If you have hypermobility or Ehlers-Danlos syndrome and you have ever asked anyone for help with your back, your pelvis, your hips or your dodgy SI joint, there is a very good chance you have been told some version of the same thing. Your core is weak. Build your core. Engage your core. Activate your TVA. Suck your belly button to your spine. Do more planks.
The advice has been so consistent for so long that most people just nod and accept it. And honestly, why wouldn’t you? It comes from physios, from trainers, from doctors, from the bloke at the gym who once read a book. It is the default explanation for almost any back-related complaint, and for the hypermobile crowd it is often the first thing reached for when joints start moving in ways they shouldn’t. The problem is, when you actually sit down with the research, the story falls apart.
It really, really falls apart. And nowhere does it fall apart more dramatically than in the hypermobility population, where the standard “engage your core” advice tends to make things worse, not better. We see this in our studios all the time. People come in having spent two or three years grinding through plank progressions, dead bugs done with breath held and abs locked solid, Pilates classes where they are told to “draw the navel in” and never actually told why, and they cannot figure out why their pain is the same or worse. They have been doing the work. They have been compliant. The work was just wrong for their body.
So this is going to be the proper, deep dive into hypermobility core exercises. What the core actually is. Why “weak core causes pain” doesn’t survive contact with the evidence. What’s genuinely different about the hypermobile core, the hypermobile pelvic floor, and the hypermobile SI joint. And what we actually do in the studios that gets people moving without the bracing, the gripping, and the constant low-grade ache that comes with it.
Bring a cup of tea. This one is long.
What your core actually is (it is not your six-pack)
Ask the average person what their core is and they will point at their abs. Ask someone who’s been to a gym for a year and they will tell you about the transversus abdominis (TVA), the deep wraparound abdominal muscle that the entire core stability industry was built on top of [1]. Both of them are partly right, and both of them are missing the bigger picture by quite a long way.
Your core is not a single muscle. It is not even a sheet of muscles. It is a pressurised cylinder, and it has at least four parts.
- The roof: the diaphragm.
- The floor: the pelvic floor.
- The walls: the transversus abdominis (the deep layer that wraps around like a built-in weightlifting belt), the internal and external obliques, and the rectus abdominis (your six-pack) at the front.
- The back wall: the deep spinal muscles, particularly the multifidus, alongside the erector spinae and the thoracolumbar fascia.
These structures don’t work in isolation. They contract together, in patterns, and what they’re actually doing is managing pressure. Imagine an empty plastic bottle. Squeeze it and it crumples. Now blow some air into it, screw the lid on, and squeeze it again. It barely moves. That is, in very crude terms, what your core does. It pressurises the abdominal cavity and that pressure stabilises the spine and pelvis. The strength of any one muscle matters far less than the coordination of the whole system.
And here is the key bit that almost nobody mentions when they tell you to “engage your core.” The system is supposed to run automatically, on a feedforward basis, based on whatever you’re about to do. In a healthy spine, the TVA fires before the deltoid when you go to lift your arm. The brain is anticipating the load, not reacting to it [2]. That timing, not the strength, is what good core stability looks like.
So when you are told to consciously tense your stomach, hold the brace, suck the belly button in and never let it out, you are doing the exact opposite of what a healthy core does. You are bracing. You are reacting. And in a hypermobile body that has been guarding against perceived instability for years, you are turning the volume up on a system that was already too loud.
The “weak core causes pain” myth (and why it has hung around for thirty years)
The whole modern core stability industry traces back to a small handful of studies in the mid-1990s. Hodges and Richardson published a paper in Spine in 1996 that found a delay, measured in milliseconds, in the activation of the TVA in people with chronic low back pain compared to controls without back pain [2]. The TVA still fired. It just fired a little late. That paper became the founding document of the entire “weak core” model, and from a tiny timing difference came a global industry of crunches, planks, abdominal hollowing manoeuvres and “draw your belly button in” cues.
Now, that finding has not been overturned. The delay is real. But what came afterwards is where it gets interesting, and where the standard story gets uncomfortable.
First, follow-up work showed that you can produce the exact same TVA delay in healthy people simply by inducing acute muscle pain. In a 2003 study, researchers injected a saline solution into the back muscles of healthy volunteers, gave them muscle pain that hadn’t existed five minutes earlier, and the feedforward TVA timing was disrupted [3]. That is a problem for the “weak TVA causes back pain” model. If pain causes the timing change, then strengthening the TVA isn’t the fix, because the TVA was never the cause.
