Why Hypermobile People Bump Into Things: Understanding Hypermobility Balance and Coordination and How Physical Therapy Can Help

You catch your shoulder on the door frame on the way out of the kitchen. You set a glass down half an inch past the edge of the counter. You have bruises on both hips and no memory of earning them. Somebody has told you, probably kindly, that you are just clumsy.

If you are hypermobile, that is worth a second look. Questions about hypermobility balance and coordination come up constantly in our practice, and the usual answer — strengthen it — skips the step that explains what is happening. We have written before about why being flexible is not the same as being stable. This is the layer underneath that: not what is loose, but why the loose joint is harder to keep track of.

It is a real pattern, and it has been measured

A 2025 review gathered every study it could find on balance and falls in hypermobile adults — nineteen of them, from nearly two thousand screened. Hypermobile participants swayed more when standing, used their muscles differently, and moved differently than people who were not hypermobile, and on survey they reported falling often and being afraid of falling.

One study puts a number on it that is hard to forget. Among twenty-two women with hypermobile Ehlers-Danlos syndrome, 95% had fallen in the previous year, alongside measurably poorer balance and slower, shorter-stepped walking. Hold that figure at arm's length in one specific way: those were women with a diagnosed condition and an average age around forty, not hypermobile people in general.

And the review is honest about what it cannot do. Studies defined hypermobility differently, several did not make clear whether participants had symptoms, and most sat low on the evidence hierarchy. Its authors state directly that the mechanisms driving poor balance have not been explored in depth. The pattern is real. Why it happens is less settled than most writing on this admits.

What a position-sense test actually measures

Move to an angle, return to it with your eyes closed. The gap is the error.

Your joint is moved to an angle. You are asked to return to it without looking. The difference is the error, and hypermobile groups miss by more. Pooling five studies, the deficit is clear in the lower limb and at the fingers — and, notably, not at the shoulder, where hypermobile and non-hypermobile people tested the same. It is not everywhere. Keep it in proportion too: this is a laboratory measure on specialized equipment, not a test you have had or can do at home.

The muscles are not weak. The signal is. — with one important condition

A 2025 study of eighty-three adults tested three things: how accurately people could reproduce a joint angle, how strong their grip was, and how they performed on functional stability tests.

What separated the hypermobile group, and what did not.

The hypermobile group was significantly worse at knowing where the joint was. On grip strength there was no difference. On the functional tests there was no difference either. The authors suggest people compensate — everyday performance holds up while the underlying position sense is poorer.

Here is the condition, and it matters for who you are. That picture describes hypermobility without much in the way of symptoms. In women with diagnosed hypermobile Ehlers-Danlos syndrome, knee strength and endurance were 30% to 49% lower than matched controls. So weakness is genuinely part of the symptomatic picture, and an article that told you otherwise would be wrong.

But look at what that same study found next: muscle mass was no different between the groups. The muscle is there. It is not wasting away. Something about how it is being recruited and sustained is the problem — which is the same story as the position sense, one step further along, and it is why the answer is rarely just "lift heavier."

A smaller study of hypermobile wrists did find strength and function affected alongside position sense, so the line between the two pictures is not clean. Different joints, different methods, both small.

Not everyone who is bendy has this

Plenty of hypermobile people go through life with no trouble at all. One study is unusually useful because it compared hypermobile people who had neck pain against hypermobile people who did not. The painful group had larger position errors and less muscle endurance, and the higher the hypermobility score, the larger the error tended to be. In the group without pain, that relationship did not hold.

So this looks like part of the symptomatic picture rather than an automatic consequence of being flexible. That is sixty-eight young adults at one center, measured once, and it says nothing about which came first — but the distinction matters, and it is the one most articles collapse.

What helps, and what we honestly do not know

The deficit is reasonably well described. The treatment evidence is thin but it is not nothing, and we got this wrong in an earlier draft of this article.

