This article is part of our comprehensive guide to exercise and rehabilitation for hypermobility.
It seems like every week a question about running with hypermobility comes up with a new client of ours in the studio. As usual, there is always a lot to cover within this topic, as when it comes to hypermobility, there is an alarming amount of misinformation surrounding the topic.
There seems to be at the forefront two main camps of thought surrounding the topic of running with hypermobility:
The “you should definitely run if you are hypermobile” camp and the “you should definitely not run if you are hypermobile” camp.
Unfortunately, both camps tend not to be especially objective in their reasonings. You can find a great many hypermobile individuals who will attest that taking up running helped their hypermobility to no end, whilst in the same breath finding just as many who blame running for making their issues worse.
So, where do we start then?
Well, it’s not so much a complicated question, but more the fact that you need to know a few things before the question can be answered.
We work mainly with those with Ehlers-Danlos syndrome(EDS) and hypermobility spectrum disorder(HMSD), and many of our clients take up running as a hobby post rehab programme, all with 0 complications. However, hypermobility is complex, and EDS and HMSD are not the only causes of hypermobility.
So, as you can see, our answers need to cover a few bases before we give it.
As the cause of your hypermobility is going to be one of the largest contributors to deciding if you can or indeed should run, I always feel that understanding the different reasons that can lead to an individual becoming hypermobile in the first place, is always a good place to start, and often it is the most simplest place to start.
There are 3 main reasons why an individual will be hypermobile, and whilst people generally only tend to fit into one category, it is not uncommon for hypermobile individuals to move into more.
These reasons are:
- Medical-related reasons
- Structurally related reasons
- Injury-related reasons
Medical reasons
Certain medical conditions such as Downs syndrome, Ehlers-Danlos syndrome (EDS), Morquio syndrome, and Hypermobility spectrum disorder, are all medical conditions that result in connective tissue laxity in some form or another. And by this, I mean that each condition listed above can cause hypermobility through a different route. If we take Morquio syndrome, hypermobility is presented in a more limited distribution than say conditions such as EDS. Those with Morquio syndrome are unable to break down sugar chains (glycosaminoglycans) that help build bone, cartilage, eye corneas, skin and connective tissue (such as tendons, ligaments). This, in turn, leads to hypermobility being achieved in a more indirect fashion than that of conditions like EDS where laxity is caused by faulty collagen production.
Structural reasons
Certain structural conditions such as shallow sockets or hip dysplasia, wherein the hip socket doesn’t fully cover the ball portion of the upper thighbone can allow the hip joint to become partially or completely dislocated. In some studies, we find an 83.3% prevalence of hypermobility in those with dysplasia.
Injury reasons
Certain injuries such as anterior cruciate ligament(ACL) rupture can cause hypermobility in the knee joints of those who do not possess connective tissue disorders. In fact, whilst some of the research is conflicting, there is a lot of research to suggest hypermobility to be the main cause of ACL ruptures, especially as around 70% of ruptures are from non-contact events. The prevalence of generalised joint laxity in those who presented for an ACL reconstruction was 42.6% (72 of 169). However, the prevalence of generalised joint laxity in the control group was 21.5% (14 of 65). This difference is statistically significant
Who should run with hypermobility
After taking a quick look at the various reasons that cause hypermobility, it leaves us with the question “Who should run?” Those with structural issues are by far the hardest to answer this question for, as there are many variables at play and each type of structural issue will be slightly different to the last.
Running with structural issues
With issues such as hip dysplasia, they are normally first observed at birth, and treatments such as soft and hard braces can be used to help reshape the joint, as well as using various surgical interventions. For those with hip dysplasia who are older, such as teens and adults, as long as the dysplasia is mild, arthroscopic surgery can be very successful. However, for more serious cases, surgery such as a periacetabular osteotomy is much more likely to be needed, as this cohort being older, are more skeletally mature.
The general consensus of whether to run or not with hip dysplasia is surprisingly sparse. There are many people who have had 0 issues when returning to running after surgery, yet many have shown an increased rate of wear and tear of their prosthetic joints from high impact activities such as running.