Second, when you actually run the trials on whether core stability training works for back pain, the results are genuinely mixed. The 2016 Cochrane review on motor control exercise for non-specific low back pain found small to moderate improvements in pain and function, which sounds like good news, but in head-to-head comparisons it was no more effective than other forms of exercise like manual therapy or general activity [4]. A separate meta-analysis around the same time found similar results, with stabilisation exercise no better than alternative active approaches for chronic LBP at any meaningful follow-up window [7].
Third, and this is the bit that should really make you raise an eyebrow, when stabilisation exercises do produce clinical improvement, the improvement is not actually correlated with measurable improvements in TVA function. Multiple studies have shown that you can do all the abdominal hollowing exercises in the world, get someone’s pain down by 40 per cent, and on ultrasound their TVA still does whatever it was doing before [5][8]. A systematic review across exercise therapy for back pain reached the same conclusion across many different exercise types: clinical improvement and the targeted physiological change are usually not linked [6].
So what’s actually going on when core training does help? Probably a mix of several things. Reduced fear of movement. The nervous system feeling safer because somebody competent has given the person something structured to do. The general benefits of being more active and less catastrophising. Some genuine improvement in coordination and timing. Endorphins. Education. Confidence.
None of that is core specific. Almost any reasonable form of structured movement, taught with care, would deliver the same gains. The “engage your core” instruction is along for the ride, not the engine.
Even the concept of “spine stability” itself is fuzzier than it sounds. A 2007 paper by Reeves and colleagues took the entire literature apart, showed that researchers were defining and measuring spine stability in completely different ways, and the field had been arguing about something it couldn’t actually agree on [10]. A separate paper went further and called clinical lumbar instability a “myth” in the sense that the term gets used clinically without any solid mechanical basis [11]. We are not exactly building from rock-solid foundations.
And then there’s the most awkward piece of evidence. Pregnancy. During pregnancy the abdominal wall stretches enormously, hormones make connective tissue more compliant, and core stability is genuinely reduced in any meaningful sense of the term. By the “weak core causes back pain” rule, every pregnant woman should still be in agony six months after giving birth. They aren’t. A study following 869 postpartum women found that most recovered from pregnancy-related back pain spontaneously, without any specific core training [27]. The brief self-management intervention they tested wasn’t even superior to usual care. The bodies just sorted themselves out.
Lederman pulled all of this together back in 2010 in a paper called, brilliantly, “The myth of core stability” [1]. It is over fifteen years old at this point. It is still right.
Why the standard advice is actively unhelpful for hypermobile bodies
If the standard core advice is mediocre for the general population, for hypermobile people it is often a lot worse. Here is why.
In a typical, non-hypermobile body, the joints provide a steady stream of accurate proprioceptive feedback to the brain. The nervous system knows where everything is. Stability happens automatically because the system has good information.
In a hypermobile body, that information stream is degraded. Lax connective tissue means joints can move further than they should, ligaments are more elastic, and the proprioceptors that should be telling the brain “this is where the joint is” are giving fuzzier signals. So the nervous system, doing its best, compensates. It cranks up muscle tone everywhere. Holds tension as a substitute for the joint stability it can’t get from the connective tissue. Recruits muscle when it can’t trust the ligaments.
You can actually see this on EMG studies. A 2022 paper looking at quadriceps control in hypermobile people showed altered motor recruitment patterns compared with non-hypermobile controls [12]. The pattern is different. Not just weaker, not just stronger, but genuinely different. And separate work has shown that hypermobile people often present with generalised hyperalgesia, meaning the entire pain system runs hotter than it should, suggesting that the problem isn’t just local mechanics, it’s central [13]. Pain in hypermobility is whole-system pain, not just a joint complaint.
So now imagine you walk into a physio with widespread hypermobility, dodgy SI joint, low back pain on and off for years, and you’re told to engage your core, hold the brace through every step, every reach, every lift. What you’re being asked to do is add another conscious layer of muscle tension on top of a system that was already gripping at 60 or 70 per cent baseline. You can guess how that ends. People come out tighter, more painful, with a pelvic floor that won’t switch off and a neck full of lumps because all the secondary muscles got conscripted to keep the chest moving.
