self-efficacy. Patients with HSD or hEDS do not require rare-disease specialty clinics to improve; they require clinicians who are prepared to recognize their presentation and deliver thoughtful, evidence-informed care. The responsibility now lies with individual practitioners, educators, and professional organizations to translate existing knowledge into everyday musculoskeletal practice. J Orthop Sports Phys Ther 2026;56(8):478-481. Epub 25 March 2026. doi:10.2519/jospt.2026.13979.
PMID:42538787 | DOI:10.2519/jospt.2026.13979