For example, one study followed more than 600 people with hip replacements for an average of five years, but only 23 ran after the surgery. Although none of the runners had bad outcomes, the sample size was far too small to set running as a safe post-surgery exercise though and left many in limbo.
Whilst you may be able to run after hip dysplasia, is it a good idea?
Most likely not. However, you are the expert on your body, you know what feels good to do and what doesn’t, so a chat with your healthcare professionals about your individual situations is likely the best option, and running could very well be an option for you after some gently graded loading and a carefully crafted running programme.
Running after an injury
For those of you reading who are post-surgery, and those who are asking if they will be able to run again after ACL surgery, it’s a resounding yes.
However, returning to running safely is going to take some patience.
Around 16 weeks after ACL surgery is the general consensus to get back into activity, but this comes with a pretty large caveat.
In order to return to running, you need to follow certain post-op rules, such as easing back into regular leg movement (extension and flexion) around 4 days after surgery. This is especially important to stave off stiffening up and to help reduce post-op swelling, whilst also restoring full range of movement. Many people make the mistake of staying inactive after their op and this makes recovery difficult, let alone returning to running.
Running after Injury, especially hypermobility related injury, falls into the same rehab principles as it does for those with conditions such as Ehlers-Danlos, and we will cover these in the sections below.
Running with medical conditions
Downs syndrome: When it comes to hypermobile running with a medical condition, again it really depends on the person and indeed the medical condition. For those with D0wns syndrome, individuals generally exhibit low aerobic fitness scores as a result of a reduced red blood cell count, this can create a large barrier as Trisomy 21 (T21), the etiological factor of Down syndrome, has been shown to cause chronic autoinflammation, causing alterations in the life span and size of a red blood cell.
A reduced red blood cell count can easily result in what is known as chronotropic incompetence (CI), which is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. However, plenty of studies have been conducted into physical exercises and down syndrome, One such reported that over the course of 12 weeks, 52 adults with Down syndrome participated in a training program that consisted of 30 minutes of cardiovascular exercise and 15 minutes of strength exercise performed three days per week.
At the conclusion of the program, the individuals in the experimental group showed significant gains in cardiovascular fitness, muscular strength and endurance when compared to the control group, which had not participated in any exercise. It is possible that if this study lasted longer than 12 weeks, the gains may have been even greater.
Research also suggests exercise training can also improve oxidative stress in those with Downs syndrome. Although less well-understood, there is also a potential for improved motor learning in individuals with DS as a result of exercise participation.
As far as running is concerned, as long as a training plan is in place to grade activity in a safe way, help stabilise hypermobile joints, and keep the activity stimulating, those with Downs syndrome can indeed run and enjoy it as a sport or hobby. By far one of my favourite stories is that of Michael Beynon who was the first man with Downs syndrome to complete the London marathon.
Morquio syndrome: Conditions such as Morquio syndrome can make exercise such as running extremely complicated, and unfortunately, potentially unsafe. In many studies, musculoskeletal diagnoses were very common, with around 90% of subjects reporting abnormal gait, genu valgum, short stature, and/or short neck and joint contractures and subluxation in 52% and 47%, respectively.
Due to issues with gait and knocked knees, these biomechanical issues have the potential to make running painful and drastically increase the risks of subluxations and dislocations. Especially considering that in studies we find cervical spinal instability (49%) in almost half the population.
One of the most dangerous aspects of Morquio syndrome is that in studies it was observed that over half (51%) of the subjects had nervous system disorders, including 30% with cervical myelopathy, 14% with cervical cord compression, and 13% with thoracolumbar cord compression. Because of the issues discussed above, along with airway blockages and the fact that older patients tend to have more severe exercise and respiratory capacity limitations, and more frequent cardiac pathology, it means that running will most definitely place unwanted strain on an already strained system. Therefore when it comes to the topic of running and hypermobility, it is not advised to run for this population.
By now, hopefully, you are starting to see that the question ” Can I run with hypermobility?” is a lot more complex than it first seems. And as stated before, is largely due to the fact that hypermobility is acquired in various ways.