This is the bit that gets overlooked. The hypermobile core, in our experience, is almost never under-active. It’s over-active. The question isn’t how to make it work harder. The question is how to teach it to coordinate, time properly, and let go when it doesn’t need to be on.
Different problem, different solution.
The breath is the brace (and this is where most people have it backwards)
This is the line we say to clients more than any other:
Core stability is the breath. The brace is the breath.
If you take one thing from this article, take that.
When the cylinder is working properly, the diaphragm does most of the stabilising work. It contracts and domes downwards on the inhale, pressurising the abdomen. The pelvic floor lengthens and descends with it. The deep abdominal wall, including the TVA, responds to the pressure change in a coordinated, low-effort way. The whole cylinder lengthens slightly on the inhale and shortens on the exhale, like a jellyfish opening and closing. There is nothing to consciously squeeze. There is no belly button to suck in.
This isn’t a vibe. The mechanical coupling of the diaphragm and pelvic floor is well established. A 2022 paper in Healthcare laid it out in detail: the pelvic floor muscles act physiologically as expiratory muscles, working alongside the anterolateral abdominal wall, contracting during expiration and relaxing during inspiration [21]. Earlier work using ultrasound has shown that pelvic floor activation, induced via electrical stimulation, improves diaphragm excursion and rib cage movement during normal breathing and coughing [22]. The two systems aren’t independent. They are mechanically linked, and they need each other to work properly.
The problem is that most hypermobile people are not breathing like this. We tend to default to chest breathing, where the diaphragm hardly moves and the rib cage gets lifted by the accessory muscles in the neck and shoulders, mainly the scalenes, sternocleidomastoid, and upper trapezius. Once those muscles take over the breathing job, they fatigue, they tighten, they protest. A huge amount of the chronic neck and upper back tension we see in hypermobile clients is downstream of a chest-dominant breathing pattern, not the other way around. And working purely on the neck almost never fixes it long-term.
There’s also a more subtle problem. A 2024 study in Scientific Reports found that people with hypermobile EDS had significantly impaired accuracy of lung volume perception compared to matched controls, and developed erratic ventilation when given a cognitive task to perform at the same time [14]. The same proprioceptive deficit that affects joint position sense seems to affect lung volume perception. People over-breathe to feel safe, because they can’t accurately tell whether they’ve taken in enough air. The fix is not to “try harder to feel it.” The fix is to clean up the breath pattern so the system has reliable information again.
And then there is the broader picture of respiratory dysfunction in this population, which a 2021 narrative review documented across multiple subtypes, including dyspnoea, decreased respiratory muscle strength, and patterns suggesting dysfunctional breathing [28]. None of this is exotic. It is well-described. It is just rarely thought about when someone walks in complaining about their back.
There’s also the carbon dioxide piece, which we have written about at length elsewhere. Most people think CO2 is a waste gas you breathe out. It isn’t. CO2 is a signal that tells haemoglobin to release oxygen at the tissue level, regulates blood vessel diameter, and is deeply involved in autonomic regulation. When people over-breathe (which is most of the time, in this community), CO2 drops too low, blood vessels constrict, including in the brain, and the result is the brain fog, dizziness, and air hunger that anyone with POTS or hypermobility will recognise instantly. If that bit is news to you, our deeper write-up on CO2 tolerance goes into it properly, and the missing link between breathlessness, fatigue and chronic pain piece extends the same idea further.
Bottom line. Before any of the dead bug, bird dog, plank, brace nonsense, the breath has to be sorted. That is where everything starts.
The hypermobile pelvic floor (where “do your Kegels” can do real harm)
For the general population, the standard pelvic floor advice is mostly fine. Most pelvic floor problems in the wider world come from weakness, particularly after childbirth, or with ageing. Strengthen the muscle, ease the symptoms, job done.
For hypermobile people, the picture is different, and the advice often runs in the wrong direction. The pelvic floor in hypermobility tends to be hypertonic, not weak. Held in a state of constant low-grade contraction, the way a jaw can be permanently slightly clenched without the person realising. The muscle is not weak in the gym sense. It is exhausted from over-working, and it has lost the ability to fully relax. This pattern, often called nonrelaxing pelvic floor dysfunction, is well-described in the wider chronic pelvic pain literature [17]. It just happens to be far more common in the hypermobility population than the standard model assumes.