A systematic review found six randomized trials of physical therapy in hypermobile Ehlers-Danlos syndrome. They are small — twenty to fifty-seven people each — they ran four to eight weeks, and they tested very different things. But the review's conclusion is worth reading twice: pain or proprioception improved regardless of which type of treatment was used. The oldest of them, from 2008, gave fifteen people eight weeks of proprioception exercise and found less pain and better day-to-day function.

Pushing the other way, a randomized trial of kinesiology taping improved shoulder range of motion and did not move joint repositioning in either group at any point. Whatever changes position sense, tape does not appear to be it.

What that adds up to: coordination and control work rather than load alone, progressed slowly, aimed at the joints and activities actually giving you trouble — and, if you are at the symptomatic end, strengthening as well, because that is where the weakness is real. It is a reasoned position on a thin evidence base, and we would rather say so than dress it up as settled.

Worth getting assessed if

• You are bruising or knocking into things often enough to notice a pattern

• You have fallen, or you have started avoiding stairs, curbs or crowds

• Particular joints feel unreliable rather than simply flexible

• You have been given strengthening work and it has not changed how you move

• Fatigue makes all of it noticeably worse by the end of the day

An assessment worth having looks at how you control joints through range, not only how far they go. We see clients in their own homes across Richmond, Midlothian and Henrico, which matters more here than it sounds — the doorway you keep catching and the stairs you have started watching are the actual setting, and they are right there to work in.

Being clumsy is a description. It is not an explanation, and it is not a verdict.

Research Used for This Article

1. Wang Y, Strutton PH, Alexander CM. Falls and balance impairment; what and how has this been measured in adults with joint hypermobility? A scoping review. BMC Musculoskeletal Disorders. 2025;26(1):88. DOI

2. Smith TO, Jerman E, Easton V, Bacon H, Armon K, Poland F, Macgregor AJ. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatology International. 2013;33(11):2709-2716. DOI

3. Akaras E, Deniz G, Eymir M, Sonmez M. The effects of joint hypermobility on strength, proprioception, and functional performance. Scientific Reports. 2025;15(1):40529. DOI

4. Karagiannopoulos C, Griech SF. Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults. Journal of Hand Therapy. 2024;37(2):209-217. DOI

5. Rombaut L, Malfait F, De Wandele I, Taes Y, Thijs Y, De Paepe A, Calders P. Muscle mass, muscle strength, functional performance, and physical impairment in women with the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care & Research. 2012;64(10):1584-1592. DOI

6. Rombaut L, Malfait F, De Wandele I, Thijs Y, Palmans T, De Paepe A, Calders P. Balance, gait, falls, and fear of falling in women with the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care & Research. 2011;63(10):1432-1439. DOI

7. Reddy RS, Tedla JS, Alshahrani MS, Asiri F, Kakaraparthi VN. Comparison and correlation of cervical proprioception and muscle endurance in general joint hypermobility participants with and without non-specific neck pain-a cross-sectional study. PeerJ. 2022;10:e13097. DOI

8. Reychler G, De Backer MM, Piraux E, Poncin W, Caty G. Physical therapy treatment of hypermobile Ehlers-Danlos syndrome: A systematic review. American Journal of Medical Genetics Part A. 2021;185(10):2986-2994. DOI

9. Sahin N, Baskent A, Cakmak A, Salli A, Ugurlu H, Berker E. Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome. Rheumatology International. 2008;28(10):995-1000. DOI

10. Tudini F, Jordon M, Levine D, Healy M, Cathey S, Chui K. Evaluating the effects of two different kinesiology taping techniques on shoulder range of motion and proprioception in patients with hypermobile Ehlers-Danlos syndrome: a randomized controlled trial. Frontiers in Rehabilitation Sciences. 2024;5:1383551. DOI

Educational disclaimer: This article is for educational purposes and is not a substitute for an individual evaluation by a licensed healthcare professional. Seek prompt medical evaluation for severe pain, significant weakness, numbness, or symptoms following trauma.