What Does a Hypermobility Physiotherapy Assessment Look Like?
If you are hypermobile, a physiotherapy assessment should look at much more than whether you can touch your thumb to your forearm or score highly on the Beighton Score.
At Rae Physiotherapy & Pilates, our hypermobility assessments are designed to look at the whole picture: your symptoms, your movement, your history, the areas that feel unstable or painful, and the ways different systems in the body may be interacting.
For some people, hypermobility is simply a trait. For others, it can sit alongside pain, recurrent injuries, fatigue, headaches, pelvic floor symptoms, foot and ankle issues, dizziness, gut symptoms, breathing changes, or difficulty feeling stable in their body.
The assessment is about understanding what is relevant for you.
We start with your story
Before we look at movement, we spend time talking.
We want to understand what has been happening, what has changed over time, and what is actually getting in the way of your day-to-day life.
That may include things like:
joint pain or instability
recurrent sprains, strains or subluxation-type symptoms
areas that feel both flexible and unusually tight or guarded
headaches, migraines, neck or jaw symptoms
foot and ankle pain
pelvic floor symptoms
fatigue
breathing or ribcage tension
dizziness, palpitations or exercise intolerance
gastrointestinal symptoms
difficulty recovering from exercise or injury
problems with balance, coordination or body awareness
We also want to know about your injury history, previous treatment, activity levels, work demands, exercise, sleep, and what you would actually like to be able to do more comfortably.
Hypermobility rarely looks exactly the same from one person to the next, so the history helps us decide what needs the most attention during your physical assessment.
We do not assess hypermobility by flexibility alone
The Beighton Score can be useful, but it is only one piece of information.
We may also use the 5-Point Questionnaire to explore historical hypermobility, particularly if you were much more flexible when you were younger or no longer demonstrate the same range because of pain, injury or years of muscular guarding.
Someone can have a relatively low Beighton Score today and still have a meaningful history of generalized joint hypermobility.
That is why we do not reduce the assessment to a number.
We are also looking at how your joints are being controlled, how your body organizes movement, and what happens when you load it.
We look at how your body moves
The physical part of the assessment is individualized, but it may include:
posture and habitual movement strategies
balance
proprioception
coordination
joint control
strength
breathing mechanics
ribcage and pelvic positioning
foot and ankle function
functional movements such as squatting, hinging, stepping or reaching
specific assessment of painful or unstable areas
One thing we are especially interested in is how much effort your body is using to create stability.
Hypermobile bodies can sometimes rely heavily on bracing, gripping, locking joints, holding the breath, or using large amounts of muscular tension to feel secure.
That can create an interesting situation where someone is technically very mobile, but also feels incredibly tight.
Understanding those strategies can be much more useful than simply measuring range of motion.
Strength matters, but so does how you create it
Hypermobility rehabilitation is not simply about getting stronger.
Strength is important, but we also want to know how you are producing that force.
Can you feel where your body is in space?
Can you control the joint through the range you are using?
Are you hanging into the end of your available range?
Are other areas of the body compensating?
Are you holding your breath or bracing excessively to complete the movement?
These details help us decide what type of exercise, cueing and progression may be most appropriate.
For one person, that might mean gradually increasing strength.
For someone else, the first step may be improving proprioception, breathing, foot contact, joint awareness or the ability to move without constantly gripping.
We look beyond the painful area
One of the reasons hypermobility assessments are often longer is that the area that hurts is not always the only area that needs attention.
For example, knee pain may be influenced by foot mechanics, hip control or how someone organizes their pelvis and trunk during movement.
Shoulder symptoms may involve the ribcage, breathing, neck, thoracic spine or scapular control.
Pelvic symptoms may sit alongside breathing, hip function, abdominal pressure management and nervous system regulation.
That does not mean every symptom has one single cause. It means the body works as a connected system, and sometimes looking beyond the painful joint gives us useful information.
We also consider the nervous system
Living in a body that frequently feels painful, unpredictable or unstable can change the way the nervous system responds to movement.
Some people become very guarded. Some become fearful of certain positions. Others have difficulty knowing how much effort to use and oscillate between doing too much and doing very little.
Nervous system support can therefore be part of physiotherapy.
That may include pacing, breathing strategies, graded exposure to movement, helping you find positions that feel more supported, and gradually increasing your confidence and capacity.
The aim is not to tell you to relax or imply that symptoms are psychological. It is to recognize that pain, movement, breathing, autonomic responses and the nervous system all influence one another.
What happens after the assessment?
At the end of the assessment, your physiotherapist will explain what they are seeing and help you make sense of the findings.
Your treatment plan may include:
individualized strength and stability work
proprioception, balance and coordination exercises
movement retraining
breathing and ribcage mechanics
nervous system regulation and support
pacing and load management
foot and ankle rehabilitation
joint support strategies such as taping or bracing where appropriate
Clinical Pilates-based rehabilitation
pelvic floor physiotherapy when relevant
manual therapy or IMS where appropriate
education around hypermobility, pain and movement
strategies for returning to exercise, sport and everyday activity
There is no single “hypermobility programme” that is right for everybody.
The plan should reflect your symptoms, your body, your priorities and your starting point.
Can a physiotherapist diagnose hEDS?
A physiotherapy assessment is not the same as a medical diagnosis of hypermobile Ehlers-Danlos syndrome.
We can assess joint hypermobility, movement, strength, stability, function and the symptoms affecting your rehabilitation. We can also identify features that may warrant further medical assessment and help guide you toward appropriate care.
If you already have a diagnosis of hEDS or hypermobility spectrum disorder, physiotherapy can help address the functional and musculoskeletal pieces of that picture.
If you do not have a diagnosis, you do not need one before coming in for a hypermobility physiotherapy assessment.
Hypermobility assessments at Rae
At Rae Physiotherapy & Pilates, Emma Gerrard and Mahan Shahrooie offer 70-minute initial hypermobility assessments.
Kim Rae Jackson offers 90-minute initial hypermobility assessments, although her in-person physiotherapy waitlist is currently closed.
If you would still like to work with Kim, KRJ Coaching offers an online pathway for people with hypermobility. You can start by watching the webinar and booking a coaching assessment call. Kim’s 12-week Hypermobile Hypermind programme is built from almost 20 years of movement and rehabilitation experience, including more than 15 years treating hypermobility.
Ready to get started? Book a hypermobility assessment at Rae Physiotherapy & Pilates.