The numbers in this group are striking. An international survey study of cisgender women with EDS, published in 2023 in the International Urogynecology Journal, documented high self-reported rates of stress urinary incontinence, urinary urgency, prolapse and pelvic pain [15]. A scoping review of urogenital and pelvic complications in EDS and HSD found a wide range of issues, with the consistent thread being that connective tissue laxity and altered motor control combine to create dysfunction across the whole pelvic system [19]. A 2021 online survey of EDS and HSD patients reported high rates of dyspareunia and probable vulvodynia, with a tangle of co-occurring conditions [20]. And a separate prospective cohort found a relationship between joint hypermobility (defined by Beighton score) and a specific pattern of obstetrical and pelvic floor outcomes [18].
Pulling all of that together, you start to see the shape of the problem. The connective tissue is more compliant, so the passive support of the pelvic organs is reduced. The nervous system compensates by ramping up muscle tone, including in the pelvic floor. The pelvic floor, gripping all day, becomes painful and starts referring symptoms in every direction: incontinence, prolapse sensations, pain on intercourse, constipation, hip pain, back pain. And on top of that, the central pain processing changes mentioned earlier mean any signal from the area gets amplified [13].
This is why blanket Kegel advice can do real harm. If your pelvic floor is hypertonic and you keep adding voluntary contractions on top of it, you are building tension on top of tension. People come in saying their symptoms have got worse since they started doing the Kegels their physio gave them, and in many cases that is exactly what has happened. We’ve seen this pattern dozens of times now. It is not the patient’s fault. It is the wrong tool for the job.
What works for hypermobile pelvic floors is the opposite. Lengthening, descending, softening with the inhale. Letting the floor move with the diaphragm rather than overriding it. The cue we use in the studio sounds ridiculous and works really well: imagine you are about to do a pee and a poo at the same time. Not bearing down. Not pushing. Just letting the floor open and drop on the inhale, and rising back up on the exhale.
If pelvic floor symptoms are part of your picture, our full guide to hypermobility, EDS and the pelvic floor goes into this in much more depth than I can here, including how to find a pelvic floor physiotherapist who actually understands hypertonicity in this group rather than assuming the standard weakness model.
The SI joint, force closure, and why nothing fixes it in isolation
If we move from the front of the cylinder to the back, we run into the sacroiliac joint. One on each side, between the sacrum and the ilium, with no muscles directly spanning the joint itself. The SI joint relies on a combination of form closure (the wedge shape of the bones plus very strong ligaments) and force closure (active compression from muscle slings that cross the joint). Vleeming and Schuenke’s 2019 review is the canonical reference here and lays it all out [23].
Form closure is the passive bit. The sacrum sits between the two ilia like a keystone in an arch. Strong ligaments hold the assembly together. If everything fits well and the ligaments are tight, you essentially have a self-locking joint that doesn’t need much help. In a typically-stable body, this gives you most of the stability for free.
Force closure is the active bit. Muscle slings cross the SI joint and create compression. The longitudinal sling (erector spinae through the thoracolumbar fascia to biceps femoris). The posterior oblique sling (latissimus dorsi through the fascia to the opposite gluteus maximus). The anterior oblique sling (external oblique to opposite internal oblique to adductors). The transversus abdominis, crossing the joint and clamping the sacrum between the two ilia. The pelvic floor, opposing lateral movement of the pelvic bones. Biomechanical modelling shows that coordinated activation of these muscles can substantially reduce SI joint shear loads [24], and in vivo work using Doppler imaging has confirmed that muscle contraction increases SI joint stiffness in real bodies [25].
Notice that none of those structures are separate from the cylinder we just talked about. The “core” muscles and the “SI joint stabilisers” are the same set of muscles in different combinations. They are not parallel systems. They are the same system seen from a different angle.
In hypermobility, form closure is reduced, because the ligaments are more compliant. The wedge does not seat as firmly. So force closure has to do more work to keep up. The active system has to work harder, which means more sustained muscle tone around the pelvis, which means more fatigue, more pain, and more grip. This is not a fringe interpretation. The 2020 narrative review on pelvic girdle pain in HSD and hEDS draws exactly the same picture, with prevalence of pelvic girdle pain notably higher in hypermobile populations than in non-hypermobile controls and force closure inefficiency identified as a likely mechanism [26].