Hypermobile EDS
Conditions such as hypermobility spectrum disorder and Ehler-Danlos syndrome (hypermobility type) are who we get questions about running from the most, as this cohort is the one we work with every day.
Like injury-related hypermobility, connective tissue disorders such as EDS (hypermobility type) and hypermobility spectrum disorder (HMSD), are conditions that need to be worked with in a very specific way.
There is much content on the internet regarding stabilising hypermobile joints, however, there are a few common misconceptions and logical fallacies associated with these training routines, which we will cover in the following section. For those with hypermobility from EDS or HMSD, as long as a few key points are hit within their training, running is not only possible, but can also help to further stabilise joints, dissipate ground reaction forces more easily, and can become a very enjoyable form of exercise.
Running with hypermobility spectrum disorder and hypermobile EDS
After looking at the various reasons why people are hypermobile in the first place, and discussing who should and probably shouldn’t run, it leaves us with individuals who are rehabbing after ACL surgery and those with hypermobile EDS and HMSD. But, as individuals with hypermobile EDS and HMSD are the type of clients that we work the most with, both in-person and online, we are going to focus the rest of this blog on this type of client.
Please keep in mind that this area does not have a great deal of research. In fact, as of 2022, a search for Ehler-Danlos syndrome between 1935 – 2022 only yields 4,458 results. These results also tend to drop once you start to get more specific. The problem we face is that the research has gone in the total opposite direction of which we needed it to go. This has resulted in us having to conduct our own research with volunteers, which in turn, has actually been a major benefit for us, as we continue to explore our own theories and conduct our own research.
As you can see from the videos below, we have had great success in our methods at turning the most unstable of hypermobile joints, into strong and capable joints, easily able to handle the load from running.
References:
Aman, J.E., Elangovan, N., Yeh, I-L. and Konczak, J. (2022) ‘The Effectiveness of Proprioceptive Training for Improving Motor Function: A Systematic Review’, Frontiers in Rehabilitation Sciences, 3:830166.
Aydin, B.K., Yilmaz, C., Yildiz, V., et al. (2022) ‘Does anterolateral ligament internal bracing improve the outcomes of ACL reconstruction in patients with generalized joint hypermobility? A retrospective study’, Orthopaedic Surgery, 14(3), pp. 503–510.
Bennett, A.N., et al. (2025) ‘Hypermobility Spectrum Disorders and Pain: A Review of Recent Developments and Their Application to Clinical Practice’, Touch Immunology, 1(1), pp. 1–7.
BMJ Open Sport & Exercise Medicine (2018) ‘Hypermobility and sports injury’, 4(1):e000366.
Charbonnier, C., et al. (2021) ‘Hypermobile Disorders and Their Effects on the Hip Joint’, Frontiers in Surgery, 8:596971.
Jacobsen, J.S., et al. (2013) ‘Changes in walking and running in patients with hip dysplasia’, Acta Orthopaedica, 84(5), pp. 502–508.
Liaghat, B., Skou, S.T., Søndergaard, J., Boyle, E., Søgaard, K. and Juul-Kristensen, B. (2022) ‘Short-term effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial’, BMJ Open Sport & Exercise Medicine, 8(2):e001300.
Morrison, N., et al. (2021) ‘The GoodHope Exercise and Rehabilitation (GEAR) Program for People with Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders’, Frontiers in Rehabilitation Sciences, 2:769792.
Palmer, S., Bailey, S., Barker, L., et al. (2022) ‘Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review’, Archives of Physical Medicine and Rehabilitation, 103(4), pp. 767–777.
Shadmehr, A., Jannati, E., Ghasemi, G.A., and Bagheri, H. (2018) ‘The effect of combined exercise therapy on knee proprioception, pain and quality of life in patients with hypermobility syndrome’, Physiotherapy Theory and Practice, 34(6), pp. 430–436.
Smith, T.O., Jerman, E., Easton, V., Bacon, H., Armon, K., Poland, F. and Macgregor, A.J. (2013) ‘The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review’, Physiotherapy, 99(1), pp. 1–8.