This is also why fixing the SI joint in isolation almost never works long-term. If your pelvic floor is gripping asymmetrically, if your breath is shallow, if your TVA is firing late, if your nervous system thinks the whole pelvis is unsafe, your SI joint is going to keep getting destabilised regardless of how many specific SI joint exercises or manipulations you do. The pain comes back. The manipulation lasts a few days. The next week you are back at the physio.
The path to a stable SI joint runs through the pelvic floor, which runs through the breath, which runs through the nervous system’s threat level. You cannot pick one piece and skip the rest. Or rather, you can, but you’ll be on a permanent rotation of “feels better for two weeks, gets worse again,” and most of you reading this know that pattern intimately.
This is the bit that’s genuinely different about how we approach this. The exercises themselves are not exotic. The breath work is not exotic. The dead bug and bird dog are not exotic. But the order matters, and the framing matters, and treating the whole cylinder as a system rather than a list of muscles to drill is what actually moves the needle.
What we actually do in the studios
Right then. Onto the practical stuff.
This is the bit a lot of people skip ahead to, but the reason we spent the first half of this article on the theory is that the practical work makes no sense without it. If you don’t understand why you are doing in-and-down rather than in-and-up, or why we don’t really care about the ten-pack abs you can develop with crunches, the exercises just become another set of moves to grind through.
The video below is the same introduction we use as homework for our Hypermobility Live Workshop and what we have our in-person clients in our studios working through early in their rehab. It walks you through the four breath stages and the entry-level movement patterns. Watch it through once before you try anything. Then read the breakdown underneath so you understand what you are doing and why.
Stage 1: Diaphragmatic breathing on your back
Lie on your back, knees bent, feet flat on the floor. Pillow behind your head if your neck is forward. Comfort first. One hand on the chest, one on the belly.
Breathe through the nose, mouth closed. As you breathe in, the belly should expand outwards and slightly sideways. The chest hand should hardly move. As you breathe out, the belly should soften back down. Slow. Don’t go for big breaths, you will get dizzy. A small weight on the belly, a 1 kg dumbbell or a water bottle, gives you a tactile cue. The job isn’t to push the weight up by force. The job is to let the breath move it.
The single most common error we see is sucking the belly in on the inhale. This is paradoxical breathing, and a lot of chronic chest breathers do it without realising. If you find yourself doing it, slow everything down and use the weight to feel the breath move the abdomen.
Stage 2: 360-degree lateral expansion
Sit up tall. Find the soft space between the bottom of your rib cage and the top of your hips. Wrap the webbing of your hands around your sides at that level, so you can feel the soft tissue under your fingers.
Breathe in and try to push your hands outwards with the breath itself. Most people cannot feel this on the first attempt. Singers and people who play wind instruments often get it straight away because their training already drilled the obliques. Everyone else needs days to weeks. If you can’t feel anything, give yourself three sharp coughs in a row, a “ha, ha, ha”, and feel the obliques punch out into your hands. That’s the muscle group we’re trying to find with the breath.
Stage 3: Back expansion (kneeling lean)
Hips above knees, leaning forward onto your hands or onto a chair seat. Sit-bones underneath, ribs over pelvis, neutral spine. Place your thumbs on either side of the lower spine and breathe into the back. Gravity opens the back of the cylinder rather than the front.
The movement here is small. You are not going to see massive expansion. Most people will see a tiny visible widening of the lower back, and that’s it. Some sensation in the SI joints is normal, because the breath mechanics are pressurising tissues that have been short and compressed for years. If you have had a forward pelvic tilt for decades, this position can feel quite strange the first few times.
Stage 4: In and down (the exhale brace)
This is the one most people get wrong, and it is the most important.
On the exhale, the belly button comes in and down. Not in and up. In and up is hollowing, the old “pull your belly button to your spine” cue, and it’s the wrong pattern. It jacks everything up under the rib cage and the neck gets jammed. In and down flattens the lower abdomen, wraps the obliques inwards like a corset, and softens the ribs over the pelvis.
Just 10 to 20 per cent. You should still be able to hold a conversation while doing it. If you can’t, you are gripping too hard.
One important note on the cue itself, because this catches a lot of people out. “In and down” is the intention, not the visible movement. The belly button doesn’t physically drop towards the floor when you do this properly. What you actually see and feel is the lower abdomen flattening and the front of the pelvis tucking very slightly underneath, because the rectus abdominis attaches from the ribs down into the pubic bone, and when you contract it gently, it pulls those two points a tiny bit closer together. The belly button itself often appears to lift up slightly because the pelvis tips under, not because anything is pushing down. The cue says “in and down” because thinking down stops you from hollowing up under the ribs, which is the wrong pattern. The result on the body is a flatter lower belly, a slight posterior tilt of the pelvis, and the obliques cinching inwards like a corset. Don’t go looking for the belly button to physically descend. Look for the lower abs to flatten and the waist to narrow.
The two movement patterns: dead bug and bird dog
Once the breath is in place, we layer it onto two simple patterns. The modified dead bug (lying on your back, one foot on the floor for stability, the other knee coming towards the chest then the leg slowly extending out, breath-led, return on the inhale). And the bird dog (on hands and knees, neutral spine, sliding one leg back, then progressing to lifting it, then opposite arm and leg).
The rule is the same for both. Inhale to set the cylinder. Exhale on the harder part of the movement, with the belly button moving in and down 10 to 20 per cent. Range only goes as far as the breath and pelvis stay neutral. The moment the pelvis tips forward or the breath gets held, you’ve gone too far. Drop back to the easier version.
Wrist pain in the bird dog? Use forearms instead, or place your hands on a low chair or sofa. The position is adjustable. The pattern is what matters. The same applies if you’ve got knee or shoulder issues, both of which we’ve got separate dedicated guides for, including knee instability exercises, the foot arch work we use to clean up the kinetic chain from the ground up, and internal tibial rotation for the lower limb piece.
That’s the entry point. Five things, in order. Breath one, breath two, breath three, breath four, then the simplest possible movement layered on top. None of it is a hard workout. It is not supposed to leave you sweating. The goal is coordination and timing, not fatigue.
The bigger picture: why we treat the cylinder as part of a system, not in isolation
One thing worth flagging, before you set off thinking the breath is the answer to everything. It is not. It is the foundation. But hypermobility is rarely just a cylinder problem. It’s a whole-body proprioceptive problem, a connective tissue problem, often a nervous system problem, and frequently an autonomic problem on top of all of that.
For the autonomic side, particularly if you’ve got POTS or any of the dysautonomia overlap, our POTS guide covers the territory in more depth, and the POTS, EDS and MCAS trifecta piece pulls together how all three commonly travel together. For the proprioceptive piece, the Beighton score article gets into how the standard hypermobility screening misses what actually matters. And if you’re earlier in this whole journey and not even sure where to start, our exercise tips for hypermobility piece is the first stop, with hypermobility and exercise part 1 going into more depth on the bigger framework.
The other thing we get asked about is the relationship between core work and other things you may already be doing or have been told to do. The honest answer is that most of those things are fine, as long as the underlying breath and cylinder work is in place. Stretching is one we get a lot, and yes, you can still stretch, but the way you stretch when you’re hypermobile matters. KT tape for support is fine for short-term sensory input but isn’t fixing anything long-term. Compression garments are similar, useful for proprioceptive input, not a structural fix.
For sleep, which matters way more than people give it credit for, our hypermobility and sleep guide goes into the whole story. Motor learning happens during sleep. If you skip sleep to do more exercise, you are sabotaging the work.
And for anyone whose pain has gone beyond the joint and started feeling like a whole-body central sensitisation thing, including the brain fog and the fatigue and the everything-hurts pattern, our piece on what causes chronic pain in fibromyalgia and hypermobility, the brain fog guide, and the article on fear of movement all sit alongside this one.
A note on what NOT to do
This is the bit where I get to be a bit grumpy.
There are still a lot of professionals out there prescribing planks, sit-ups, crunches and traditional ab work to hypermobile clients, often as a fix for back or hip pain. In most cases that is the worst thing you can do. Those exercises hammer the rectus abdominis, which already works fine in most people, encourage breath holding, which collapses the cylinder you are trying to build, and reinforce a “tense everything” pattern that most hypermobile bodies are already stuck in.
If your physio or trainer has you doing planks for a hypermobility-related back issue and ignoring your breath, your pelvic floor and your nervous system, you are probably in the wrong place. Not always. There are some genuinely thoughtful practitioners who know how to use those tools well. But the average prescription of “more crunches” for a hypermobile back is, in our experience, almost never the right answer.
The other thing to flag is the constant-bracing advice. Some practitioners genuinely tell hypermobile clients to “engage your core every time you walk around” or to keep the belly button pulled in throughout the day. This is, I cannot stress this enough, a fantastic way to wreck your breath. You cannot be at 80 per cent abdominal tension all day and breathe properly. The two are mechanically incompatible. The brace is meant to be situational, the way you might crank up support to push a heavy shopping trolley around a corner. It is not meant to be on all the time.
Likewise, just doing more rounds of the same Kegel programme that did nothing the first time, especially if you’ve got a hypertonic pelvic floor, isn’t a strategy. It’s repetition.
If you have spent years bracing, the unwinding takes a while. That is normal. Be patient with it, and don’t expect three weeks of breath work to undo a decade of grip.
Putting it all together
Here is the short version of everything above, in case you want to read just one paragraph.
Your core is a pressurised cylinder, not a six-pack. The breath drives it. In hypermobile bodies the system is usually over-active, not weak, and the standard “engage your core” advice tends to pour petrol on the fire. The pelvic floor in particular is far more often hypertonic than weak in this group, which means Kegels can make things worse rather than better. The SI joint is downstream of all of this, and treating it in isolation rarely sticks. What works is restoring the breath, restoring the diaphragm-pelvic floor rhythm, building a light situational brace at 10 to 20 per cent rather than a constant 80 per cent grip, and layering simple breath-led movements like the dead bug and bird dog on top of that. None of it is exotic. The order and the framing are what change the outcome.
If you’ve been doing core work for years and it hasn’t helped, this is probably why.
The work is doable. It isn’t even particularly hard, in the gym sense. It’s just different from what you’ve probably been told, and it takes more patience than most people are sold on the front end. A few minutes a day, every day. Breath first, then movement, then sleep on it.
Frequently Asked Questions
Core exercises themselves aren’t the problem. The problem is the way they’re usually prescribed. The standard “engage your core, suck the belly in, hold the brace” approach reinforces the chronic guarding pattern that most hypermobile people are already stuck in. Properly designed core work, breath-led, taught with attention to the diaphragm and pelvic floor, can be genuinely helpful. The issue is that this kind of programme is the exception, not the rule.
Generally not as the main strategy. Planks and crunches focus on the rectus abdominis, encourage breath holding, and reinforce the “tense everything” pattern. They aren’t catastrophic if used sparingly within a wider, breath-led programme, but as the headline exercise for hypermobility back or hip pain, they tend to underperform. The cylinder, breath, dead bug and bird dog approach we describe in this article is a much better starting point.
Probably because your pelvic floor is hypertonic rather than weak, which is the more common pattern in hypermobility. Adding voluntary contractions on top of a muscle that’s already gripping all day builds tension on tension. The fix is the opposite direction: lengthening, descending, softening with the breath. A pelvic floor physiotherapist who specifically understands hypertonicity in hypermobility is the most important referral here.
A few weeks for the breath pattern to start landing properly, longer for the bracing habit to unwind. Most people start to notice their neck and upper back loosening within two to three weeks of consistent diaphragmatic work, because the accessory breathing muscles finally get a break. Pain changes take longer and depend on how much else is going on. Sleep matters here. Motor learning consolidates overnight, so consistent practice plus decent rest does more than long sessions on no sleep.
If your symptoms are mild and you’re confident with the breath work, you can absolutely start on your own with the video and the breakdown above. If you’ve got persistent pelvic floor symptoms, ongoing back pain that isn’t shifting, or anything that feels structurally off, a physio who specifically understands hypermobility is worth the investment. The standard “core stability physio” approach often misses the mark for this group, so it’s worth asking what their philosophy is before you book in.
If anything in this piece has shifted how you think about core work, or you’re now eyeing up the planks in your existing programme with mild suspicion, that’s the point. The standard advice for hypermobility has been weak for a long time. The evidence supports a different approach, and our experience in the studios has consistently borne it out.
Take the breath work seriously. Be patient with the unwinding. Don’t grind. And if you’ve got more questions, the rest of our hypermobility hub covers most of the related territory.
— The Fibro Guy Team —
For the next layer of this picture, see our piece on motor learning for hypermobility: how your nervous system actually builds reliable movement.
